Study: Puberty Onset in Type 1 Diabetes Happening at Younger Age in Recent Years


An analysis of more 13,000 children with type 1 diabetes suggests puberty onset in children with type 1 diabetes is occurring earlier now than it had been at the turn of the century.

Reinhard Holl, MD | Credit: SWEET Initiative

Reinhard Holl, MD
Credit: SWEET Initiative

Children with type 1 diabetes are entering puberty earlier than they had been previously, according to new research from investigators in Germany.

An analysis of more than 13,000 children with type 1 diabetes from the German Diabetes Prospective Follow-up registry, results of the study suggest children with type 1 diabetes were entering puberty about 0.5 year earlier in 2021 than they were in 2000, with further analysis pointing to diabetes duration, body mass index (BMI) standard deviation score (SDS), and migration background.1

“We confirm a significant trend for an earlier start of puberty for girls with diabetes since 2000. In addition, we found a similar trend for boys with diabetes mellitus over the last 20 years,” wrote investigators.1 “This is especially important to know because of the interaction of metabolic control in diabetes and puberty, which is connected to a decrease in insulin sensitivity.”

Although most of the attention from the medical community and public health system in recent years has focused on the growing prevalence of type 2 diabetes, recent reports have also outlined a growing burden of type 1 diabetes.2 In this context, a greater understanding of the effects of type 1 diabetes throughout the lifespan of children and adolescents could stand have a significant impact on quality of life and long-term outcomes for these patients.

With this in mind, a team of investigators led by Reinhard Holl, MD, of the German Center for Diabetes Research, designed a population-based cohort study with the intent of examining trends in onset of puberty among boys and girls with the 1 diabetes using data from the German Diabetes Prospective Follow-up registry. A collaborative database pooling data from medical centers in Germany, Austria, Switzerland and Luxembourg, the database provided investigators with data from 13,127 patients aged 6 to 18 years of aged with a clinical diagnosis of type 1 diabetes who received care between 2000 and 2021.1

Investigators noted the overall median number of participants per year across the study period was 920 (Interquartile range [IQR], 995.5 to 865). Among girls, the median number of participants per year was 437 (IQR, 450 to 421) and, among boys, the median number of participants per year was 483 (IQR, 510.2 to 470.1).1

Investigators used regression analysis to estimate associations between diabetes duration, BMI SDS, HbA1c level, migration background, and the onset of puberty in cohorts stratified by patient sex.1

Upon analysis, results suggested the puberty onset in girls (thelarche Tanner stage B2) decreased from 11.48 (IQR, 11.35 to 11.65) years in 2000 to 10.93 (IQR, 10.79 to 11.08) years in 2021 (P <.001). Among boys, results indicated age at gondarche (Tanner stage G2/testicular volume >3 mL) decreased from 12.62 (12.42-12.82) years in 2000 to 11.98(11.79-12.16) years in 2021 in boys (P <.001). Further analysis revealed longer diabetes duration, greater BMI SDS, and lower HbA1c level were associated with earlier puberty in both sexes (P <.001).1

“Studying pubertal onset in children with [type 1 diabetes] provides valuable insights into long-term outcomes and optimizing diabetes management. It sheds light on unique challenges and long-term health implications,” investigators wrote.1


  1. Gohlke B, Reschke F, Lanzinger S, et al. Time trends towards earlier puberty in boys and girls with type 1 diabetes: Insights from the German Diabetes Prospective Follow-up (DPV) registry, 2000 to 2021 [published online ahead of print, 2023 Oct 12]. Diabetes Obes Metab. 2023;10.1111/dom.15315. doi:10.1111/dom.15315
  2. Campbell P. Rates of type 1, type 2 diabetes expected to balloon in US by 2060. HCP Live. January 12, 2023. Accessed October 18, 2023.
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