This can be explained by the precision of the Greulich and Pyle method: the older the child, the greater the SD for skeletal age ( 2). The correlation between bone age and chronological age was less strong in the subgroup of subjects ≥12 years of age. In each of our subgroups, the difference between chronological age and bone age was in the range of the Greulich and Pyle atlas SDs. In the Greulich and Pyle atlas, SDs for skeletal age are reported and depend on chronological age and sex ( 2). It has been shown that the use of the Greulich and Pyle atlas is simple and reproductive and that the intra- and interobserver errors are small ( 13). Published in 1959, this method is still applicable ( 3). We used the Greulich and Pyle atlas ( 2) to determine the skeletal maturation. We did not find any significant differences between chronological age and bone age in either the entire population of 496 patients or in the subgroups (by age and sex). We reported bone age at diagnosis of type 1 diabetes in 207 girls and 289 boys. ( 5) reported retarded bone aging in 201 girls and 188 boys. ( 4) reported advanced bone aging in 38 girls and 39 boys, and Holl et al. To our knowledge, only two controversial studies reported on bone age at diagnosis in diabetic children: Edelsten et al. Bone age has been reported as being advanced ( 4, 12) or delayed ( 5) in children and adolescents with type 1 diabetes. At diagnosis, diabetic children have been reported as being taller than ( 4, 9), shorter than ( 9, 10), or similar to ( 9, 11) control subjects. Many controversies about height and skeletal maturation remain. The stunted growth in Mauriac syndrome was seen in poorly controlled diabetic children ( 8). Adequate insulin secretion or insulin replacement in diabetic children is needed to promote growth. The presence of growth hormone excess has been argued in the pathogenesis of type 1 diabetes since Young (1937) showed the diabetogenic effect of pituitary extracts ( 7). Many studies have been published about insulin deficiency and growth in patients with type 1 diabetes ( 1). There was no correlation between Δ (bone age − chronological age) and A1C ( P = NS). The Δ (bone age − chronological age) was 0.0 years (−0.9, 0.9) for those <12 years of age and 0.1 years (−1.4, 1.6) for those ≥12 years of age. Bone age corresponded with chronological age: Δ (bone age − chronological age) was median 0.0 years (25th, 75th percentiles −1.0, 1.0) for the entire population, 0.1 years (−0.9, 1.1) for girls, and 0.0 years (−1.1, 1.1) for boys. There was a strongly significant correlation between chronological age and bone age for the entire population of 496 patients ( r = 0.967 P < 0.001), for girls ( r = 0.981 P < 0.001), for boys ( r = 0.957 P < 0.001), for those <12 years of age ( r = 0.956 P < 0.001), and for those ≥12 years of age ( r = 0.653 P < 0.001) ( Fig. Chronological age and bone age were 7.0 ± 3.2 and 7.2 ± 3.5 years, respectively, for children <12 years of age and 13.8 ± 1.3 and 14.0 ± 1.6 years, respectively, for children ≥12 years of age. Chronological age and bone age were 8.12 ± 4.1 and 8.4 ± 4.4 years, respectively, for girls and 9.0 ± 3.9 and 9.1 ± 4.2 years, respectively, for boys. Chronological age and bone age were 8.7 ± 4.0 and 8.8 ± 4.3 years, respectively, for the entire population. P < 0.05 was considered to be significant.Īt diagnosis, mean ± SD height SDS was 0.35 ± 0.95 in girls and 0.37 ± 1.07 in boys ( P = NS). Linear regression analysis was used to test for the correlations between chronological age and bone age and between Δ (bone age − chronological age) and A1C. Six different trained radiologists analyzed the X rays and evaluated the bone age according to the Greulich and Pyle method ( 2). Radiographies of left hands and wrists were made at diagnosis of type 1 diabetes. Standing height was measured and transformed into an SD score (SDS) according to the British 1990 growth reference ( 6).Ī1C levels were measured by chromatography (normal A1C <7.7%) before March 1990 in 10 patients (3 girls and 7 boys) and by high-performance liquid chromatography (normal A1C <6.2%) after March 1990 (204 girls and 282 boys). At diagnosis, bone age was determined in 496 patients (207 girls and 289 boys), of which 376 (76%) were <12 years of age and 120 (24%) ≥12 years of age. A total of 663 subjects less than 18 years of age developed type 1 diabetes before the age of 18 years, from 1986 to 2008, and attended the Diabetology Clinic of the University Children's Hospital Queen Fabiola.
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