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Ha J, Chung ST, Springer M, Kim JY, Chen P, Chhabra A, Cree MG, Diniz Behn C, Sumner AE, Arslanian SA, Sherman AS. Estimating insulin sensitivity and β-cell function from the oral glucose tolerance test: validation of a new insulin sensitivity and secretion (ISS) model. Am J Physiol Endocrinol Metab 2024; 326:E454-E471. [PMID: 38054972 DOI: 10.1152/ajpendo.00189.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
Efficient and accurate methods to estimate insulin sensitivity (SI) and β-cell function (BCF) are of great importance for studying the pathogenesis and treatment effectiveness of type 2 diabetes (T2D). Existing methods range in sensitivity, input data, and technical requirements. Oral glucose tolerance tests (OGTTs) are preferred because they are simpler and more physiological than intravenous methods. However, current analytical methods for OGTT-derived SI and BCF also range in complexity; the oral minimal models require mathematical expertise for deconvolution and fitting differential equations, and simple algebraic surrogate indices (e.g., Matsuda index, insulinogenic index) may produce unphysiological values. We developed a new insulin secretion and sensitivity (ISS) model for clinical research that provides precise and accurate estimates of SI and BCF from a standard OGTT, focusing on effectiveness, ease of implementation, and pragmatism. This model was developed by fitting a pair of differential equations to glucose and insulin without need of deconvolution or C-peptide data. This model is derived from a published model for longitudinal simulation of T2D progression that represents glucose-insulin homeostasis, including postchallenge suppression of hepatic glucose production and first- and second-phase insulin secretion. The ISS model was evaluated in three diverse cohorts across the lifespan. The new model had a strong correlation with gold-standard estimates from intravenous glucose tolerance tests and insulin clamps. The ISS model has broad applicability among diverse populations because it balances performance, fidelity, and complexity to provide a reliable phenotype of T2D risk.NEW & NOTEWORTHY The pathogenesis of type 2 diabetes (T2D) is determined by a balance between insulin sensitivity (SI) and β-cell function (BCF), which can be determined by gold standard direct measurements or estimated by fitting differential equation models to oral glucose tolerance tests (OGTTs). We propose and validate a new differential equation model that is simpler to use than current models and requires less data while maintaining good correlation and agreement with gold standards. Matlab and Python code is freely available.
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Affiliation(s)
- Joon Ha
- Department of Mathematics, Howard University, Washington, District of Columbia, United States
| | - Stephanie T Chung
- Section on Pediatric Diabetes, Obesity, and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - Max Springer
- Department of Mathematics, University of Maryland, College Park, Maryland, United States
| | - Joon Young Kim
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York, United States
| | | | - Aaryan Chhabra
- Department of Biology, Indian Institute of Science Education and Research, Pune, India
| | - Melanie G Cree
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Cecilia Diniz Behn
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, Colorado, United States
| | - Anne E Sumner
- Intramural Research Program, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health, Bethesda, Maryland, United States
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland, United States
- Hypertension in Africa Research Team, North-West University, Potchefstroom, South Africa
| | - Silva A Arslanian
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Arthur S Sherman
- Laboratory of Biological Modeling, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States
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Lu C, Wolfs D, El ghormli L, Levitsky LL, Levitt Katz LE, Laffel LM, Patti ME, Isganaitis E. Growth Hormone Mediators and Glycemic Control in Youths With Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240447. [PMID: 38421647 PMCID: PMC10905312 DOI: 10.1001/jamanetworkopen.2024.0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/06/2024] [Indexed: 03/02/2024] Open
Abstract
Importance Youth-onset type 2 diabetes (T2D) has a more aggressive phenotype than adult-onset T2D, including rapid loss of glycemic control and increased complication risk. Objective To identify associations of growth hormone mediators with glycemic failure, beta cell function, and insulin sensitivity in youth-onset T2D. Design, Setting, and Participants This post hoc secondary analysis of the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) randomized clinical trial, which enrolled participants from July 2004 to February 2009, included 398 participants from 15 university-affiliated medical centers with available plasma samples from baseline and 36 months. Participants were youths aged 10 to 17 years with a duration of T2D of less than 2 years who were randomized to metformin, metformin plus lifestyle intervention, or metformin plus rosiglitazone. Participants were followed up for a mean (SD) of 3.9 (1.5) years during the trial, ending in 2011. Statistical analysis was performed from August 2022 to November 2023. Exposure Plasma insulin-like growth factor-1 (IGF-1), growth hormone receptor (GHR), and insulin-like growth factor binding protein 1 (IGFBP-1). Main Outcomes and Measures Main outcomes were (1) loss of glycemic control during the TODAY study, defined as hemoglobin A1c (HbA1c) level of 8% or more for 6 months or inability to wean from insulin therapy, and (2) baseline and 36-month measures of glycemia (fasting glucose, HbA1c), insulin sensitivity (1/fasting C-peptide), high-molecular-weight adiponectin, and beta cell function (C-peptide index, C-peptide oral disposition index). Results This analysis included 398 participants (mean [SD] age, 13.9 [2.0] years; 248 girls [62%]; 166 Hispanic participants [42%]; 134 non-Hispanic Black participants [34%], and 84 non-Hispanic White participants [21%]). A greater increase in IGF-1 level between baseline and 36 months was associated with lower odds of glycemic failure (odds ratio [OR], 0.995 [95% CI, 0.991-0.997]; P < .001) and higher C-peptide index per 100-ng/mL increase in IGF-1 (β [SE], 0.015 [0.003]; P < .001). A greater increase in log2 GHR level between baseline and 36 months was associated with higher odds of glycemic failure (OR, 1.75 [95% CI, 1.05-2.99]; P = .04) and lower C-peptide index (β [SE], -0.02 [0.006]; P < .001). A greater increase in log2 IGFBP-1 level between baseline and 36 months was associated with higher odds of glycemic failure (OR, 1.37 [95% CI, 1.09-1.74]; P = .007) and higher high-molecular-weight adiponectin (β [SE], 431 [156]; P = .007). Conclusions and Relevance This study suggests that changes in plasma growth hormone mediators are associated with loss of glycemic control in youth-onset T2D, with IGF-1 associated with lower risk and GHR and IGFBP-1 associated with increased risk. Trial Registration ClinicalTrials.gov Identifier: NCT00081328.
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Affiliation(s)
- Chang Lu
- Division of Endocrinology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Danielle Wolfs
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Laure El ghormli
- The Biostatistics Center, George Washington University, Washington, DC
| | - Lynne L. Levitsky
- Division of Pediatric Endocrinology and Diabetes, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lorraine E. Levitt Katz
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Lori M. Laffel
- Division of Endocrinology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | | | - Elvira Isganaitis
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
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Griffith GJ, Wang AP, Liem RI, Carr MR, Corson T, Ward K. Reference Values for Cardiorespiratory Fitness in Patients Aged 6 to 18 Years. J Pediatr 2024; 264:113770. [PMID: 37802386 DOI: 10.1016/j.jpeds.2023.113770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To develop reference values for cardiorespiratory fitness, as quantified by peak oxygen uptake (VO2peak) and treadmill time, in patients aged 6 through 18 years referred for cardiopulmonary exercise testing (CPET). STUDY DESIGN We reviewed a clinical pediatric CPET database for fitness data in children aged 6-18 years with no underlying heart disease. CPET was obtained via the Bruce protocol utilizing objectively confirmed maximal effort via respiratory exchange ratio. Fitness data (VO2peak and treadmill test duration) were analyzed to determine age- and sex-specific reference values for this pediatric cohort. RESULTS Data from 2025 pediatric CPETs (53.2% female) were included in the analyses. VO2peak increased with age in males, but not females. Treadmill test duration increased with age in both males and females. Fitness was generally higher in males when compared with females in the same age groups. CONCLUSIONS Our study provides extensive reference values for both VO2peak and total treadmill test time via the Bruce protocol for a pediatric population without known cardiac disease. Furthermore, the inclusion of objectively confirmed maximal exercise effort increases confidence in these findings compared with prior studies in this area. Clinicians performing CPET in pediatric populations can utilize these reference values to characterize test results according to representative peer data.
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Affiliation(s)
| | - Alan P Wang
- Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Robert I Liem
- Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Hematology, Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michael R Carr
- Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Tyler Corson
- Rush University College of Health Sciences, Chicago, IL
| | - Kendra Ward
- Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Racil G, Russo L, Migliaccio GM, Signorelli P, Larion A, Padulo J, Jlid MC. High-Intensity Interval Training in Female Adolescents with Moderate or Severe Obesity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1495. [PMID: 37761456 PMCID: PMC10528164 DOI: 10.3390/children10091495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
This study aimed to investigate the impact of moderate- or high-intensity interval training (MIIT or HIIT) on anthropometric and biological measurements in four groups of females with obesity. Fifty-seven participants were divided into a moderate obesity group (MOG, n = 29) and a severe obesity group (SOG, n = 28). Two sub-groups were established to practice HIIT and MIIT programs (SOGHI, n = 14; SOGMI, n = 14; MOGHI, n = 14; MOGMI, n = 15). During the training sessions, each group performed two sets of 4 × 1 min intervals on a cycle ergometer. The intervals were conducted at 65% and 85% of the heart rate reserve (HRR) for MIIT and HIIT, respectively. Between each repetition, there was an active recovery phase at 50% HRR, and, between sets, there was a 4 min period of free pedaling. All groups significantly improved their anthropometric data, while only MOGHI and SOGHI significantly improved their lean body mass (LBM) and blood lactate (BL), with p ˂ 0.05; the higher percentage of change in blood insulin levels (-25.49 and -25.34) and the homeostasis model assessment of the insulin resistance index (-31.42 and -28.88) were noted. Only MOGHI showed improvements in growth hormone (GH) and blood glucose (p < 0.05), which were negatively correlated with body fat percentage (r = -0.76 and r = -0.72) and waist circumference (r = -0.77 and r = -0.82), respectively. We may conclude that HIIT was an effective method of managing anthropometric and biological parameters, as confirmed by the pronounced body fat reduction in the moderate obesity group.
