One-hour postload plasma glucose levels as a new criterion for assessing insulin secretion in obese children

BACKGROUND: Incidence of Type 2 Diabetes Mellitus (T2DM) and associated dysglycemic conditions, increasing the risk of diabetes development, continues to rise worldwide, most notably due to ever-growing obesity rate. Early identification of the persons who are exposed to the risk of T2DM development holds much significance for prevention of both this disease and associated cardiometabolic complications.AIM: To study characteristics of insulin secretion and insulin sensitivity among obese children and adolescents versus the glycemic level 60 minutes (GL60) after the standard oral glucose tolerance test (OGTT).METHODS: This open-label comparative cross-sectional study involved 613 children in the age between 6 and 17.9 years old with constitutive-exogenous obesity, divided into 2 groups: 173 patients with GL60 level ≥ 8.6 mmol/L and 440 children with GL60 level < 8.6 mmol/L. They underwent a screening for dyslipidemia, non-alcoholic fatty liver disease, arterial hypertension and impaired glucose tolerance (IGT). Insulin secretion was evaluated on the basis of maximal (IRI max), average level (IRI avg) of insulin in the course of OGTT and insulinogenic index (IGI), insulin resistance (IG) — by Matsuda index.RESULTS: The groups were comparable in the terms of age, sex, sexual maturation stage and obesity level. Children with GL60 level ≥ 8.6 mmol/L were characterized by higher IR (Matsuda 2.8 ± 2.3 vs 3.5 ± 2.2, р < 0.01), hyperinsulinemia (IRI max 190.0 ± 59.5 vs 157.1 ± 63.4 μU/ml, р < 0.001, IRI avg 115.3 ± 59.7 vs 90.2 ± 54.1 μU/ml, p < 0.001) along with low IGI value (1.84 ± 1.62 vs 2.61 ± 1.3, р < 0.01), which is indicative of the first phase insulin secretion impairment. The lowest IGI values were found among the "GL60 level ≥ 8.6 mmol/L" group patients with IGT (1.4 ± 0.9). Besides, the patients with GL60 level ≥ 8.6 mmol/L are characterized by the higher rate of metabolic complications in the form of impaired glucose tolerance, arterial hypertension, fatty hepatosis and steatohepatitis.CONCLUSIONS: GL60 level ≥ 8.6 mmol/L can be used as an additional marker for metabolically complicated obesity among children and adolescents with a high risk of the carbohydrate metabolism disorder development.

Download Full-text

Predictors of Impaired Glucose Tolerance in Overweight Children and Adolescents and Comparison of Surrogate Insulin Sensitivity Indexes Derived from a Fasting Oral Glucose Tolerance Test (OGGT).

10.1210/endo-meetings.2010.part2.p15.p2-727 ◽

2010 ◽

pp. P2-727-P2-727

Author(s):

GS Babar ◽

JR Broussard ◽

AK Sherman ◽

F Ugrasbul

Keyword(s):

Insulin Sensitivity ◽

Glucose Tolerance ◽

Oral Glucose Tolerance Test ◽

Impaired Glucose Tolerance ◽

Children And Adolescents ◽

Glucose Tolerance Test ◽

Tolerance Test ◽

Oral Glucose ◽

Overweight Children ◽

Oral Glucose Tolerance

Download Full-text

Triglycerides-to-HDL cholesterol ratio as screening tool for impaired glucose tolerance in obese children and adolescents

Acta Diabetologica ◽

10.1007/s00592-015-0824-y ◽

2015 ◽

Vol 53 (3) ◽

pp. 493-498 ◽

Cited By ~ 10

Author(s):

Melania Manco ◽

Graziano Grugni ◽

Mario Di Pietro ◽

Antonio Balsamo ◽

Stefania Di Candia ◽

...

Keyword(s):

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Children And Adolescents ◽

Screening Tool ◽

Hdl Cholesterol ◽

Obese Children ◽

Cholesterol Ratio

Download Full-text

The relationship between fasting hyperglycemia and insulin secretion in subjects with normal or impaired glucose tolerance

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00674.2007 ◽

2008 ◽

Vol 295 (2) ◽

pp. E401-E406 ◽

Cited By ~ 43

Author(s):

Muhammad A. Abdul-Ghani ◽

Masafumi Matsuda ◽

Rucha Jani ◽

Christopher P. Jenkinson ◽

Dawn K. Coletta ◽

...

