Comparison between [beta ]-cell function and insulin resistance indexes in prepubertal and pubertal obese children

Guzzaloni, G; Grugni, Graziano; Mazzilli, G; Moro, D. Del; Morabito, F.

doi:10.1053/meta.2002.34029

Cited by 69 publications

(61 citation statements)

References 12 publications

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“…The 13.5% prevalence of IGT in our patients is higher than the 4.4% reported in European countries, 28 but lower than reported in studies from America. 12, 29 Sinha et al 12 found a 25% prevalence of IGT in children and 21% in adolescents, and a prevalence of 4% for type 2 diabetes.…”

Section: Discussioncontrasting

confidence: 82%

Insulin resistance and impaired glucose tolerance in obese children and adolescents referred to a tertiary-care center in Israel

et al. 2005

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OBJECTIVE:To establish the prevalence of insulin resistance and impaired glucose tolerance (IGT) and their determinants in a cohort of obese children and adolescents. METHODS: A retrospective design was used. The study group included 234 patients with a body mass index (BMI) greater than the 95th percentile for age and gender and 22 patients with a BMI between the 85th and 95th percentile for age and gender referred for evaluation to a major tertiary-care center in Israel. Ages ranged from 5 to 22 y. Estimates of insulin resistance (homeostatic model assessment (HOMA-IR)); insulin sensitivity (ratio of fasting glucose (GF) to fasting insulin (IF) (GF/IF), the quantitative insulin sensitivity check index (QUICKI)), and pancreatic b-cell function (HOMA-derived b-cell function (HOMA %B)) were derived from fasting measurements. An oral glucose tolerance test (OGTT) was performed in 192 patients to determine the presence of IGT. RESULTS: Insulin resistance was detected in 81.2% of the patients, IGT in 13.5%, and silent diabetes in one adolescent girl. Only two patients with IGT also had impaired fasting glucose (IFG). The prevalence of IGT was higher in adolescents than prepubertal children (14.7 vs 8.6%). GF/IF and QUICKI decreased significantly during puberty (Po0.005), whereas HOMA-IR and HOMA %B did not. Insulin resistance and insulin sensitivity indexes were not associated with ethnicity, presence of acanthosis nigricans or family history of type 2 diabetes. Patients with obesity complications had lower insulin sensitivity indexes than those without (P ¼ 0.05). Compared with subjects with normal glucose tolerance (NGT), patients with IGT had significantly higher fasting blood glucose (85.976.5 vs 89.2710.6 mg/dl, Po0.05), higher 2-h post-OGGT insulin levels (101.2774.0 vs 207.67129.7 mU/ml, Po0.001), a lower QUICKI (0.32370.031 vs 0.30970.022, Po0.05), and higher fasting triglyceride levels (117.4753.1 vs 156.9768.9, P ¼ 0.002). However, several of the fasting indexes except QUICKI failed to predict IGT. There was no difference between the group with IGT and the group with NGT in fasting insulin, HOMA-IR, HOMA %B or the male-to-female ratio, age, BMI-SDS, presence of acanthosis nigricans, ethnicity, and family history of type 2 diabetes. CONCLUSIONS: Insulin resistance is highly prevalent in obese children and adolescents. The onset of IGT is associated with the development of severe hyperinsulinemia as there are no predictive cutpoint values of insulin resistance or insulin sensitivity indexes for IGT, and neither fasting blood glucose nor insulin levels nor HOMA-IR or HOMA %B are effective screening tools; an OGTT is required in all subjects at high risk. Longitudinal studies are needed to identify the metabolic precursors and the natural history of the development of type 2 diabetes in these patients.

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Section: Discussioncontrasting

confidence: 82%

Insulin resistance and impaired glucose tolerance in obese children and adolescents referred to a tertiary-care center in Israel

et al. 2005

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“…Boost) test are desirable. Although fasting indices are used frequently as surrogate estimates of insulin sensitivity (9-14), they have not been consistently as useful in estimating insulin secretion (13,(15)(16). Several insulin secretion indices derived from the OGTT have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…Several insulin secretion indices derived from the OGTT have been proposed. The insulinogenic index, calculated as the ratio of the 30 minute increment in insulin to glucose concentration (17), is widely used to estimate insulin secretion (15,(18)(19) and to predict risk of diabetes (16,20) in both adults and youth. In adolescents, ΔI 30 /ΔG 30 was used to assess insulin secretion in subjects with type 2 diabetes compared with those with impaired glucose tolerance (21) and in normoglycemic obese children (22).…”

Section: Discussionmentioning

confidence: 99%

Measures of β-Cell Function during the Oral Glucose Tolerance Test, Liquid Mixed-Meal Test, and Hyperglycemic Clamp Test