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Affiliation(s)
- Ghazi Racil
- Research Unit (UR 17JS01) “Sport Performance, Health & Society” Higher Institute of Sport and Physical Education of Ksar Said, Tunis 1000, Tunisia; (G.R.); (M.C.J.)
- Department of Biological Sciences Applied for Physical Activities and Sport, Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Manouba 2010, Tunisia
| | - Luca Russo
- Department of Human Sciences, Università Telematica degli Studi IUL, 50122 Florence, Italy;
| | - Gian Mario Migliaccio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Rome Open University, 00166 Rome, Italy;
| | - Paola Signorelli
- Institute for Molecular and Translational Cardiology (IMTC), San Donato Milanese, 20097 Milan, Italy;
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Alin Larion
- Faculty of Physical Education and Sport, Ovidius University of Constanta, 900029 Constanta, Romania;
| | - Johnny Padulo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | - Mohamed Chedly Jlid
- Research Unit (UR 17JS01) “Sport Performance, Health & Society” Higher Institute of Sport and Physical Education of Ksar Said, Tunis 1000, Tunisia; (G.R.); (M.C.J.)
- Department of Biological Sciences Applied for Physical Activities and Sport, Higher Institute of Sport and Physical Education of Ksar Said, University of La Manouba, Manouba 2010, Tunisia
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Racil G, Chelly MS, Coquart J, Padulo J, Teodor DF, Russo L. Long- and Short-Term High-Intensity Interval Training on Lipid Profile and Cardiovascular Disorders in Obese Male Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1180. [PMID: 37508677 PMCID: PMC10378083 DOI: 10.3390/children10071180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
This study investigated the effects of short-term and long-term periods (8 and 16 weeks) of high-intensity interval training (HIIT) on cardiovascular components, blood lipids, and 6-min walking test performance in obese young boys (age = 16.2 ± 0.7) with >34% body fat. The participants were split into two groups: severe obesity (SOG; n = 17) and moderate obesity (MOG; n = 16). All participants performed on a cycle ergometer for 16 weeks (3 times per week) of HIIT at 100% peak power output at the ventilatory threshold and recovered at 50% of peak power. Except for BMI, both groups improved all body composition measures after 16 weeks, with a higher percentage of change (Δ) in SOG. The 6-min walking test increased in both groups (p < 0.001). Furthermore, cardiovascular variables, blood lactate concentration at rest and after 5-min post-exercise, blood lipids, and insulin concentrations improved significantly in both groups. After 16 weeks, MOG significantly improved in HRpeak, blood glucose concentration, and rating of perceived exertion (RPE), but the percentage of change (Δ) was higher in SOG for all the other variables. SOG showed a higher (Δ) waist-to-hip ratio, maximum heart rate, resting heart rate, systolic blood pressure, blood lactate at 5-min post-exercise, and triglyceride concentrations after 8 and 16 weeks of training. In conclusion, a long-term HIIT program appears to be an appropriate training approach for obese boys with extra body fat. However, considering the RPE values, short-duration training sessions should be planned.
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Affiliation(s)
- Ghazi Racil
- Research Laboratory (LR23JS01) "Sport Performance, Health & Society", Higher Institute of Sport and Physical Education of Ksar Said, University of Manouba, Tunis 1000, Tunisia
- Department of Biological Sciences Applied for Physical Activities and Sport, Higher Institute of Sport and Physical Education of Ksar Said, University of Manouba, Manouba 2010, Tunisia
| | - Mohamed-Souhaiel Chelly
- Research Laboratory (LR23JS01) "Sport Performance, Health & Society", Higher Institute of Sport and Physical Education of Ksar Said, University of Manouba, Tunis 1000, Tunisia
- Department of Biological Sciences Applied for Physical Activities and Sport, Higher Institute of Sport and Physical Education of Ksar Said, University of Manouba, Manouba 2010, Tunisia
| | - Jeremy Coquart
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369-URePSSS-Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000 Lille, France
| | - Johnny Padulo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | - Dragos Florin Teodor
- Faculty of Physical Education and Sport, Ovidius University of Constanta, 900029 Constanta, Romania
| | - Luca Russo
- Department of Human Sciences, Università Telematica Degli Studi IUL, 50122 Florence, Italy
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Ha J, Chung ST, Springer M, Kim JY, Chen P, Cree MG, Behn CD, Sumner AE, Arslanian S, Sherman AS. Estimating Insulin Sensitivity and Beta-Cell Function from the Oral Glucose Tolerance Test: Validation of a new Insulin Sensitivity and Secretion (ISS) Model. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.06.16.545377. [PMID: 37503271 PMCID: PMC10370185 DOI: 10.1101/2023.06.16.545377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Efficient and accurate methods to estimate insulin sensitivity (SI) and beta-cell function (BCF) are of great importance for studying the pathogenesis and treatment effectiveness of type 2 diabetes. Many methods exist, ranging in input data and technical requirements. Oral glucose tolerance tests (OGTTs) are preferred because they are simpler and more physiological. However, current analytical methods for OGTT-derived SI and BCF also range in complexity; the oral minimal models require mathematical expertise for deconvolution and fitting differential equations, and simple algebraic models (e.g., Matsuda index, insulinogenic index) may produce unphysiological values. We developed a new ISS (Insulin Secretion and Sensitivity) model for clinical research that provides precise and accurate estimates of SI and BCF from a standard OGTT, focusing on effectiveness, ease of implementation, and pragmatism. The model was developed by fitting a pair of differential equations to glucose and insulin without need of deconvolution or C-peptide data. The model is derived from a published model for longitudinal simulation of T2D progression that represents glucose-insulin homeostasis, including post-challenge suppression of hepatic glucose production and first- and second-phase insulin secretion. The ISS model was evaluated in three diverse cohorts including individuals at high risk of prediabetes (adult women with a wide range of BMI and adolescents with obesity). The new model had strong correlation with gold-standard estimates from intravenous glucose tolerance tests and hyperinsulinemic-euglycemic clamp. The ISS model has broad clinical applicability among diverse populations because it balances performance, fidelity, and complexity to provide a reliable phenotype of T2D risk.
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Affiliation(s)
- Joon Ha
- Department of Mathematics, Howard University, Washington, DC
| | - Stephanie T. Chung
- Section on Pediatric Diabetes, Obesity, and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Max Springer
- Department of Mathematics, University of Maryland, College Park, MD
| | - Joon Young Kim
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY
| | | | - Melanie G. Cree
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cecilia Diniz Behn
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, Colorado
| | - Anne E. Sumner
- Intramural Research Program, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health, Bethesda, MD
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Center for Pediatric Research in Obesity and Metabolism, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Arthur S. Sherman
- Laboratory of Biological Modeling, National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Di Bonito P, Valerio G, Licenziati MR, Corica D, Wasniewska M, Di Sessa A, Miraglia del Giudice E, Morandi A, Maffeis C, Mozzillo E, Calcaterra V, Franco F, Maltoni G, Faienza MF. One-Hour Post-Load Plasma Glucose and Altered Glucometabolic Profile in Youths with Overweight or Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5961. [PMID: 37297565 PMCID: PMC10252535 DOI: 10.3390/ijerph20115961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/04/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
In youths, two cut-offs (133 and 155 mg/dL) have been proposed to identify high glucose levels at the 1 h (G60) mark during an oral glucose tolerance test (OGTT). We evaluated which cut-off was more closely associated with isolated impaired glucose tolerance (IGT) and cardiometabolic risk (CMR) in 1199 youth with overweight/obesity (OW/OB) and normal fasting glucose and/or HbA1c. The disposition index (DI) was available in 724 youths. The sample was divided by two cut-offs of G60: <133 mg/dL (n = 853) and ≥133 mg/dL (n = 346), or G60 < 155 mg/dL (n = 1050) and ≥155 mg/dL (n = 149). Independent of the cut-off, youths with high levels of G60 showed higher levels of G120, insulin resistance (IR), triglycerides to HDL ratio (TG/HDL), alanine aminotransferase (ALT), and lower insulin sensitivity (IS) and DI than youths with lower levels of G60. The percentage of youths showing IGT, IR, low IS, high TG/HDL ratio, high ALT, and low DI was 50% higher in the G60 ≥ 133 mg/dL group than in the G60 ≥ 155 mg/dL one. In youths with OW/OB and IGT, a cut-off of G60 ≥ 133 mg/dL is more useful than G60 ≥ 155 mg/dL to identify those at high risk of IGT and altered CMR profile.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Napoli “Parthenope”, 80133 Napoli, Italy
| | - Maria Rosaria Licenziati
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, 80139 Napoli, Italy
| | - Domenico Corica
- Department of Human Pathology in Adulthood and Childhood, University of Messina, 98125 Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, 98125 Messina, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Emanuele Miraglia del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Anita Morandi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Enza Mozzillo
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, University of Naples “Federico II”, 80131 Napoli, Italy
| | - Valeria Calcaterra
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milano, Italy
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Francesca Franco
- Pediatric Department, Azienda Sanitaria Universitaria Friuli Centrale, Hospital of Udine, 33100 Udine, Italy
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy
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de Cassia da Silva C, Zambon MP, Vasques ACJ, Camilo DF, de Góes Monteiro Antonio MÂR, Geloneze B. The threshold value for identifying insulin resistance (HOMA-IR) in an admixed adolescent population: A hyperglycemic clamp validated study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:119-125. [PMID: 36468919 PMCID: PMC9983787 DOI: 10.20945/2359-3997000000533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective To validate the homeostasis model assessment (HOMA) of insulin resistance (IR) as a surrogate to the hyperglycemic clamp to measure IR in both pubertal and postpubertal adolescents, and determine the HOMA-IR cutoff values for detecting IR in both pubertal stages. Subjects and methods The study sample comprised 80 adolescents of both sexes (aged 10-18 years; 37 pubertal), in which IR was assessed with the HOMA-IR and the hyperglycemic clamp. Results In the multivariable linear regression analysis, adjusted for sex, age, and waist circumference, the HOMA-IR was independently and negatively associated with the clamp-derived insulin sensitivity index in both pubertal (unstandardized coefficient - B = -0.087, 95% confidence interval [CI] = -0.135 to -0.040) and postpubertal (B = -0.101, 95% CI, -0.145 to -0.058) adolescents. Bland-Altman plots showed agreement between the predicted insulin sensitivity index and measured clamp-derived insulin sensitivity index in both pubertal stages (mean =-0.00 for pubertal and postpubertal); all P > 0.05. The HOMA-IR showed a good discriminatory power for detecting IR with an area under the receiver operator characteristic curve of 0.870 (95% CI, 0.718-0.957) in pubertal and 0.861 (95% CI, 0.721-0.947) in postpubertal adolescents; all P < 0.001. The optimal cutoff values of the HOMA-IR for detecting IR were > 3.22 (sensitivity, 85.7; 95% CI, 57.2-98.2; specificity, 82.6; 95% CI, 61.2-95.0) for pubertal and > 2.91 (sensitivity, 63.6; 95% CI, 30.8-89.1, specificity, 93.7; 95%CI, 79.2-99.2) for postpubertal adolescents. Conclusion The threshold value of the HOMA-IR for identifying insulin resistance was > 3.22 for pubertal and > 2.91 for postpubertal adolescents.
