Reliable Assessment of Insulin Resistance in Children
- PDF / 134,247 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 2 Downloads / 187 Views
PEDIATRICS (S GIDDING, SECTION EDITOR)
Reliable Assessment of Insulin Resistance in Children Michelle Van Name & Sonia Caprio
Published online: 5 June 2013 # Springer Science+Business Media New York 2013
Abstract Obesity is on the rise in the pediatric population. Obese individuals are at risk for insulin resistance and this, in combination with impaired β-cell function, can result in type 2 diabetes. The diagnosis of insulin resistance is made in clinical practice by using estimates of insulin sensitivity. Scientific evidence regarding the evaluation of insulin resistance in children has revealed conflicting conclusions. Keywords Insulin Resistance . Obesity . Pediatrics
Introduction Rates of obesity in children are rising at an alarming rate in the United States and have tripled since 1980 [1]. Data based on the National Health and Nutrition Examination Survey (NHANES) reveal that of children aged 2–19 years, nearly 17 % had a body mass index (BMI) at the 95th percentile or greater for age, and nearly 32 % at the 85th percentile or greater for age [1]. These trends in obesity are especially concerning given its association with insulin resistance and possible progression to type 2 diabetes. The pancreatic beta cells produce insulin. Insulin resistance refers to a loss of sensitivity of the peripheral tissues to insulin. Individuals with insulin resistance who have sufficient beta cell function can compensate with higher insulin levels to maintain euglycemia. However if beta cell function declines in the setting of insulin resistance, glucose tolerance becomes impaired, putting the individual at risk for the development of type 2 diabetes [2•, 3–5]. β-cell dysfunction has been studied in obese adolescents, and is related to glucose tolerance. During an oral glucose tolerance test (OGTT), of those obese adolescents whose 2-hour glucose levels were in the normal M. Van Name : S. Caprio (*) Department of Pediatrics, Yale University School of Medicine, 330 Cedar St, PO Box 208064, New Haven, CT 06520, USA e-mail: [email protected]
range, progressively higher 2-hour glucose values (though normal) were associated with lower insulin sensitivity and decreased insulin secretion, indicating an early beta cell dysfunction [2•]. Worsening β-cell function in comparison to insulin sensitivity has also been demonstrated in overweight children with normal glucose tolerance whose 2hour glucose values were in the higher part of the normal range [3]. In addition, obese adolescents with the higher (though normal) 2-hour glucose values were more likely to develop impaired glucose tolerance at a 2-year follow-up [2•]. Insulin resistance is one of the key features of the metabolic syndrome. Additional features of the metabolic syndrome include obesity, hypertension, and dyslipidemia [4, 5]. The metabolic syndrome is associated with an increased risk of type 2 diabetes and heart disease [5]. While insulin resistance is usually found in individuals who are obese, not all obese individuals have insulin resistance. There are factors
Data Loading...
