Insulin resistance and secretion relationship in obese adolescents with a high risk for type 2 diabetes

Beograd : [ V. M. Zdravković]

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Medicina - Dečja endokrinologija

Uvod: Paralelno sa povećanjem gojaznosti kod dece dolazi do porasta udruženih komorbiditeta. Kod ove grupe dece postoji kombinacija kardiovaskularnih rizika, a poremećaj glukozne homeostaze je jedan od njih. Stanja, kao što su izolovana povišena glikemija našte ili poremećaj tolerancije glukoze i kombinacija ova dva poremećaja glukoze mogu se definisati kao predijabetes. Insulinska rezistencija predstavlja fiziološki adaptivni mehanizam, koji se javlja u pubertetu kod zdrave dece. Kod gojazne dece postoji insulinska rezistencija koja je posledica neosetljivosti perifernih tkiva na dejstvo insulina. Da bi se održala glukozna homeostaza, ćelije pankreasa kao kompenzatorni mehanizam povećavaju sekreciju insulina što dovodi do hronične hiperinsulinemije. U tom pokušaju da postigne adekvatnu sekreciju insulin, beta ćelija progresivno propada, što se smatra glavnim uzrokom nastanka tipa 2 dijabetesa. Cilj: Glavni ciljevi našeg ispitivanja su bili procena insulinske senzitivnosti i insulinske sekrecije kod gojaznih ispitanika. Ostali ciljevi su bili procena statusa glikozne tolerancije kod ovih ispitanika sa rizikom za razvoj tipa 2 dijabetesa, kao i odnos određenih kliničkih parametara prema njoj. Metode: Prospektivna studija sprovedena u Univerzitetskoj dečjoj klinici, uključila je 85 gojaznih ispitanika i 17 normalno uhranjenih ispitanika. Svi pacijenti su bili bele rase, 60 M/42 Ž, uzrasta od 7.4-18.3 godine, sa prisutnim znacima puberteta. Prosečan indeks telesne mase je iznosio 32±5.5 kg/m2. Gojazne pacijente smo podelili u dve grupe u skladu sa stepenom gojaznosti. Grupu umereno gojaznih su činili ispitanici sa skorom standardne devijacije indeksa telesne mase u rasponu od 2-3, a grupu ekstremno gojaznih iznad tri u odnosu na uzrast. Prikupljeni su podaci iz lične i porodične anamneze, kao i fizikalnog nalaza. Nakon prekonoćnog gladovanja je urađen oralni i/ili intravenski test opterećenja glukozom. Na osnovu parametara izvedenih iz ovih testova određena je insulinska senzitivnost i sekrecija, kao i procena statusa glikozne tolerancije...

Background: Global increase in childhood obesity is associated with the development of other co-morbidities at younger age. Among the other cardiovascular risks, obese children could have glucose intolerance. Prediabetes is defined by isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) or combination of both IFG and IGT. Insulin resistance of puberty leading to compensatory hyperinsulinemia may serve to facilitate protein anabolism during this period of rapid growth. It is more pronounced in obese children with peripheral insulin resistance. Beta cells increase the insulin secretion in the attempt to maintain blood glucose levels in the normal range. That could lead to the exhaustion of beta cell and consequently to beta cell failure, which is believed to be the main cause of type 2 diabetes. Objective: The main objective of this study was the estimation of insulin sensitivity and secretion in a cohort of obese adolescents. The secondary objective was to establish the prevalence of prediabetes in this group of patients. Methods: In a prospective study we recruited 85 obese patients from obesity clinic at University Children’s Hospital and 17 normal weight controls. All patients were Caucasian origin, 60M/42F, aged 7.4-18.3 years with at least Tanner 2 stage of puberty. The main inclusion criteria were obesity (defined as BMI >97 th percentile) and puberty. We divided obese patients into groups according to the degree of obesity. Two groups were: moderate obesity group (BMI SDS between 1.5-3) and severe obesity group (BMI SDS>3). Data collections included: personal and family history and physical examination. After the overnight fast we performed oGTT and/or IVGTT. Indices of insulin resistance and secretion were calculated from these tests and glucose tolerance status was established. Results: The mean BMI was 32 ± 5.5 kg/m2. Groups were comparable and did not differ by age, gender and pubertal stage. Depending on the criteria we used, insulin resistance was confirmed in 62-100% of obese patients, predominantly in a group with severe obesity. We also identified lower insulin secretion, especially in a group with severe obesity. The oGTT revealed isolated impaired fasting glucose (IFG) in 13.9%, impaired glucose tolerance (IGT) in 20.8% and combined IFG and IGT only in 2.8% obese patients...

Deca, adolescenti, gojaznost, insulinska rezistencija, predijabetes

children, adolescents, impaired glucose tolerance, obesity, prediabetes

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