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Affiliation(s)
- Cleliani de Cassia da Silva
- Laboratório de Investigação em Metabolismo e Diabetes (Limed), Centro de Diagnóstico e Pesquisa Gastroenterológica (Gastrocentro), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil, ; .,Programa de Pós-graduação em Saúde da Criança e do Adolescente, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Mariana Porto Zambon
- Programa de Pós-graduação em Saúde da Criança e do Adolescente, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.,Departamento de Pediatria, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Ana Carolina Junqueira Vasques
- Laboratório de Investigação em Metabolismo e Diabetes (Limed), Centro de Diagnóstico e Pesquisa Gastroenterológica (Gastrocentro), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.,Programa de Pós-graduação em Saúde da Criança e do Adolescente, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.,Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas (Unicamp), Limeira, SP, Brasil
| | - Daniella Fernandes Camilo
- Laboratório de Investigação em Metabolismo e Diabetes (Limed), Centro de Diagnóstico e Pesquisa Gastroenterológica (Gastrocentro), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.,Programa de Pós-graduação em Saúde da Criança e do Adolescente, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Maria Ângela Reis de Góes Monteiro Antonio
- Programa de Pós-graduação em Saúde da Criança e do Adolescente, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.,Departamento de Pediatria, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Bruno Geloneze
- Laboratório de Investigação em Metabolismo e Diabetes (Limed), Centro de Diagnóstico e Pesquisa Gastroenterológica (Gastrocentro), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.,Programa de Pós-graduação em Saúde da Criança e do Adolescente, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.,Instituto Nacional de Ciência e Tecnologia da Obesidade e Diabetes, Campinas, SP, Brasil
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9
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Garonzi C, Maguolo A, Maffeis C. Pros and Cons of Current Diagnostic Tools for Risk-Based Screening of Prediabetes and Type 2 Diabetes in Children and Adolescents with Overweight or Obesity. Horm Res Paediatr 2022; 96:356-365. [PMID: 36509067 DOI: 10.1159/000528342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
It is still a matter of debate which is the most suitable diagnostic test for risk-based screening of prediabetes and type 2 diabetes (T2D) in children and adolescents with overweight or obesity. This review highlighted benefits and pitfalls of currently recommended screening tools (fasting plasma glucose [FPG], oral glucose tolerance test [OGTT], glycated hemoglobin A1c [HbA1c]). The greatest advantage of OGTT is the ability to detect people with impaired glucose tolerance, a subcategory at high risk of developing both T2D and cardiovascular disease. Important disadvantages are low reproducibility and inconvenience. FPG measurement is more practical, as it needs only one blood draw, although both OGTT and FPG require fasting. The reliability of HbA1c as a screening tool has been questioned, especially in children and adolescents, but its undeniable convenience can lead to increased adherence to screening. In contrast, it can be altered by several nonglycemic factors. Importantly, none of these tests have been validated in the pediatric population. Alternative tests have been recently proposed, including new OGTT-derived biomarkers and additional nonfasting glycemic markers. In conclusion, when choosing the most suitable test in clinical practice, advantages and disadvantages should be considered, as well as the possibility of performing different tests at once.
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Affiliation(s)
- Chiara Garonzi
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Alice Maguolo
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Claudio Maffeis
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
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10
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Di Bonito P, Licenziati MR, Corica D, Wasniewska MG, Di Sessa A, Del Giudice EM, Morandi A, Maffeis C, Faienza MF, Mozzillo E, Calcaterra V, Franco F, Maltoni G, Valerio G. Phenotypes of prediabetes and metabolic risk in Caucasian youths with overweight or obesity. J Endocrinol Invest 2022; 45:1719-1727. [PMID: 35579861 PMCID: PMC9360115 DOI: 10.1007/s40618-022-01809-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the prevalence of pre-diabetes phenotypes, i.e., impaired fasting glucose (IFG), impaired glucose tolerance (IGT), increased HbA1c (IA1c), and their association with metabolic profile and atherogenic lipid profile in youths with overweight/obesity (OW/OB). METHODS This cross-sectional study analyzed data of 1549 youths (5-18 years) with OW/OB followed in nine Italian centers between 2016 and 2020. Fasting and post-load measurements of glucose, insulin, and HbA1c were available. Insulin resistance (IR) was estimated by HOMA-IR and insulin sensitivity (IS) by reciprocal of fasting insulin. The atherogenic lipid profile was assessed by triglycerides-to-HDL ratio or cholesterol-to-HDL ratio. Insulinogenic index was available in 939 youths, in whom the disposition index was calculated. RESULTS The prevalence of overall pre-diabetes, IFG, IGT and IA1c was 27.6%, 10.2%, 8% and 16.3%, respectively. Analyzing each isolated phenotype, IGT exhibited two- to three-fold higher odds ratio of family history of diabetes, and worse metabolic and atherogenic lipid profile vs normoglycemic youths; IFG was associated only with IR, while IA1c showed a metabolic and atherogenic lipid profile intermediate between IGT and IFG. CONCLUSION Prevalence of pre-diabetes was high and IA1c was the most prevalent phenotype in Italian youths with OW/OB. The IGT phenotype showed the worst metabolic and atherogenic lipid profile, followed by IA1c. More studies are needed to assess whether HbA1c may help improving the prediction of diabetes.
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Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, "S. Maria Delle Grazie" Hospital, Pozzuoli, Italy
| | - M R Licenziati
- Obesity and Endocrine Disease Unit, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - D Corica
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - M G Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - A Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - E Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - A Morandi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - C Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera, Universitaria Integrata of Verona, Verona, Italy
| | - M F Faienza
- Department of Biomedical Sciences and Human Oncology, Pediatric Unit, University of Bari "Aldo Moro", Bari, Italy
| | - E Mozzillo
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, University of Naples "Federico II", Naples, Italy
| | - V Calcaterra
- Pediatric Department, "V. Buzzi" Children's Hospital, Milan, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - F Franco
- Pediatric Department, Azienda Sanitaria Universitaria del Friuli Centrale, Hospital of Udine, Udine, Italy
| | - G Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - G Valerio
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", via Medina 40, 80133, Naples, Italy.
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11
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Saleh M, Kim JY, March C, Gebara N, Arslanian S. Youth prediabetes and type 2 diabetes: Risk factors and prevalence of dysglycaemia. Pediatr Obes 2022; 17:e12841. [PMID: 34382374 DOI: 10.1111/ijpo.12841] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The American Diabetes Association recommends risk-based screening for dysglycaemia (prediabetes and type 2 diabetes) in youth with overweight/obesity plus ≥1 risk factor. However, evidence for these recommendations is lacking. OBJECTIVES Examine the association between the number of risk factors and the prevalence of dysglycaemia in youth with overweight/obesity at initial presentation. METHODS In a paediatric obesity registry, youth (>10 and <20 years old, body mass index ≥85th percentile) were categorized into four groups according to number of risk factors (1, 2, 3 and ≥4). Based on oral glucose tolerance test, participants were classified into normal glucose tolerance or dysglycaemia. RESULTS Of 635 youth, 31.5% had prediabetes and 6.1% had type 2 diabetes. The prevalence of dysglycaemia was 23.1% with 1 risk factor and increased to 44.9% with ≥4 risk factors (p = 0.025). Dyslipidaemia, family history of type 2 diabetes and maternal history of gestational diabetes were significantly associated with dysglycaemia. Fasting and 2-h insulin, 2-h glucose increased (all p < 0.0001) and ALT increased (p = 0.001) with increasing risk factors. Insulin sensitivity and β-cell function deteriorated significantly with increasing risk factors. CONCLUSION Screening for dysglycaemia in youth with obesity and any additional risk factor is warranted to target early management.