Keyword(s):

Insulin Secretion ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Plasma Glucose ◽

Early Phase ◽

Mexican Americans ◽

Late Phase ◽

Oral Glucose ◽

C Peptide ◽

The Relationship

To assess the relationship between the fasting plasma glucose (FPG) concentration and insulin secretion in normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) subjects, 531 nondiabetic subjects with NGT ( n = 293) and IGT ( n = 238; 310 Japanese and 232 Mexican Americans) received an oral glucose tolerance test (OGTT) with measurement of plasma glucose, insulin, and C-peptide every 30 min. The insulin secretion rate was determined by plasma C-peptide deconvolution. Insulin sensitivity (Matsuda index) was measured from plasma insulin and glucose concentrations. The insulin secretion/insulin resistance (IS/IR) or disposition index was calculated as ΔISR/ΔG ÷ IR. As FPG increased in NGT subjects, the IS/IR index declined exponentially over the range of FPG from 70 to 125 mg/dl. The relationship between the IS/IR index and FPG was best fit with the equation: 28.8 exp(−0.036 FPG). For every 28 mg/dl increase in FPG, the IS/IR index declined by 63%. A similar relationship between IS/IR index and FPG was observed in IGT. However, the decay constant was lower than in NGT. The IS/IR index for early-phase insulin secretion (0–30 min) was correlated with the increase in FPG in both NGT and IGT ( r = −0.43, P < 0.0001 and r = −0.20, P = 0.001, respectively). However, the correlation between late-phase insulin secretion (60–120 min) and FPG was not significant. In conclusion, small increments in FPG, within the “normal” range, are associated with a marked decline in glucose-stimulated insulin secretion and the decrease in insulin secretion with increasing FPG is greater in subjects with NGT than IGT and primarily is due to a decline in early-phase insulin secretion.

Download Full-text

Plasma concentrations of retinol in obese children and adolescents: relationship to metabolic syndrome components

Revista Paulista de Pediatria ◽

10.1590/s0103-05822014000100009 ◽

2014 ◽

Vol 32 (1) ◽

pp. 50-54 ◽

Cited By ~ 4

Author(s):

Marcia Teske ◽

Ana Paula B. Melges ◽

Fabiola Isabel S. de Souza ◽

Fernando Luiz A. Fonseca ◽

Roseli Oselka S. Sarni

Keyword(s):

Metabolic Syndrome ◽

Glucose Tolerance ◽

Children And Adolescents ◽

Plasma Concentrations ◽

Oral Glucose ◽

Inverse Association ◽

Obese Children ◽

Arterial Blood ◽

Plasma Retinol ◽

Metabolic Syndrome Components

Objective: To evaluate obese children and adolescents' retinol plasma levels and to correlate them with metabolic syndrome components. Methods: Cross-sectional study with 61 obese children and adolescents (body mass index Z score - ZBMI>+2). Pubertal development, arterial blood pressure, body weight and height for nutritional classification and waist circumference were obtained. A 15mL blood sample was collected (after a 12-hour fasting in a low luminosity room) for retinol determination (cut-off inadequate if <30µg/dL), lipid profile (HDL-c, LDL-c, and triglycerides), oral glucose tolerance test (fasting and 120 minutes) and for high sensitivity C-reactive protein. Spearman correlation and multiple linear regression were used in the statistical analysis. Results: Mean age was 10.7±2.7 years. There was a predominance of male gender 38/61 (62%) and pre-pubertal 35/61 (57%) subjects. The average plasmatic retinol was 48.5±18.6ug/dL. Retinol deficiency and severe obesity were observed in 6/61 (10%) and 36/61 (59%), respectively. Glucose level at 120 minutes was the independent and predictive variable of plasma retinol levels [β=-0.286 (95%CI -0.013 - -0.001)]. Conclusions: An independent and inverse association between plasma retinol levels and glucose tolerance was observed, suggesting an important contribution of this vitamin in the morbidities associated to obesity in children and adolescents.

Download Full-text

Impact of incretin hormones on β-cell function in subjects with normal or impaired glucose tolerance

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00571.2005 ◽

2006 ◽

Vol 291 (6) ◽

pp. E1144-E1150 ◽

Cited By ~ 60

Author(s):

Elza Muscelli ◽

Andrea Mari ◽

Andrea Natali ◽

Brenno D. Astiarraga ◽

Stefania Camastra ◽

...

