Type 2 diabetes and impaired glucose tolerance in European children and adolescents with obesity -- a problem that is no longer restricted to minority groups

Wiegand, Susanna; Maikowski, Ursula; Blankenstein, Oliver; Biebermann, Heike; Tarnow, Patrick; Grüters, Annette

doi:10.1530/eje.0.1510199

Cited by 185 publications

(126 citation statements)

References 39 publications

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“…The incidence data are scarce, the highest numbers of type 2 diabetes in young adults have been reported in non-Europid ethnic groups [11,21] but the age of diagnosis of type 2 diabetes has decreased also in Europid populations [41,42]. Consistent with these reports, our results indicate that a considerable number of Finnish patients are diagnosed with type 2 diabetes before the age of 40.…”

Section: Discussionsupporting

confidence: 88%

A high incidence of type 1 diabetes and an alarming increase in the incidence of type 2 diabetes among young adults in Finland between 1992 and 1996

Lammi¹,

Taskinen²,

Moltchanova³

et al. 2007

Diabetologia

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Aims/hypothesis The aim of this study was to examine the incidence and trends of type 1 and type 2 diabetes in the 15-39 year-old population between 1992 and 1996 in Finland. Subjects and methods Data on the nationwide incidence of diabetes were obtained from four data sources: standardised reports from diabetes nurses, the Finnish National Hospital Discharge Register, the Drug Reimbursement Register and the Drug Prescription Register. The inclusion criterion was consistency in the diagnosis of diabetes across at least two data sources. The sex-and age-specific incidence was calculated for 5-year age groups, both for type 1 and type 2 diabetes. The effects of age, sex and year of diagnosis were assessed by fitting the linear regression model to the incidence data. Results Between 1992 and 1996 the age-adjusted incidence of type 1 diabetes among 15-39 year olds was 15.9 per 100,000/year. The incidence was highest among the 15-19 year olds and decreased with age. Conversely, the incidence of type 2 diabetes was very low among 15-19 year olds and increased with age. The total age-adjusted incidence of type 2 diabetes among 15-39 year olds was 11.8 per 100,000/ year. The average annual increase in the incidence of type 2 diabetes was 7.9% (95% CI 3.7-12.2%). Conclusions/interpretation The age at which the Finnish population is at risk of type 1 diabetes extends into young adulthood. The rapid increase in the incidence of type 2 diabetes in the young adult population is a current public health problem.

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Section: Discussionsupporting

confidence: 88%

A high incidence of type 1 diabetes and an alarming increase in the incidence of type 2 diabetes among young adults in Finland between 1992 and 1996

Lammi¹,

Taskinen²,

Moltchanova³

et al. 2007

Diabetologia

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“…Also, Philips et al (17) reported r= 0.55 for the relationship between the insulinogenic index and 3 min insulin level as a measure of first phase insulin during intravenous glucose tolerance test in normoglycemic subjects. Given that the typical sampling times during an OGTT, whether as a clinical or research tool, do not include a 15 minute blood sample (21,22,(24)(25)(26)(27), our findings would suggest that a determination of 15 minute insulin and C-peptide levels may be a better reflection of early phase insulin secretion than the 30 minute. Moreover, because the impairment in first phase insulin secretion is the earliest abnormality in the transition from a normoglycemic state to impaired glucose tolerance/pre diabetes to type 2 diabetes in adults (1,28) and youth (29-31), a 15 minute determination may give a more reliable estimate of changes in first phase insulin secretion in observational or intervention studies.…”

Section: Discussionmentioning

confidence: 94%

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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“…[4][5][6][7][8] The clinical and metabolic presentation T2DM in Caucasian children differed from the initial reports predominantly of Afro-Americans, Hispanics or Indians. The clinical presentation of 20 European Caucasian children with T2DM is presented in Table 2 and the data concerning the metabolic presentation in Table 3.…”

Section: Clinical Features Of Caucasian Children With T2dmmentioning

confidence: 86%

Clinical presentation of type 2 diabetes mellitus in children and adolescents

Reinehr

2005

Int J Obes

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OBJECTIVE:Recent reports indicate an increasing prevalence of type 2 diabetes mellitus (TD2M) in children and adolescents around the world in all ethnicities, possibly due to increasing prevalence of obesity. Therefore, it is essential that clinicians are aware of the clinical features of T2DM in these age groups. METHODS: All published cases of T2DM in children and adolescents were evaluated and the different clinical presentations of T2DM in minorities and Caucasian described. RESULTS: Manifestation of T2DM is usually at mid-to-late puberty with few symptoms such as mild-polyuria or polydipsia. Most of the children and adolescents are extremely obese. The great majority of children and adolescents with T2DM have relatives with T2DM, and show other clinical features of the insulin resistance syndrome such as hypertension, dyslipidemia, polycystic ovarian syndrome (PCOS) or acanthosis nigricans. One-third of the minority children with T2DM and the majority of the Caucasian children with T2DM were detected by screening in the absence of symptoms. CONCLUSIONS: It is becoming increasingly clear that overweight children above the age of 10 y with (1) clinical signs of insulin resistance (acanthosis nigricans, dyslipidemia, hypertension, PCOS), or (2) relatives with T2DM, or (3) of particular ethnic populations (Asian, Indians, Africa-Americans, Hispanics), or (4) extremely obese children should be screened for T2DM. International Journal of Obesity (2005) 29, S105-S110. doi:10.1038/sj.ijo.0803065Keywords: type 2 diabetes mellitus; children; clinical manifestation; screening Type 2 diabetes mellitus (T2DM) is a serious and costly disease associated with excess morbidity and mortality. It is a complex metabolic disorder of heterogeneous etiology with social, behavioral, and environmental risk factors unmasking the effects of genetic susceptibility. T2DM develops, when insulin resistance is accompanied by inadequate b-cell insulin secretion. The criteria for diagnosis of diabetes in children and adolescents are (1) symptoms of diabetes (polyuria, polydipsia, and unexplained weight loss) plus casual glucose concentration Z200 mg/dl (11.1 mmol/l) in venous plasma or capillary whole-blood samples; or (2) fasting glucose Z126 mg/dl (7.0 mmol/l) in venous or capillary plasma; or (3) 2 h glucose during oral glucose tolerance test Z200 mg/dl (11.1 mmol/l) in venous plasma or capillary whole-blood sample.1,2 In the absence of unequivocal hyperglycemia with acute metabolic decompensation, these criteria should be confirmed by repeat testing on a different day.

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Type 2 diabetes and impaired glucose tolerance in European children and adolescents with obesity -- a problem that is no longer restricted to minority groups

Cited by 185 publications

References 39 publications

A high incidence of type 1 diabetes and an alarming increase in the incidence of type 2 diabetes among young adults in Finland between 1992 and 1996

A high incidence of type 1 diabetes and an alarming increase in the incidence of type 2 diabetes among young adults in Finland between 1992 and 1996

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

Clinical presentation of type 2 diabetes mellitus in children and adolescents

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