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Affiliation(s)
- Mohamed Saleh
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joon Young Kim
- Department of Exercise Science, Syracuse University, Syracuse, New York, USA
| | - Christine March
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nour Gebara
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Pediatric Research in Obesity and Metabolism, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Pediatric Research in Obesity and Metabolism, UPMC-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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Tagi VM, Samvelyan S, Chiarelli F. An update of the consensus statement on insulin resistance in children 2010. Front Endocrinol (Lausanne) 2022; 13:1061524. [PMID: 36465645 PMCID: PMC9709113 DOI: 10.3389/fendo.2022.1061524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
In our modern society, where highly palatable and calorie-rich foods are readily available, and sedentary lifestyle is common among children and adolescents, we face the pandemic of obesity, nonalcoholic fatty liver disease, hypertension, atherosclerosis, and T2D. Insulin resistance (IR) is known to be the main underlying mechanism of all these associated health consequences; therefore, the early detection of IR is fundamental for preventing them.A Consensus Statement, internationally supported by all the major scientific societies in pediatric endocrinology, was published in 2010, providing all the most recent reliable evidence to identify the definition of IR in children, its measurement, its risk factors, and the effective strategies to prevent and treat it. However, the 2010 Consensus concluded that further research was necessary to assess some of the discussed points, in particular the best way to measure insulin sensitivity, standardization of insulin measurements, identification of strong surrogate biomarkers of IR, and the effective role of lifestyle intervention and medications in the prevention and treatment of IR.The aim of this review is to update each point of the consensus with the most recent available studies, with the goal of giving a picture of the current state of the scientific literature regarding IR in children, with a particular regard for issues that are not yet fully clarified.
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Affiliation(s)
- Veronica Maria Tagi
- Department of Pediatrics, University of Chieti, Chieti, Italy
- *Correspondence: Veronica Maria Tagi,
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13
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Barchetta I, Dule S, Bertoccini L, Cimini FA, Sentinelli F, Bailetti D, Marini G, Barbonetti A, Loche S, Cossu E, Cavallo MG, Baroni MG. The single-point insulin sensitivity estimator (SPISE) index is a strong predictor of abnormal glucose metabolism in overweight/obese children: a long-term follow-up study. J Endocrinol Invest 2022; 45:43-51. [PMID: 34142364 PMCID: PMC8741725 DOI: 10.1007/s40618-021-01612-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the relationship between the single-point insulin sensitivity estimator (SPISE) index, an insulin sensitivity indicator validated in adolescents and adults, and metabolic profile in overweight/obese children, and to evaluate whether basal SPISE is predictive of impaired glucose regulation (IGR) development later in life. METHODS The SPISE index (= 600 × HDL0.185/Triglycerides0.2 × BMI1.338) was calculated in 909 overweight/obese children undergoing metabolic evaluations at University of Cagliari, Italy, and in 99 normal-weight, age-, sex-comparable children, selected as a reference group, together with other insulin-derived indicators of insulin sensitivity/resistance. 200 overweight/obese children were followed-up for 6.5 [3.5-10] years, data were used for longitudinal retrospective investigations. RESULTS At baseline, 96/909 (11%) overweight/obese children had IGR; in this subgroup, SPISE was significantly lower than in normo-glycaemic youths (6.3 ± 1.7 vs. 7 ± 1.6, p < 0.001). The SPISE index correlated positively with the insulin sensitivity index (ISI) and the disposition index (DI), negatively with age, blood pressure, HOMA-IR, basal and 120 min blood glucose and insulin (all p values < 0.001). A correlation between SPISE, HOMA-IR and ISI was also reported in normal-weight children. At the 6.5-year follow-up, lower basal SPISE-but not ISI or HOMA-IR-was an independent predictor of IGR development (OR = 3.89(1.65-9.13), p = 0.002; AUROC: 0.82(0.72-0.92), p < 0.001). CONCLUSION In children, low SPISE index is significantly associated with metabolic abnormalities and predicts the development of IGR in life.
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Affiliation(s)
- I Barchetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Dule
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - L Bertoccini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F A Cimini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F Sentinelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Bailetti
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences (MeSVA), University of L'Aquila, L'Aquila, Italy
| | - G Marini
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Barbonetti
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences (MeSVA), University of L'Aquila, L'Aquila, Italy
| | - S Loche
- Pediatric Endocrine Unit, Ospedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | - E Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - M G Cavallo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M G Baroni
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences (MeSVA), University of L'Aquila, L'Aquila, Italy.
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, IS, Italy.
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14
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Clark ELM, Gulley LD, Prince MA, Casamassima M, Sanchez N, Jimenez V, Johnson SA, Miller RL, Conte I, Kaar JL, Simon SL, Melby C, Lucas-Thompson RG, Shomaker LB. The role of mindfulness in associations among depression symptoms, sleep duration, and insulin resistance in adolescents. J Behav Med 2021; 44:694-703. [PMID: 33884531 DOI: 10.1007/s10865-021-00225-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/10/2021] [Indexed: 12/14/2022]
Abstract
Sleep difficulties may be one explanatory factor in the association between depression and insulin resistance; yet, explicit tests of this hypothesis are lacking. We determined if there was an indirect effect of depression symptoms on insulin resistance through sleep duration in adolescents at risk for excess weight gain. We also investigated whether dispositional mindfulness moderated the interconnections among depression, sleep, and insulin resistance. Ninety adolescents (14.2 ± 1.6y; 50% female) at risk for excess weight gain (body mass index [BMI, kg/m2] z score 1.6 ± 0.6) participated in the cross-sectional, baseline phase of a health behaviors study. Depression was assessed with the Center for Epidemiologic Studies-Depression Scale, sleep duration with the Sleep Habits Survey, and mindfulness with the Mindful Attention and Awareness Scale. Homeostatic model assessment of insulin resistance was determined from fasting insulin and glucose. The product-of-coefficients method was used to test the indirect effect of depression on insulin resistance through sleep duration, accounting for age, sex, BMIz, puberty, and socioeconomic status (SES). Dispositional mindfulness was tested as a moderator of the associations among depression, sleep, and insulin resistance. There was a significant indirect effect of depression on insulin resistance through sleep duration, controlling for age, sex, BMIz, puberty, and SES, 95%CI [0.001, 0.05]. Dispositional mindfulness moderated the association between sleep duration and insulin resistance, such that lower sleep duration related to greater insulin resistance only among adolescents with lower mindfulness (p < .001). Short sleep may be one explanatory factor in the depression-insulin resistance connection in adolescents at risk for excess weight gain. Adolescents with poorer mindfulness and short sleep are at highest risk for insulin resistance, whereas higher mindfulness may be protective.
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Affiliation(s)
- Emma L M Clark
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523-1570, US
| | - Lauren D Gulley
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523-1570, US
- Department of Pediatrics, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, US
| | - Mark A Prince
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523-1570, US
- Department of Psychology, Colorado State University, Fort Collins, US
| | | | - Natalia Sanchez
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523-1570, US
| | - Virginia Jimenez
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523-1570, US
| | - Sarah A Johnson
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, US
| | - Reagan L Miller
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523-1570, US
| | - Isabella Conte
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523-1570, US
| | - Jill L Kaar
- Department of Pediatrics, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, US
- Colorado School of Public Health, Fort Collins, US
| | | | - Christopher Melby
- Colorado School of Public Health, Fort Collins, US
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, US
| | - Rachel G Lucas-Thompson
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523-1570, US
- Department of Pediatrics, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, US
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO, 80523-1570, US.
- Department of Pediatrics, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Aurora, US.
- Colorado School of Public Health, Fort Collins, US.
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15
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Redondo MJ, Warnock MV, Libman IM, Bocchino LE, Cuthbertson D, Geyer S, Pugliese A, Steck AK, Evans-Molina C, Becker D, Sosenko JM, Bacha F. TCF7L2 Genetic Variants Do Not Influence Insulin Sensitivity or Secretion Indices in Autoantibody-Positive Individuals at Risk for Type 1 Diabetes. Diabetes Care 2021; 44:2039-2044. [PMID: 34326068 PMCID: PMC8740915 DOI: 10.2337/dc21-0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/10/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to test whether type 2 diabetes (T2D)-associated TCF7L2 genetic variants affect insulin sensitivity or secretion in autoantibody-positive relatives at risk for type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS We studied autoantibody-positive TrialNet Pathway to Prevention study participants (N = 1,061) (mean age 16.3 years) with TCF7L2 single nucleotide polymorphism (SNP) information and baseline oral glucose tolerance test (OGTT) to calculate indices of insulin sensitivity and secretion. With Bonferroni correction for multiple comparisons, P values < 0.0086 were considered statistically significant. RESULTS None, one, and two T2D-linked TCF7L2 alleles were present in 48.1%, 43.9%, and 8.0% of the participants, respectively. Insulin sensitivity (as reflected by 1/fasting insulin [1/IF]) decreased with increasing BMI z score and was lower in Hispanics. Insulin secretion (as measured by 30-min C-peptide index) positively correlated with age and BMI z score. Oral disposition index was negatively correlated with age, BMI z score, and Hispanic ethnicity. None of the indices were associated with TCF7L2 SNPs. In multivariable analysis models with age, BMI z score, ethnicity, sex, and TCF7L2 alleles as independent variables, C-peptide index increased with age, while BMI z score was associated with higher insulin secretion (C-peptide index), lower insulin sensitivity (1/IF), and lower disposition index; there was no significant effect of TCF7L2 SNPs on any of these indices. When restricting the analyses to participants with a normal OGTT (n = 743; 70%), the results were similar. CONCLUSIONS In nondiabetic autoantibody-positive individuals, TCF7L2 SNPs were not related to insulin sensitivity or secretion indices after accounting for BMI z score, age, sex, and ethnicity.
