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Association of β-cell function and insulin resistance with pediatric type 2 diabetes among Chinese children
Zhen-Ran Xu1, Hong-Wei Du2, Lan-Wei Cui3
1Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China.
Insights
Impaired beta-cell function, not just insulin resistance, significantly increases type 2 diabetes mellitus (T2DM) risk in Chinese children. This highlights the need for targeted screening and prevention strategies for pediatric T2DM.
Area of Science:
- Endocrinology
- Pediatric Endocrinology
- Metabolic Disorders
Background:
- Type 2 diabetes mellitus (T2DM) pathogenesis involves both insulin resistance and impaired insulin secretion.
- Clinical data on pediatric T2DM, particularly in China, remain limited.
Purpose of the Study:
- To investigate the association of beta-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study.
- To assess the roles of HOMA2-%B and HOMA2-IR in the development of T2DM among children and adolescents.
Main Methods:
- A multicenter cross-sectional study involving 161 newly diagnosed T2DM children/adolescents and 1935 healthy controls.
- Homeostasis models (HOMAs) used to measure beta-cell function (HOMA2-%B) and insulin resistance (HOMA2-IR), standardized by sex and age.
- Logistic regression analysis to determine odds ratios for T2DM risk, adjusting for confounding factors.
Main Results:
- Newly diagnosed T2DM patients showed significantly lower HOMA2-%B and higher HOMA2-IR compared to controls (P < 0.001).
- Decreased HOMA2-%B (OR=8.40) and increased HOMA2-IR (OR=1.79) were strongly associated with higher T2DM risk.
- Impaired beta-cell function (lower HOMA2-%B) demonstrated a stronger association with T2DM risk than insulin resistance.
Conclusions:
- Beta-cell function impairment is a critical factor in Chinese pediatric T2DM, alongside insulin resistance.
- Gender differences in susceptibility and high prevalence of comorbidities necessitate tailored screening and prevention strategies for pediatric T2DM in China.
Background:
In addition to insulin resistance, impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus (T2DM). Scarce clinical data exist for pediatric T2DM.
Aim:
To investigate the association of β-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study.
Methods:
This multicenter cross-sectional study included 161 newly diagnosed T2DM children and adolescents between January 2017 and October 2019. Children with normal glycemic levels (n = 1935) were included as healthy control subjects. The homeostasis models (HOMAs) were used to assess the β-cell function (HOMA2-%B) and insulin resistance (HOMA2-IR) levels. The HOMA index was standardized by sex and age. We performed logistic regression analysis to obtain odds ratios (ORs) for T2DM risk using the standardized HOMA index, adjusted for confounding factors including sex, Tanner stage, T2DM family history, body mass index z-score, and lipid profile.
Results:
The male-female ratio of newly diagnosed T2DM patients was 1.37:1 (OR = 2.20, P = 0.011), and the mean ages of onset for boys and girls were 12.5 ± 1.9 years and 12.3 ± 1.7 years, respectively. The prevalence of related comorbidities including obesity, elevated blood pressure, and dyslipidemia was 58.2%, 53.2%, and 80.0%, respectively. The T2DM group had lower HOMA2-%B levels (P < 0.001) and higher HOMA2-IR levels (P < 0.001) than the control group. Both the decrease in HOMA2-%B z-score (OR = 8.40, 95%CI: 6.40-11.02, P < 0.001) and the increase in HOMA2-IR z-score (OR = 1.79, 95%CI: 1.60-2.02, P < 0.001) were associated with a higher risk of T2DM, and the decrease in HOMA2-%B z-score always had higher ORs than the increase in HOMA2-IR z-score after adjusting for confounding factors.
Conclusion:
Besides insulin resistance, β-cell function impairment is also strongly associated with Chinese pediatric T2DM. Gender difference in susceptibility and high comorbidities warrant specific T2DM screening and prevention strategies in Chinese children.
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