A large study of nearly a million adolescent boys reveals that late puberty isn't as harmless as once thought, linking it to a sharply higher risk of developing type 2 diabetes in early adulthood.
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Boys who enter puberty later than average are more likely to develop type 2 diabetes as adults, irrespective of their weight or socio-economic factors, according to research presented at the first Joint Congress between the European Society of Paediatric Endocrinology (ESPE) and the European Society of Endocrinology (ESE). The findings may uncover a potential new risk factor for boys developing type 2 diabetes.
Type 2 diabetes is the most common form of diabetes that results from the body's inability to make enough insulin or properly use insulin. Over 90% of people with diabetes have type 2 diabetes, which is driven by socio-economic, demographic, environmental, and genetic factors. Type 2 diabetes - once called adult-onset diabetes - most often develops in people 45 or older, but more and more children, teens, and young adults are now being diagnosed too, and researchers are investigating the various risk factors.
In this study, researchers from Israel examined 964,108 Israeli adolescent boys aged 16–19 years old who were recruited for military service between 1992 and 2015, of whom 4,307 were diagnosed with delayed puberty. They followed the individuals until the end of 2019. They found that adolescent boys with delayed puberty were about 2.5 times more likely to develop type 2 diabetes in early adulthood than boys without delayed puberty, even after adjusting for birth year and country, socio-economic status, cognitive function, and education level. After accounting for body weight, the risk for type 2 diabetes was 37% higher in these boys. In addition, the researchers found that, among teens with delayed puberty, about 140 per 100,000 developed type 2 diabetes each year, whereas only about 41 per 100,000 teens without delayed puberty developed the disease every year.
"To our knowledge, our large-scale study is the first to report an association between delayed puberty in adolescent boys and an increased risk of developing type 2 diabetes," said lead author Professor Orit Pinhas-Hamiel from Sheba Medical Center.
She added: "One study suggests a protective association between delayed puberty and type 2 diabetes risk, but it had a low response rate (5.5%) and relied on recall-based anthropometric and pubertal timing data, using voice breaking as a surrogate marker for puberty."
"Our results are surprising as delayed puberty is generally considered a benign condition," said Professor Pinhas-Hamiel. "We think the higher risk of early type 2 diabetes in boys with delayed puberty may be due to a window of opportunity during development when the body is especially sensitive to hormones and environmental factors - similar to how early childhood shapes language skills or how puberty affects bone strength."
"Our findings contribute to a better understanding of how pubertal timing may influence long-term metabolic health and highlight the need for medical follow-up to enable early diagnosis of type 2 diabetes. Recognising delayed puberty in males as an early-life marker for increased risk of type 2 diabetes may help identify vulnerable individuals, allowing for targeted prevention strategies," said Professor Pinhas-Hamiel.
Researchers from Sheba Medical Center, Tel Aviv University, the Maccabi Healthcare Services, the Israel Defense Forces Medical Corps, the Gertner Institute for Epidemiology and Health Policy Research, and the Israel Center for Disease Control carried out the study. The data on the delayed puberty diagnoses were collected from the Israel Defense Forces Medical Corps, while the diabetes data were retrieved from the Israeli National Diabetes Registry.