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Affiliation(s)
- Maria J Redondo
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | | | - Laura E Bocchino
- University of South Florida, Tampa, FL.,Jaeb Center for Health Research, Tampa, FL
| | | | - Susan Geyer
- University of South Florida, Tampa, FL.,Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Andrea K Steck
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Carmella Evans-Molina
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN
| | | | - Jay M Sosenko
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Fida Bacha
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX.,Children's Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture, Houston, TX
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16
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Nokoff NJ, Scarbro SL, Moreau KL, Zeitler P, Nadeau KJ, Reirden D, Juarez-Colunga E, Kelsey MM. Body Composition and Markers of Cardiometabolic Health in Transgender Youth on Gonadotropin-Releasing Hormone Agonists. Transgend Health 2021; 6:111-119. [PMID: 33937527 DOI: 10.1089/trgh.2020.0029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: Up to 1.8% of youth identify as transgender; many will be treated with a gonadotropin-releasing hormone agonist (GnRHa). The impact of GnRHa on insulin sensitivity and body composition in transgender youth is understudied. We aimed to evaluate differences in insulin sensitivity and body composition in transgender youth on GnRHa therapy compared with cisgender youth. Methods: Transgender participants were matched to cisgender participants on age, body mass index, and sex assigned at birth. Transgender males (n=9, ages 10.1-16.0 years) on GnRHa (mean±standard deviation duration of exposure: 20.9±19.8 months) were compared with cisgender females (n=14, ages 10.6-16.2). Transgender females (n=8, ages 12.6-16.1) on GnRHa (11.3±7 months) were compared with cisgender males (n=17, ages 12.5-15.5). Differences in insulin sensitivity (1/[fasting insulin], homeostatic model of insulin resistance [HOMA-IR]), glycemia (hemoglobin A1C [HbA1c], fasting glucose), and body composition (dual-energy X-ray absorptiometry) were evaluated using a mixed linear regression model. Results: Transgender males had lower 1/fasting insulin and higher HOMA-IR (p=0.031, p=0.01, respectively), fasting glucose (89±4 vs. 79±13 mg/dL, p=0.012), HbA1c (5.4±0.2 vs. 5.2±0.2%, p=0.039), and percent body fat (36±7 vs. 32±5%, p=0.042) than matched cisgender females. Transgender females had lower 1/fasting insulin and higher HOMA-IR (p=0.028, p=0.035), HbA1c (5.4±0.1% vs. 5.1±0.2%, p=0.007), percent body fat (31±9 vs. 24±10%, p=0.002), and lower percent lean mass (66±8 vs. 74±10%, p<0.001) than matched cisgender males. Conclusion: Transgender youth on a GnRHa have lower estimated insulin sensitivity and higher glycemic markers and body fat than cisgender controls with similar characteristics. Longitudinal studies are needed to understand the significance of these changes. Clinical Trial.gov ID: NCT02550431.
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Affiliation(s)
- Natalie J Nokoff
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sharon L Scarbro
- Department of Community and Behavioral Health, University of Colorado Denver Colorado School of Public Health, Aurora, Colorado, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, Colorado, USA.,Rocky Mountain Prevention Research Center, University of Colorado Denver Colorado School of Public Health, Aurora, Colorado, USA
| | - Kerrie L Moreau
- Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Veteran Affairs (VA) Eastern Colorado Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA
| | - Philip Zeitler
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristen J Nadeau
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel Reirden
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth Juarez-Colunga
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, Colorado, USA.,Department of Biostatistics and Informatics, University of Colorado Denver Colorado School of Public Health, Aurora, Colorado, USA
| | - Megan M Kelsey
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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17
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Merjaneh L, Toprak D, McNamara S, Nay L, Sullivan E, Rosenfeld M. Acute hyperglycaemia in cystic fibrosis pulmonary exacerbations. Endocrinol Diabetes Metab 2021; 4:e00208. [PMID: 33855211 PMCID: PMC8029509 DOI: 10.1002/edm2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/27/2020] [Accepted: 11/08/2020] [Indexed: 11/07/2022] Open
Abstract
Background Hyperglycaemia may contribute to failure to recover from pulmonary exacerbations in cystic fibrosis (CF). We aimed to evaluate the prevalence and mechanism of hyperglycaemia during and post-exacerbations. Methods Nine paediatric CF patients, not on insulin, hospitalized for intravenous antibiotics, underwent an oral glucose tolerance test (OGTT) and continuous glucose monitoring (CGM) upon admission (visit 1) and an OGTT 2 weeks (visit 2) and 6 weeks to 12 months later when at stable baseline (visit 3). Insulin and glucose levels were measured before, 30, 60 and 120 min after glucose ingestion during OGTT. Hyperglycaemia on OGTT was defined according to the American Diabetes Association criteria as abnormal OGTT or consistent with diabetes. Hyperglycaemia on CGM was defined as CGM time above 140 mg/dL > 4.5%. Results At visit 1, 8/9 patients had hyperglycaemia on both CGM and OGTT (2 diabetes and 6 abnormal OGTT). At visit 2, 5/8 had hyperglycaemia (all abnormal OGTT). At visit 3, (median (IQR) time since visit 1, 4.9 (3.8-6.3) months), 5/7 had hyperglycaemia (2 diabetes and 3 abnormal OGTT). At visits 1, 2 and 3, respectively, mean (SD) 2-hour OGTT glucose was 175.8 (42.3), 146.3 (31.9) and 176.9 (51.7) mg/dL. CGM time above 140 mg/dL at visit 1 was 25.3% (16.9). Insulin AUC decreased from visit 2 (median (IQR) 5449 (3321-8123) mcIU-min/mL) to visit 3 (3234 (2913-3680) mcIU-min/mL). Conclusion Hyperglycaemia is prevalent during paediatric CF exacerbations; it appears to improve with exacerbation treatment but to worsen later in association with decreased insulin secretion.
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Affiliation(s)
- Lina Merjaneh
- Division of Endocrinology and DiabetesSeattle Children’s HospitalSeattleWAUSA
- Department of PediatricsUniversity of WashingtonSeattleWAUSA
| | - Demet Toprak
- Department of PediatricsUniversity of WashingtonSeattleWAUSA
- Division of Pulmonary and Sleep MedicineSeattle Children’s HospitalSeattleWAUSA
| | - Sharon McNamara
- Division of Pulmonary and Sleep MedicineSeattle Children’s HospitalSeattleWAUSA
| | - Laura Nay
- Division of Pulmonary and Sleep MedicineSeattle Children’s HospitalSeattleWAUSA
| | - Erin Sullivan
- Children’s Core for Biomedical StatisticsCenter for Clinical and Translational ResearchSeattle Children’s HospitalSeattleWAUSA
| | - Margaret Rosenfeld
- Department of PediatricsUniversity of WashingtonSeattleWAUSA
- Division of Pulmonary and Sleep MedicineSeattle Children’s HospitalSeattleWAUSA
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18
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Bartlette K, Carreau AM, Xie D, Garcia-Reyes Y, Rahat H, Pyle L, Nadeau KJ, Cree-Green M, Diniz Behn C. Oral minimal model-based estimates of insulin sensitivity in obese youth depend on oral glucose tolerance test protocol duration. Metabol Open 2021; 9:100078. [PMID: 33511337 PMCID: PMC7817496 DOI: 10.1016/j.metop.2021.100078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/01/2021] [Accepted: 01/02/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction The Oral Minimal Model (OMM), a differential-equations based mathematical model of glucose-insulin dynamics, utilizes data from a frequently sampled oral glucose tolerance test (OGTT) to quantify insulin sensitivity ( S I ). OMM-based estimates of S I can detect differences in insulin resistance (IR) across population groups and quantify effects of clinical or behavioral interventions. These estimates of S I have been validated in healthy adults using data from OGTTs with durations from 2 to 7 h. However, data demonstrating how protocol duration affects S I estimates in highly IR populations such as adolescents with obesity are limited. Methods A 6-h frequently sampled OGTT was performed in adolescent females with obesity. Two, 3-, and 4- hour implementations of OMM assuming an exponentially-decaying rate of glucose appearance beyond measured glucose concentrations were compared to the 6-h implementation. A 4- hour OMM implementation with truncated data (4h Tr) was also considered. Results Data from 68 participants were included (age 15.8 ± 1.2 years, BMI 35.4 ± 5.6 kg/m2). Although S I values were highly correlated for all implementations, they varied with protocol duration (2h: 2.86 ± 3.31, 3h: 2.55 ± 2.62, 4h: 2.81 ± 2.59, 4h tr: 3.13 ± 3.14, 6h: 3.06 ± 2.85 x 10-4 dl/kg/min per U/ml). S I estimates based on 2 or 3 h of data underestimated S I values, whereas 4-h S I estimates more closely approximated 6-h S I values. Discussion These results suggest that OGTT protocol duration should be considered when implementing OMM to estimate S I in adolescents with obesity and other IR populations.
