Type 1 diabetes is the most common form of diabetes in children. Puberty brings about hormonal changes that can impact metabolic control in diabetes, for instance the body can become more resistant to insulin, increasing blood sugar levels. In recent years, many studies have reported earlier puberty onset across the world, particularly in healthy girls. However, diabetes is known to be associated with a delay of pubertal onset in children.
In this study, researchers from Germany analysed data on the onset of puberty and pubic hair development of 65,518 children aged 6-18 years, all diagnosed with type 1 diabetes between 2000 and 2021, from the German DPV registry. They found that over two decades both girls and boys are going through puberty at about six months earlier than before. This result was more evident in children who had diabetes longer, were overweight, or had lower blood sugar levels.
“While the findings for girls align with previous research, our study is groundbreaking in revealing a similar trend in boys with type 1 diabetes for the first time,” said lead researcher Dr Felix Reschke from the Children’s Hospital Auf Der Bult in Hanover. “As a result, we now anticipate that the average onset of puberty in boys with diabetes will occur just before the age of 12 (11.98 years).”
He adds: “Our study demonstrates that children with diabetes are also experiencing this trend towards an earlier puberty, which is already known in healthy girls, but not evident in boys yet. It's also important to note that previous research indicated that type 1 diabetes may lead to delayed pubertal onset, thus our study provides new insights into the complex relationship between type 1 diabetes and puberty onset.”
Many factors that alter puberty in children, such as body weight, disease and genetics, have been associated with early puberty. However, early puberty often does not have an obvious cause. “Our research not only sheds light on the evolving landscape of puberty timing in children with type 1 diabetes but also underscores the intricate interplay between metabolic factors, hormones, and environmental influences,” said Dr Reschke. “Further investigations are warranted to explore these dynamics comprehensively and inform targeted interventions for this vulnerable population.”
The researchers will now compare this trend of an early onset of puberty with children without chronic diseases and delve deeper into understanding the underlying causes. “It is crucial for both society and pediatricians to recognise this trend, and if necessary, we may need to reevaluate and adjust our clinical approaches to examining premature puberty accordingly,” said Dr Reschke.
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Earlier Occurrence of Puberty and Pubertal Hair Development in Boys and Girls - Insights from the DPV Initiative Data
Felix Reschke1, Bettina Gohlke2, Stefanie Lanzinger3,4, Claudia Boettcher5, Gita Gemulla6, Susanne Thiele-Schmitz7, Desiree Dunstheimer8, Louise van den Boom9, Woelfle Joachim10, Holl Reinhard3,4
1Centre for Paediatric Endocrinology/ Diabetology & Obesity, Children`s Hospital AUF DER BULT, Hannover, Germany. 2Pediatric Endocrinology and Diabetology Division, Children's Hospital, University of Bonn, Bonn, Germany. 3Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany. 4German Center for Diabetes Research (DZD), Munich, Germany. 5Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland. 6Paediatric Endocrinology, University Hospital, Technical University of Dresden, Dresden, Germany. 7Pediatric Endocrinology and Diabetology, Children`s Hospital St. Louise, Paderborn, Germany. 8Department of Pediatric Endocrinology, University Hospital Augsburg, Augsburg, Germany. 9Division of Pediatrics/Pediatric Diabetology, DRK Hospital, Kirchen, Germany. 10Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
Abstract
Introduction:
Pubertal onset is signaled by thelarche (in girls) and gonadarche (in boys) and indicates the beginning of the hypothalamic-pituitary-gonadal axis activity. Thus, the onset of pubic hair development usually coincides with adrenarche. Girls worldwide are experiencing earlier puberty, but it is uncertain if this trend affects boys, or if it applies to children with type 1 diabetes (T1D).
Aim:
The aim of this study is to analyze puberty onset and pubertal hair development in adolescents with T1D from a large, multicenter (German/Austrian/Swiss/Luxemburg) diabetes registry spanning 2000 to 2021.
Methods:
The mean age of thelarche (♀), gonadarche (♂), and pubarche (all sexes) among adolescents with T1D was analyzed. Linear regression models were used and adjusted for diabetes duration, BMI, HbA1C, and migratory background. The results are presented in 5-year intervals (mean) for the periods ≤2005 and >2015.
Results:
The onset of puberty has shifted forward over the last two decades in both girls and boys, according to the analyzed data from 20,064 children. The mean age for the onset of puberty in girls decreased from 11.46 years to 11.06 years, and in boys from 12.41 years to 12.19 years. Additionally, an annual advance of thelarche by 0.26 years or 3.17 months per decade in girls and an annual advance of gonadarche by 0.15 years or 1.78 months per decade in boys was observed.
The study also found that children with overweight (BMI SDS ≥ 90th percentile) had a significantly earlier onset of puberty than those with normal weight or underweight. An HbA1C value of ≤ 7.5% was associated with a significantly earlier onset of puberty in both sexes than a value of >7.5% to <8.5% or ≥ 8.5%.
The mean age at documentation of Tanner P2 for girls decreased from 11.47 years in 2000 to 10.97 years in 2021, with a change of -0.0227/ year or a decrease of 2.72 months/ decade. For boys, the mean age at documentation of Tanner P2 decreased from 12.06 years in 2000 to 11.57 years in 2021, with a change of -0.0222/ year or a decrease of 2.67 months/ decade.
Discussion/ Conclusion:
In summary, this study provides the first evidence of a decline in pubertal age in young male adolescents, consistent with the known and demonstrated age regression of pubertal onset in girls. Moreover, the development of pubertal hair shows a similar pattern in both sexes. These results highlight pubertal complexity and indicate further research needed.
Notes for Editors:
For press enquiries, or to arrange an interview with the study authors, please contact the ESPE 2023 press office:
Joanna Williams
Communications Executive
Mob: +44 (0) 7876 842 027
Email: joanna.williams@endocrinology.org
The study “Earlier Occurrence of Puberty and Pubertal Hair Development in Boys and Girls - Insights from the DPV Initiative Data” will be presented on Friday 22 September 2023 at the 61st Annual Meeting of the European Society for Paediatric Endocrinology (ESPE 2023) at the World Forum in The Hague, Netherlands.
The 61st Annual Meeting of the European Society for Paediatric Endocrinology is held at the World Forum in The Hague, Netherlands, on 21-23 September 2023. This year's theme is “Global Challenges in Paediatric Endocrinology”. See the full scientific programme here. END
