[Glucose intolerance in obese children: a preliminary study]
Salesa Barja1, M Isabel Hodgson, Ana M Acosta
1Departamento de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile. sbarja@puc.cl
Insights
Obese children with glucose intolerance (GI) show reduced insulin secretion, not increased insulin resistance (IR), despite similar clinical features. This suggests impaired insulin production contributes to GI in pediatric obesity.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Obesity Research
Context:
- Childhood obesity is rising, increasing the risk of Type 2 Diabetes Mellitus.
- Glucose intolerance (GI) is a precursor to Type 2 Diabetes, following a period of insulin resistance (IR).
- Understanding metabolic characteristics in obese children is crucial for early intervention.
Purpose:
- To characterize the clinical and metabolic profiles of obese children based on their glucose tolerance status.
- To investigate differences in insulin resistance and secretion between obese children with and without GI.
Summary:
- A study of 52 obese children (ages 8-17) assessed glucose tolerance and insulin dynamics using an oral glucose tolerance test and HOMA index.
- Children with GI (11.5%) exhibited similar clinical features and HOMA scores to those with normal glucose tolerance.
- However, children with GI had lower 30-minute insulin levels, a reduced Insulinogenic Index, and higher total and LDL cholesterol.
Impact:
- Identifies decreased insulin secretion as a key factor in the development of glucose intolerance in severely obese children with IR.
- Highlights the need for monitoring lipid profiles in obese children.
- Informs potential therapeutic strategies targeting insulin secretion in pediatric metabolic health.
Background:
Glucose intolerance (GI) is preceded by a prolonged period of Insulin Resistance (IR) and is an advanced stage towards the development of Type 2 Diabetes Mellitus (NIDDM), whose incidence is increasing in the pediatric population, along with obesity.
Aim:
To describe clinical and metabolic characteristics of obese children according to their glucose tolerance.
Patients And Methods:
We studied 52 obese children, aged 8 to 17 years, with a body mass index z-score of 4.7 +/- 1.6. An oral glucose tolerance test with insulin measurements in the basal period and at 30 minutes, was done. IR was estimated through the Homeostasis Model Assessment index (HOMA) and insulin secretion through the Insulinogenic Index.
Results:
Six children (11.5%) had GI. When compared with children with normal glucose tolerance, children with GI had similar clinical features, similar HOMA (5.4 +/- 3.3 and 5.2 +/- 2.0 respectively) and basal insulinemia (23.4 +/- 11 and 24.6 +/- 10 microU/ml). But they had lower insulin level at 30 min (128 +/- 61 and 253.7 +/- 357 microU/ml respectively, p > 0.05) a lower Insulinogenic Index (1.44 +/- 0.4 and 4.4 +/- 1.0 microU/ml/mg/dl, p < 0.05), a higher total cholesterol (192 +/- 37 vs 168 +/- 34 mg/dl, p < 0.05) and a higher LDL cholesterol (123 +/- 35 and 101 +/- 28 mg/dl, respectively, p < 0.05).
Conclusions:
Obese children with or without GI have similar clinical features and body mass index. In severe obese children with marked IR, the appearance of Glucose Intolerance seems to be associated to a decrease in insulin secretion and not to an increase in IR.
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