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Affiliation(s)
- Kai Bartlette
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO, 80401, USA
| | - Anne-Marie Carreau
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Danielle Xie
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Yesenia Garcia-Reyes
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Haseeb Rahat
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA.,Department of Biostatics and Informatics, Colorado School of Public Health, Aurora, CO, 80045, USA
| | - Kristen J Nadeau
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA.,Center for Women's Health Research, Aurora, CO, USA
| | - Melanie Cree-Green
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA.,Department of Biostatics and Informatics, Colorado School of Public Health, Aurora, CO, 80045, USA
| | - Cecilia Diniz Behn
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO, 80401, USA.,Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA
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19
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Smetanina N, Valickas R, Vitkauskiene A, Albertsson-Wikland K, Verkauskienė R. Prevalence of Metabolic Syndrome and Impaired Glucose Metabolism among 10- to 17-Year-Old Overweight and Obese Lithuanian Children and Adolescents. Obes Facts 2021; 14:271-282. [PMID: 33951670 PMCID: PMC8255643 DOI: 10.1159/000514720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Overweight (Ow) and obesity among adults and children increases the risk of metabolic consequences. Metabolic syndrome (MS) and impaired glucose metabolism are well-known risk factors for cardiovascular diseases and type 2 diabetes. The aim of this study was to evaluate the prevalence of MS and impaired glucose metabolism among Ow and obese (Ob) children and adolescents (aged 10-17 years) in Lithuania, and to evaluate the associations between insulin resistance (IR) indices and anthropometric parameters as well as metabolic disturbances. METHODS The study population consisted of 344 OwOb children and adolescents of all pubertal stages. Oral glucose tolerance tests (OGTTs), IR and β cell function indices, lipid profile, and anthropometric parameters of all subjects were analyzed. MS was defined according to the International Diabetes Federation consensus guidelines. RESULTS MS was found in 21.3% of the OwOb children and adolescents, and 12.1% had impaired glucose metabolism (6.9% with impaired fasting glucose, 4.5% with impaired glucose tolerance, and 0.6% with type 2 diabetes). IR was directly related to body mass index and waist circumference, waist-to-height and waist-to-hip ratios, and sum of skin-fold thicknesses. Children with MS were more insulin-resistant, had higher odds ratio for prediabetes and had a more disturbed lipid profile than subjects without MS. Moreover, total cholesterol and low-density lipoprotein cholesterol levels were significantly lower in the more mature OwOb adolescents. CONCLUSION MS and lipid profile disturbances are common in OwOb children and adolescents. MS is directly associated with IR. Therefore, OwOb children and adolescents should be carefully followed up for metabolic abnormalities during late childhood as these can persist into adulthood.
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Affiliation(s)
- Natalija Smetanina
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- *Natalija Smetanina,
| | - Raimondas Valickas
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Astra Vitkauskiene
- Department of Laboratory Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Rasa Verkauskienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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20
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Kim JY, Jeon JY. Role of exercise on insulin sensitivity and beta-cell function: is exercise sufficient for the prevention of youth-onset type 2 diabetes? Ann Pediatr Endocrinol Metab 2020; 25:208-216. [PMID: 33401879 PMCID: PMC7788350 DOI: 10.6065/apem.2040140.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022] Open
Abstract
Parallel with the current pediatric obesity epidemic, the escalating rates of youthonset type 2 diabetes mellitus (T2DM) have become a major public health burden. Although lifestyle modification can be the first-line prevention for T2DM in youths, there is a lack of evidence to establish optimal specific exercise strategies for obese youths at high risk for T2DM. The purpose of this narrative review is to summarize the potential impact of exercise on 2 key pathophysiological risk factors for T2DM, insulin sensitivity and β-cell function, among obese youths. The studies cited are grouped by use of metabolic tests, i.e., direct and indirect measures of insulin sensitivity and β-cell function. In general, there are an increasing number of studies that demonstrate positive effects of aerobic exercise, resistance exercise, and the 2 combined on insulin sensitivity. However, a lack of evidence exists for the effect of any exercise modality on β-cell functional improvement. We also suggest a future direction for research into exercise medical prevention of youth-onset T2DM. These suggestions focus on the effects of exercise modalities on emerging biomarkers of T2DM risk.
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Affiliation(s)
- Joon Young Kim
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Justin Y. Jeon
- Department of Sport Industry Studies, Exercise Medicine Center for Diabetes and Cancer Patients, ICONS Yonsei University, Seoul, Korea,Address for correspondence: Justin Y. Jeon, PhD Department of Sport Industry Studies, Exercise Medicine Center for Diabetes and Cancer Patients, ICONS Yonsei University, 50 Yonseiro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2123-6197 E-mail:
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21
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Hannon TS, Edelstein SL, Arslanian SA, Caprio S, Zeitler PS, Buchanan TA, Ehrmann DA, Mather KJ, Tripputi M, Kahn SE, Nadeau KJ. Withdrawal of medications leads to worsening of OGTT parameters in youth with impaired glucose tolerance or recently-diagnosed type 2 diabetes. Pediatr Diabetes 2020; 21:1437-1446. [PMID: 32985775 PMCID: PMC7642167 DOI: 10.1111/pedi.13129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The RISE Pediatric Medication Study compared strategies for preserving β-cell function, including a 9-month follow-up after treatment withdrawal to test treatment effect durability. OBJECTIVE Evaluate OGTT measures of glucose and β-cell response through 12 months of intervention and 9 months of medication washout. PARTICIPANTS Youth (n = 91) aged 10 to 19 years with BMI ≥85th percentile and impaired glucose tolerance (IGT) or recently diagnosed type 2 diabetes (T2D). METHODS A multicenter randomized clinical trial comparing insulin glargine for 3 months followed by metformin for 9 months (G→Met) or metformin alone (Met) for 12 months. We report within-group changes from baseline to end of medication intervention (M12), baseline to 9 months post-medication withdrawal (M21), and end of medication (M12) to M21. OGTT C-peptide index [CPI] paired with 1/fasting insulin evaluated β-cell response. RESULTS At M12, both treatments were associated with stable fasting glucose (G→Met baseline 6.0 ± 0.1 vs M12 5.9 ± 0.2 mmol/L, P = .62; Met baseline 6.1 ± 0.2 vs M12 6.0 ± 0.2 mmol/L, P = .73) and 2-hour glucose (G→Met baseline 10.2 ± 0.4 vs M12 9.3 ± 0.5 mmol/L, P = .03; Met baseline 10.2 ± 0.4 vs M12 10.6 ± 0.6 mmol/L, P = .88). Following medication withdrawal, fasting glucose worsened (G→Met M21 8.6 ± 1.8, P = .004; Met M21 7.8 ± 0.7 mmol/L, P = .003), as did 2-hour glucose (G→Met M21 13.2 ± 1.4, P = .002; Met M21 13.1 ± 1.2 mmol/L, P = .006), associated with declines in β-cell response. CONCLUSIONS G→Met and Met were associated with stable glucose measures during 12 months of treatment in youth with IGT or recently diagnosed T2D. Glucose and β-cell response worsened post-medication withdrawal, suggesting treatment must be long-term or alternative treatments pursued.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Steven E Kahn
- VA Puget Sound Health Care System and University of Washington
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22
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Chang N, Yeh MY, Raymond JK, Geffner ME, Ryoo JH, Chao LCC. Glycemic control in youth-onset type 2 diabetes correlates with weight loss. Pediatr Diabetes 2020; 21:1116-1125. [PMID: 33103329 PMCID: PMC8629030 DOI: 10.1111/pedi.13093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/19/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To identify risk factors for glycemic failure in youth with type 2 diabetes (T2D). METHODS A retrospective review of HbA1c, anthropomorphic measures, medication records, and laboratory studies was performed using registry data from a dedicated pediatric T2D clinic. Latent profile analysis (LPA) was performed to model longitudinal trajectory of HbA1c over 5 years. RESULTS The registry includes 229 youth with T2D, of whom 80% self-identify as Latinx. The odds ratio (OR) for uncontrolled diabetes 5 years after diagnosis correlated with diagnostic HbA1c, with OR of 2.41 if HbA1c at diagnosis >8.5% (sensitivity 68%, specificity 54%, P = .015). LPA modeling identified three HbA1c profiles: (a) mean HbA1c <8% throughout the 5 years, (b) persistent elevation of mean HbA1c >9%, and (c) mean HbA1c of 12% at diagnosis, rapid decline to 6.4% by 4 to 6 months, and increase to 11% by 18 months. Our analysis of medication regimen showed that, amongst patients treated with metformin, the addition of multiple daily injections (MDI) did not improve HbA1c compared to those on basal insulin. Finally, weight loss over the 1 year after diagnosis correlated with improvement in HbA1c in both subjects prescribed metformin monotherapy, as well as insulin-containing regimen. CONCLUSION Youth with T2D exhibit distinct HbA1c profiles. Patients with diagnostic HbA1c >8.5% are at high risk for glycemic failure, irrespective of short-term improvement in HbA1c. Weight management has the potential to improve short-term HbA1c outcome in youth with T2D. Additional studies are needed to determine the role of medication adherence on glycemic control.
