Prevalence of Impaired Glucose Tolerance among Children and Adolescents with Marked Obesity
| Autor: | Gene Fisch, Sonia Caprio, Vera Rieger, Robert S. Sherwin, Barbara Teague, Gina Barbetta, Mary Savoye, Karin Allen, Bruna Banyas, Sara E. Taksali, William V. Tamborlane, Ranjana Sinha |
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| Rok vydání: | 2002 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Adolescent medicine.medical_treatment Black People Type 2 diabetes White People Childhood obesity Impaired glucose tolerance Insulin resistance Risk Factors Internal medicine Insulin Secretion Diabetes Mellitus Prevalence Humans Insulin Medicine Obesity Child Proinsulin C-Peptide business.industry Hispanic or Latino General Medicine Glucose Tolerance Test medicine.disease Cross-Sectional Studies Glucose Endocrinology Child Preschool Homeostatic model assessment Female business |
| Zdroj: | New England Journal of Medicine. 346:802-810 |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejmoa012578 |
| Popis: | Childhood obesity, epidemic in the United States, has been accompanied by an increase in the prevalence of type 2 diabetes among children and adolescents. We determined the prevalence of impaired glucose tolerance in a multiethnic cohort of 167 obese children and adolescents.All subjects underwent a two-hour oral glucose-tolerance test (1.75 g [DOSAGE ERROR CORRECTED] of glucose per kilogram of body weight), and glucose, insulin, and C-peptide levels were measured. Fasting levels of proinsulin were obtained, and the ratio of proinsulin to insulin was calculated. Insulin resistance was estimated by homeostatic model assessment, and beta-cell function was estimated by calculating the ratio between the changes in the insulin level and the glucose level during the first 30 minutes after the ingestion of glucose.Impaired glucose tolerance was detected in 25 percent of the 55 obese children (4 to 10 years of age) and 21 percent of the 112 obese adolescents (11 to 18 years of age); silent type 2 diabetes was identified in 4 percent of the obese adolescents. Insulin and C-peptide levels were markedly elevated after the glucose-tolerance test in subjects with impaired glucose tolerance but not in adolescents with diabetes, who had a reduced ratio of the 30-minute change in the insulin level to the 30-minute change in the glucose level. After the body-mass index had been controlled for, insulin resistance was greater in the affected cohort and was the best predictor of impaired glucose tolerance.Impaired glucose tolerance is highly prevalent among children and adolescents with severe obesity, irrespective of ethnic group. Impaired oral glucose tolerance was associated with insulin resistance while beta-cell function was still relatively preserved. Overt type 2 diabetes was linked to beta-cell failure. |
| Databáze: | OpenAIRE |
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