Keyword(s):

Insulin Secretion ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Cell Function ◽

Oral Glucose ◽

Incretin Effect ◽

Β Cell ◽

Β Cell Function ◽

Glucose Sensitivity ◽

Cell Glucose

The mechanisms by which the enteroinsular axis influences β-cell function have not been investigated in detail. We performed oral and isoglycemic intravenous (IV) glucose administration in subjects with normal (NGT; n = 11) or impaired glucose tolerance (IGT; n = 10), using C-peptide deconvolution to calculate insulin secretion rates and mathematical modeling to quantitate β-cell function. The incretin effect was taken to be the ratio of oral to IV responses. In NGT, incretin-mediated insulin release [oral glucose tolerance test (OGTT)/IV ratio = 1.59 ± 0.18, P = 0.004] amounted to 18 ± 2 nmol/m2 (32 ± 4% of oral response), and its time course matched that of total insulin secretion. The β-cell glucose sensitivity (OGTT/IV ratio = 1.52 ± 0.26, P = 0.02), rate sensitivity (response to glucose rate of change, OGTT/IV ratio = 2.22 ± 0.37, P = 0.06), and glucose-independent potentiation were markedly higher with oral than IV glucose. In IGT, β-cell glucose sensitivity (75 ± 14 vs. 156 ± 28 pmol·min−1·m−2·mM−1 of NGT, P = 0.01) and potentiation were impaired on the OGTT. The incretin effect was not significantly different from NGT in terms of plasma glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide responses, total insulin secretion, and enhancement of β-cell glucose sensitivity (OGTT/IV ratio = 1.73 ± 0.24, P = NS vs. NGT). However, the time courses of incretin-mediated insulin secretion and potentiation were altered, with a predominance of glucose-induced vs. incretin-mediated stimulation. We conclude that, under physiological circumstances, incretin-mediated stimulation of insulin secretion results from an enhancement of all dynamic aspects of β-cell function, particularly β-cell glucose sensitivity. In IGT, β-cell function is inherently impaired, whereas the incretin effect is only partially affected.

Download Full-text

Prevalence of Metabolic Syndrome among Obese Children and Adolescents

BIRDEM Medical Journal ◽

10.3329/birdem.v1i1.12382 ◽

2012 ◽

Vol 1 (1) ◽

pp. 21-25 ◽

Cited By ~ 5

Author(s):

F Mohsin ◽

A Baki ◽

J Nahar ◽

S Akhtar ◽

T Begum ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Glucose Tolerance ◽

Children And Adolescents ◽

Blood Pressure Measurement ◽

Hdl Cholesterol ◽

Oral Glucose ◽

Obese Children ◽

Female Ratio ◽

Age And Sex

Objectives: The Prevalence and magnitude of childhood obesity are increasing dramatically. The study was undertaken to see the prevalence of metabolic syndrome among children and adolescents with obesity, attending the Paediatric Endocrine OPD, BIRDEM. Methods: A cross sectional study was conducted from January 2006 to December 2008 among obese children and adolescents (6-18 years) attending Paediatric endocrine out patient department of BIRDEM. Children with any other endocrine disorder, dysmorphism/syndrome were excluded. Obesity was defined as BMIe95th percentile for age and sex using CDC growth chart. Children underwent two-hour oral glucose tolerance test, anthropometric and blood pressure measurement. Fasting serum insulin and lipid profile were measured. Impaired glucose tolerance (IGT) was defined as fasting plasma glucose (FPG) <7 mmol/L and 2 hr post glucose load e7.8 mmol/L to<11.1 mmol/L. Metabolic syndrome was identified if 3 or more of following criteria were met: BMI > 97th percentile for age and sex, high triglyceride (TGe150 mg/dl), low high-density lipoprotein cholesterol (HDL cholesterol<40mg/dl), Systolic or diastolic blood pressure>95th percentile for age and sex, IGT. Results: A total of 161 children presented with obesity. Male to female ratio was 1.3:1. Mean age was 10.3±2.5 years. Metabolic syndrome was identified in 36.6% subjects (59 out of 161, twenty five male and 34 female). Higher BMI and hip circumference, systolic and diastolic hypertension, high TG, low HDL cholesterol and IGT were significantly associated with metabolic syndrome. Conclusions: The prevalence of metabolic syndrome is high among obese children and adolescents. Factors contributing towards obesity needs to be identified and strategies should be planned for prevention and management of this health problem. DOI: http://dx.doi.org/10.3329/birdem.v1i1.12382 Birdem Med J 2011; 1(1): 21-25

Download Full-text