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Affiliation(s)
- Nancy Chang
- The Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, USA.,The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Mei Yu Yeh
- Biostatistics Core, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Jennifer K. Raymond
- The Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, USA.,The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Mitchell E. Geffner
- The Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, USA.,The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Ji Hoon Ryoo
- Biostatistics Core, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA,Department of Education, College of Educational Sciences, Yonsei University, Seoul, South Korea
| | - Lily Chih-Chen Chao
- The Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, USA.,The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
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23
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Tommerdahl KL, Brinton JT, Vigers T, Cree-Green M, Zeitler PS, Nadeau KJ, Chan CL. Delayed glucose peak and elevated 1-hour glucose on the oral glucose tolerance test identify youth with cystic fibrosis with lower oral disposition index. J Cyst Fibros 2020; 20:339-345. [PMID: 32928701 DOI: 10.1016/j.jcf.2020.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/24/2020] [Accepted: 08/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Alternate methods for characterizing oral glucose tolerance tests (OGTT) have emerged as superior to the 2-hour glucose in identifying individuals at risk for type 2 diabetes. The significance of these methods in cystic fibrosis (CF) is unclear. We compared 3 OGTT classifications in youth with CF: 1. curve shape (biphasic vs. monophasic), 2. time to glucose peak (≤30minutes vs. >30minutes), 3. 1-hour glucose (1hG) <155 mg/dL vs. ≥155 mg/dL to traditional OGTT criteria to determine which best identifies lower oral disposition index (oDI), pulmonary function, and body mass index (BMI). METHODS Youth 10-18 years with CF, not on insulin, underwent 2-hour OGTT. Glucoses were classified by traditional criteria and 3 alternate methods as normal (biphasic curve, glucose peak ≤30minutes, and/or 1hG <155 mg/dL) or abnormal (monophasic curve, glucose peak >30minutes, and/or 1hG ≥155 mg/dL). oDI was calculated [1/fasting insulin*(ΔInsulin0-30 min/ΔGlucose0-30 min)]. Mean oDI, BMI, forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC) were compared by OGTT classification. RESULTS Fifty-two youth with CF participated (mean±SD age 13±4years; 37% male; BMI z-score 0.0±0.8; FEV1 88±16.3%; FVC 97±14.8%). Late time to peak glucose and 1hG ≥155 mg/dL identified individuals with lower oDI (p=0.01); traditional OGTT criteria for prediabetes did not. No OGTT classification identified individuals with worse BMI nor pulmonary function. oDI was not associated with BMI, FEV1, or FVC. CONCLUSIONS Alternate OGTT measures including time to peak glucose and 1hG better identify oDI abnormalities than traditional criteria. Further studies are required to determine whether these alternate methods identify individuals with CF at risk for future clinical decline.
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Affiliation(s)
- Kalie L Tommerdahl
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA; Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - John T Brinton
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Tim Vigers
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Melanie Cree-Green
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Zeitler
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristen J Nadeau
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christine L Chan
- Department of Pediatrics, Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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24
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Ryder JR, Xu P, Nadeau KJ, Kelsey MM, Xie C, Jenkins T, Inge TH, Bjornstad P. Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity. Surg Obes Relat Dis 2020; 17:23-33. [PMID: 33071178 DOI: 10.1016/j.soard.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/08/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D. OBJECTIVE To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D. SETTING Longitudinal multicenter studies at University hospitals. METHODS A secondary analysis of data collected from the participants with T2D enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS, n = 30) and participants of similar age and racial distribution from the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY, n = 63) studies was performed. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. A 30-year CVD event score developed by the Framingham Heart Study was the primary outcome, assessed at baseline (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up. RESULTS Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m2) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001). CONCLUSION Despite higher pretreatment risk for CVD events, treatment with MBS resulted in a reduction in estimated CVD event risks, whereas medical therapy associated with an increase in risk among adolescents with T2D and severe obesity.
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Affiliation(s)
- Justin R Ryder
- University of Minnesota Medical School and Center for Pediatric Obesity Medicine, Minneapolis, Minnesota, United States
| | - Peixin Xu
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, Ohio, United States
| | - Kristen J Nadeau
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, United States
| | - Megan M Kelsey
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, United States
| | - Changchun Xie
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, Ohio, United States
| | - Todd Jenkins
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, Ohio, United States
| | - Thomas H Inge
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, United States
| | - Petter Bjornstad
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, United States.
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25
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Syed F, Tersey SA, Turatsinze JV, Felton JL, Kang NJ, Nelson JB, Sims EK, Defrance M, Bizet M, Fuks F, Cnop M, Bugliani M, Marchetti P, Ziegler AG, Bonifacio E, Webb-Robertson BJ, Balamurugan AN, Evans-Molina C, Eizirik DL, Mather KJ, Arslanian S, Mirmira RG. Circulating unmethylated CHTOP and INS DNA fragments provide evidence of possible islet cell death in youth with obesity and diabetes. Clin Epigenetics 2020; 12:116. [PMID: 32736653 PMCID: PMC7393900 DOI: 10.1186/s13148-020-00906-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Identification of islet β cell death prior to the onset of type 1 diabetes (T1D) or type 2 diabetes (T2D) might allow for interventions to protect β cells and reduce diabetes risk. Circulating unmethylated DNA fragments arising from the human INS gene have been proposed as biomarkers of β cell death, but this gene alone may not be sufficiently specific to report β cell death. RESULTS To identify new candidate genes whose CpG sites may show greater specificity for β cells, we performed unbiased DNA methylation analysis using the Infinium HumanMethylation 450 array on 64 human islet preparations and 27 non-islet human tissues. For verification of array results, bisulfite DNA sequencing of human β cells and 11 non-β cell tissues was performed on 5 of the top 10 CpG sites that were found to be differentially methylated. We identified the CHTOP gene as a candidate whose CpGs show a greater frequency of unmethylation in human islets. A digital PCR strategy was used to determine the methylation pattern of CHTOP and INS CpG sites in primary human tissues. Although both INS and CHTOP contained unmethylated CpG sites in non-islet tissues, they occurred in a non-overlapping pattern. Based on Naïve Bayes classifier analysis, the two genes together report 100% specificity for islet damage. Digital PCR was then performed on cell-free DNA from serum from human subjects. Compared to healthy controls (N = 10), differentially methylated CHTOP and INS levels were higher in youth with new onset T1D (N = 43) and, unexpectedly, in healthy autoantibody-negative youth who have first-degree relatives with T1D (N = 23). When tested in lean (N = 32) and obese (N = 118) youth, increased levels of unmethylated INS and CHTOP were observed in obese individuals. CONCLUSION Our data suggest that concurrent measurement of circulating unmethylated INS and CHTOP has the potential to detect islet death in youth at risk for both T1D and T2D. Our data also support the use of multiple parameters to increase the confidence of detecting islet damage in individuals at risk for developing diabetes.
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Affiliation(s)
- Farooq Syed
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sarah A Tersey
- Kovler Diabetes Center and Department of Medicine, The University of Chicago, 900 E. 57th Street, KCBD-8130, Chicago, IL, 60637, USA
| | | | - Jamie L Felton
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicole Jiyun Kang
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jennifer B Nelson
- Kovler Diabetes Center and Department of Medicine, The University of Chicago, 900 E. 57th Street, KCBD-8130, Chicago, IL, 60637, USA
| | - Emily K Sims
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mathieu Defrance
- Laboratory for Cancer Epigenetics, Faculty of Medicine, and ULB Cancer Research Center, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Bizet
- Laboratory for Cancer Epigenetics, Faculty of Medicine, and ULB Cancer Research Center, Université Libre de Bruxelles, Brussels, Belgium
| | - Francois Fuks
- Laboratory for Cancer Epigenetics, Faculty of Medicine, and ULB Cancer Research Center, Université Libre de Bruxelles, Brussels, Belgium
| | - Miriam Cnop
- ULB Center for Diabetes Research, Université Libre de Bruxelles, Brussels, Belgium
- Division of Endocrinology (ULB Erasmus Hospital), Université Libre de Bruxelles, Brussels, Belgium
| | - Marco Bugliani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Piero Marchetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | | | - Appakalai N Balamurugan
- Department of Surgery, Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati, Cincinnati, OH, 45229, USA
| | - Carmella Evans-Molina
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Decio L Eizirik
- ULB Center for Diabetes Research, Université Libre de Bruxelles, Brussels, Belgium
- Indiana Biosciences Research Institute, Indianapolis, IN, USA
| | - Kieren J Mather
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Silva Arslanian
- Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raghavendra G Mirmira
- Kovler Diabetes Center and Department of Medicine, The University of Chicago, 900 E. 57th Street, KCBD-8130, Chicago, IL, 60637, USA.