Bacha

Güngör

Arslanian

2008

The Journal of Pediatrics

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Objective-To evaluate clinically useful measures of Beta-cell function derived from the oral glucose tolerance test (OGTT) or mixed meal (Boost) tolerance test to assess insulin secretion, in comparison with the gold standard method of the hyperglycemic clamp (Hyper-C).Study design-We hypothesized that OGTT/Boost derived measures are useful estimates of β-cell function and correlate well with insulin secretion measured during the Hyper-C. We assessed the correlation between the ratio of the early incremental insulin/glucose responses at 15 and 30 min (ΔI 15 /ΔG 15 , ΔI 30 /ΔG 30 ) of the OGTT and Boost, with insulin secretion during the Hyper-C (225 mg/ dl). The same indices were evaluated using C-peptide (C). 26 (14M/12F) children (9.9±0.2yrs, BMI: 22.1±1.2kg/m 2 ) underwent a 2 hour Hyper-C (225 mg/dl) and a 3 hour OGTT and Boost with measurements of glucose (G), insulin (I) and C.Results-Correlations between clamp-and OGTT-derived measures of insulin secretion were stronger for the 15 minute than the 30 minute indices of insulin secretion and stronger with the use of C-peptide than insulin levels (r = 0.7, p < 0.001 for 1 st phase C-peptide vs both OGTT and Boost ΔC 15 /ΔG 15 ).Conclusion-In youth with normal glucose tolerance, C-peptide rather than insulin at 15 minutes of the OGTT and/or Boost provides a reliable estimate of β-cell function that correlates well with clamp derived insulin secretion. KeywordsOGTT; Boost test; Insulinogenic index; C-peptide; insulin clearance Obesity, impaired glucose tolerance (IGT), and type 2 diabetes are characterized with insulin resistance, in addition to impaired insulin secretion in the latter two (1). With the increasing rates of obesity (2,3), IGT, and type 2 diabetes in youth (4), simple, clinically obtainable measures of insulin secretion are desirable for the follow-up of progression from one stage to the other and for evaluation of therapeutic interventions. The oral glucose tolerance test (OGTT) is recommended by the WHO and the ADA for the diagnosis of IGT and diabetes and is a frequently utilized clinical tool. The objective of our study was to evaluate if measures of Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. We hypothesized that OGTT or mixed meal (Boost) derived measures of insulin release are useful estimates of β-cell function, and correlate well with insulin secretion measured during the hyperglycemic clamp (Hyper-C). NIH Public Access METHODSThe study population consisted of 26 (14M/12F) children, 7 to 12 years of age (mean 9.9±1.1 years). They included 15 African American and 11 Caucasian normoglyce...

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“…This relatively low baseline value limits the capacity for further reduction in HOMA-IR in response to weight status change. Second, research has shown that insulin sensitivity declines as youth mature and pass through puberty [7, 14, 15]. In this investigation, most participants advanced by at least one pubertal stage over the two-year period.…”

Section: Discussionmentioning

confidence: 86%

“…Researchers have noted that pubertal status [5, 7, 14, 15] and aerobic fitness [16] influence HOMA-IR; thus, both measures were included in this investigation. Pubertal development was quantified using self-report questionnaires [17].…”

Section: Methodsmentioning

confidence: 99%

The Relationship between Changes in Weight Status and Insulin Resistance in Youth

Ondrak

McMurray

Battaglini

et al. 2009

International Journal of Pediatric Endocrinology

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This study examined changes in insulin resistance (IR) in 120 youth over two years. IR was quantified via homeostatic model (HOMA-IR), and weight status changes were quantified via body mass index (BMI). When all participants were considered, the mean HOMA-IR and BMI increased 13.4% and 1.65 units, respectively. Change in BMI z-score and percent change in HOMA-IR were moderately associated (r = 0.39). Follow-up analyses were performed for the following weight groups: NN (normal at baseline and two years later), NO (normal to overweight), ON (overweight to normal), and OO (overweight at both points). The NO group had a greater change in HOMA-IR (+50%) compared to other groups: ON (−8%), NN (+2%), and OO (−0.1%) (P < .05). The association between changes in BMI z-score and HOMA-IR was r = 0.49 when only the NO and ON groups were included. These results reinforce the importance of preventing youth from becoming overweight to control IR.

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Comparison between [beta ]-cell function and insulin resistance indexes in prepubertal and pubertal obese children

Cited by 69 publications

References 12 publications

Insulin resistance and impaired glucose tolerance in obese children and adolescents referred to a tertiary-care center in Israel

Insulin resistance and impaired glucose tolerance in obese children and adolescents referred to a tertiary-care center in Israel

Measures of β-Cell Function during the Oral Glucose Tolerance Test, Liquid Mixed-Meal Test, and Hyperglycemic Clamp Test

The Relationship between Changes in Weight Status and Insulin Resistance in Youth

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