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[Insulin resistance in newly diagnosed type 1 diabetic children and adolescents]

Agnieszka Szadkowska1, Iwona Pietrzak, Agnieszka Zmysłowska

  • 1Klinika Chorób Dzieci, Instytut Pediatrii, Uniwersytet Medyczny, ul. Sporna 36/50, 91-738 Łódź, Poland.

Medycyna Wieku Rozwojowego
|July 25, 2003
PubMed

Insights

Insulin resistance is common in newly diagnosed type 1 diabetes in children and adolescents. This study found no link between insulin secretion and resistance, but higher resistance in obese children and during puberty.

Area of Science:

  • Pediatrics
  • Endocrinology
  • Metabolic Disorders

Background:

  • Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by insulin deficiency.
  • Insulin resistance, a condition where the body's cells don't respond effectively to insulin, can coexist with T1DM, particularly in children and adolescents.
  • Understanding the prevalence and factors associated with insulin resistance in this population is crucial for effective management.

Purpose of the Study:

  • To estimate the degree of insulin resistance in newly diagnosed pediatric and adolescent patients with T1DM.
  • To analyze the correlation between insulin secretion and impaired insulin action in this cohort.
  • To identify factors associated with insulin resistance, such as age, puberty stage, body mass index (BMI), and body composition.

Main Methods:

  • The study included 37 children and adolescents (mean age 12.9 +/- 3 years) with newly diagnosed T1DM (duration <= 6 months).
  • Insulin resistance was assessed using the Euglycemic-Hyperinsulinemic Clamp technique, calculating the glucose disposal rate (M index).
  • Insulin secretion was measured via glucagon test, alongside assessments of metabolic control (HbA1c), lipid profiles, anthropometric measurements (BMI, waist/hip ratio, skinfold thickness), and Tanner stage for puberty assessment.

Main Results:

  • Insulin resistance was observed in a significant proportion of newly diagnosed T1DM patients, with M index values ranging from 3.2 to 11.8 mg/kg/min (mean 7.08 +/- 2.5 mg/kg/min).
  • Insulin resistance showed a negative correlation with age (r=-0.3, p<0.05) and was more pronounced during Tanner stage III of puberty and in obese children (related to BMI and skinfold thickness).
  • No significant difference in insulin secretion was found between insulin-resistant and insulin-sensitive groups, and insulin resistance did not correlate with metabolic control (HbA1c). Insulin doses were lower in insulin-sensitive children.

Conclusions:

  • Insulin resistance is a common finding in children and adolescents newly diagnosed with T1DM.
  • The study found no relationship between insulin secretion capacity and the degree of insulin resistance in this population.
  • Factors such as age, pubertal development (Tanner stage III), and obesity (indicated by BMI and skinfold thickness) are associated with increased insulin resistance in pediatric T1DM.

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