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Insulin dynamics predict body mass index and z-score response to insulin suppression or sensitization pharmacotherapy

Robert H Lustig1, Michele L Mietus-Snyder, Peter Bacchetti

  • 1Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, USA. rlustig@peds.ucsf.edu

The Journal of Pediatrics
|January 21, 2006
PubMed

Insights

Oral glucose tolerance testing (OGTT) can predict how well obese children respond to metformin or octreotide. Pre-treatment insulin resistance predicts metformin efficacy, while insulin hypersecretion and sensitivity predict octreotide efficacy.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Pharmacotherapy

Background:

  • Obesity in children is linked to insulin resistance and hypersecretion, potentially affecting drug efficacy.
  • Oral glucose tolerance testing (OGTT) is a key diagnostic tool for metabolic assessment.

Purpose of the Study:

  • To determine if OGTT can predict the effectiveness of metformin and octreotide in obese children.
  • To investigate the relationship between insulin resistance, insulin hypersecretion, and treatment outcomes.

Main Methods:

  • Forty-three obese children without central nervous system (CNS) insult received metformin; 24 with CNS insult received octreotide.
  • Insulin sensitivity (CISI) and secretion (CIRgp) were measured using OGTT.
  • Body mass index (BMI) z-score changes were modeled based on baseline insulin parameters.

Main Results:

  • Metformin efficacy in white children was associated with baseline insulin resistance (CISI) and secretion (CIRgp).
  • Octreotide efficacy showed a dependency on the interaction between insulin secretion and sensitivity.
  • Response to treatments varied, with Black children showing limited response to metformin.

Conclusions:

  • Pre-treatment insulin resistance predicts metformin efficacy in obese children.
  • Insulin hypersecretion and sensitivity predict octreotide efficacy in obese children with CNS insult.
Abstract

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