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Arslanian S, El ghormli L, Haymond MH, Chan CL, Chernausek SD, Gandica RG, Gubitosi-Klug R, Levitsky LL, Siska M, Willi SM. Beta cell function and insulin sensitivity in obese youth with maturity onset diabetes of youth mutations vs type 2 diabetes in TODAY: Longitudinal observations and glycemic failure. Pediatr Diabetes 2020; 21:575-585. [PMID: 32064729 PMCID: PMC7654712 DOI: 10.1111/pedi.12998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE In treatment options for type 2 diabetes in adolescents and youth (TODAY), 4.5% of obese youth clinically diagnosed with type 2 diabetes (T2D) had genetic variants consistent with maturity onset diabetes of youth (MODY) diagnosis. The course of IS and β-cell function in obese youth with MODY remains unknown. In this secondary analysis, we examined IS and β-cell function in MODY vs. non-MODY obese youth at randomization and over time. METHODS Genetic data in TODAY included 426 non-MODY (T2D) and 22 MODY youth (7 glucokinase MODY mutation positive [GCK-MODY], 12 hepatocyte nuclear factor MODY mutation positive [HNF-MODY], 2 Insulin gene mutation [insulin (INS)-MODY], and 1 Kruppel-like factor 11 [KLF11-MODY]). Oral glucose tolerance test (OGTT)-derived IS, C-peptide index, and β-cell function relative to IS oral disposition index (oDI) was measured at randomization, and over 24 months in addition to total and high-molecular-weight adiponectin (HMWA). RESULTS At randomization, IS, total adiponectin, and HMWA were significantly higher in the two MODY groups than in non-MODY. β-cell function measured by C-peptide oDI was 3-fold higher in GCK-MODY than in HNF-MODY and 1.5-fold higher than non-MODY (P for both <.05). Glycemic failure rate was 75.0% in HNF-MODY, 46.9% in non-MODY, and zero in GCK-MODY youth. While the changes in IS and oDI were not different among the three groups in the first 6 months, IS improved from 6 to 24 months in HNF-MODY vs GCK-MODY youth. CONCLUSIONS In TODAY, β-cell function at randomization was worse in obese HNF-MODY youth compared with GCK-MODY youth, while insulin sensitivity was worse in non-MODY compared with the other two MODY groups. Over time, IS showed the greatest improvement in HNF-MODY youth. This raises the possibility that TODAY therapeutic modalities of insulin sensitization in these obese HNF-MODY youth may have played a beneficial role.
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Affiliation(s)
- Silva Arslanian
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laure El ghormli
- George Washington University Biostatistics Center, Rockville, Maryland
| | | | | | | | | | | | | | | | - Steven M. Willi
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Higgins V, Asgari S, Hamilton JK, Wolska A, Remaley AT, Hartmann B, Holst JJ, Adeli K. Postprandial Dyslipidemia, Hyperinsulinemia, and Impaired Gut Peptides/Bile Acids in Adolescents with Obesity. J Clin Endocrinol Metab 2020; 105:5673404. [PMID: 31825485 PMCID: PMC7065844 DOI: 10.1210/clinem/dgz261] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/10/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND With increased rates of obesity and insulin resistance in youth, development of postprandial dyslipidemia, an important cardiovascular disease risk factor, is a concern. Glucagon-like peptides (ie, GLP-1 and GLP-2) and bile acids have been shown to regulate dietary fat absorption and postprandial lipids in animal models and humans. We hypothesize that the physiological response of GLPs and bile acids to dietary fat ingestion is impaired in adolescents with obesity and this associates with marked postprandial dyslipidemia and insulin resistance. METHODS In this cross-sectional study, normal weight adolescents and adolescents with obesity underwent a 6-hour oral fat tolerance test. The postprandial lipoprotein phenotype profile was determined using various assays, including nuclear magnetic resonance spectroscopy, to characterize lipoprotein particle number, size, lipid content, and apolipoproteins. GLP-1 and GLP-2 were quantified by electrochemiluminescent immunoassays. Total bile acids were measured by an automated enzymatic cycling colorimetric method and the bile acid profile by mass spectrometry. RESULTS Adolescents with obesity exhibited fasting and postprandial dyslipidemia, particularly augmented postprandial excursion of large triglyceride-rich lipoproteins. Postprandial GLPs were reduced and inversely correlated with postprandial dyslipidemia and insulin resistance. Postprandial bile acids were also diminished, particularly lithocholic acid, a potent stimulator of GLP-1 secretion. CONCLUSION Blunted postprandial GLP and bile acid response to dietary fat ingestion strongly associates with marked postprandial dyslipidemia. Further investigation is needed to assess their potential utility as early biomarkers for postprandial dyslipidemia in adolescents with obesity.
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Affiliation(s)
- Victoria Higgins
- Molecular Medicine and Pediatric Laboratory Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Shervin Asgari
- Molecular Medicine and Pediatric Laboratory Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jill K Hamilton
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Anna Wolska
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Alan T Remaley
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Bolette Hartmann
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Khosrow Adeli
- Molecular Medicine and Pediatric Laboratory Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Correspondence and Reprint Requests: Khosrow Adeli, Clinical Biochemistry, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8 Canada. E-mail:
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Rajakumar K, Moore CG, Khalid AT, Vallejo AN, Virji MA, Holick MF, Greenspan SL, Arslanian S, Reis SE. Effect of vitamin D3 supplementation on vascular and metabolic health of vitamin D-deficient overweight and obese children: a randomized clinical trial. Am J Clin Nutr 2020; 111:757-768. [PMID: 31950134 PMCID: PMC7138671 DOI: 10.1093/ajcn/nqz340] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/19/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Obese children are vulnerable to vitamin D deficiency and impaired cardiovascular health; vitamin D replenishment might improve their cardiovascular health. OBJECTIVES The aims were to determine, in vitamin D-deficient overweight and obese children, whether supplementation with vitamin D3 1000 or 2000 IU/d is more effective than 600 IU/d in improving arterial endothelial function, arterial stiffness, central and systemic blood pressure (BP), insulin sensitivity (1/fasting insulin concentration), fasting glucose concentration, and lipid profile and to explore whether downregulation of adipocytokines and markers of systemic inflammation underlies vitamin D effects. METHODS We conducted a randomized, double-masked, controlled clinical trial in 225 10- to 18-y-old eligible children. Change in endothelial function at 6 mo was the primary outcome. RESULTS Dose-response increases in serum 25-hydroxyvitamin D concentrations were significant and tolerated without developing hypercalcemia. Changes at 3 and 6 mo in endothelial function, arterial stiffness, systemic-systolic BP, lipids, and inflammatory markers did not differ between children receiving 1000 or 2000 IU vitamin D and children receiving 600 IU. Some secondary outcomes differed between groups. Compared with the 600-IU group, central-systolic, central-diastolic, and systemic-diastolic BP was lower at 6 mo in the 1000-IU group [-2.66 (95% CI: -5.27, -0.046), -3.57 (-5.97, -1.17), and -3.28 (-5.55, -1.00) mm Hg, respectively]; insulin sensitivity increased at 3 and 6 mo and fasting glucose concentration declined at 6 mo (-2.67; 95% CI: -4.88, -0.46 mg/dL) in the 2000-IU group. CONCLUSIONS Correction of vitamin D deficiency in overweight and obese children by vitamin D3 supplementation with 1000 or 2000 IU/d versus 600 IU/d did not affect measures of arterial endothelial function or stiffness, systemic inflammation, or lipid profile, but resulted in reductions in BP and fasting glucose concentration and in improvements in insulin sensitivity. Optimization of children's vitamin D status may improve their cardiovascular health. This trial was registered at clinicaltrials.gov as NCT01797302.
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Affiliation(s)
- Kumaravel Rajakumar
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA,Address correspondence to KR (e-mail: )
| | - Charity G Moore
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Arshad T Khalid
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Abbe N Vallejo
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Mohamed A Virji
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael F Holick
- Department of Medicine, Boston University Medical Center, Boston, MA, USA
| | - Susan L Greenspan
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Silva Arslanian
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Steven E Reis
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Nokoff NJ, Scarbro SL, Moreau KL, Zeitler P, Nadeau KJ, Juarez-Colunga E, Kelsey MM. Body Composition and Markers of Cardiometabolic Health in Transgender Youth Compared With Cisgender Youth. J Clin Endocrinol Metab 2020; 105:dgz029. [PMID: 31544944 PMCID: PMC7112978 DOI: 10.1210/clinem/dgz029] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/20/2019] [Indexed: 01/29/2023]
Abstract
CONTEXT As many as 1.8% of adolescents identify as transgender and many more seek care, yet the impact of gender-affirming hormone therapy (GAHT) on cardiometabolic health is unknown. OBJECTIVE To determine insulin sensitivity and body composition among transgender females (TF) and males (TM) on estradiol or testosterone, compared with cisgender females (CF) and males (CM). DESIGN Pilot, cross-sectional study conducted from 2016-2018. SETTING Academic regional transgender referral center. PARTICIPANTS Transgender adolescents on either testosterone or estradiol for at least 3 months were recruited. Nineteen TM were matched to 19 CM and 42 CF on pubertal stage and body mass index (BMI). Eleven TF were matched to 23 CF and 13 TF to 24 CM on age and BMI. MAIN OUTCOME MEASURES 1/[fasting insulin] and body composition (dual-energy x-ray absorptiometry). RESULTS Total body fat was lower in TM than CF mean ± SD: (29% ± 7% vs 33% ± 7%; P = 0.002) and higher than in CM (28% ± 7% vs 24% ± 9%; P = 0.047). TM had higher lean mass than CF (68% ± 7% vs 64% ± 7%, P = 0.002) and lower than CM (69% ± 7% vs 73% ± 8%; P = 0.029). Insulin sensitivity was not different between the groups.TF had lower body fat than CF (31% ± 7% vs 35% ± 8%; P = 0.033) and higher than CM (28% ± 6% vs 20% ± 10%; P = 0.001). TF had higher lean mass than CF (66% ± 6% vs 62% ± 7%; P = 0.032) and lower than CM (69% ± 5% vs 77% ± 9%; P = 0.001). TF were more insulin resistant than CM (0.078 ± 0.025 vs 0.142 ± 0.064 mL/μU; P = 0.011). CONCLUSIONS Transgender adolescents on GAHT have significant differences in body composition compared with cisgender controls, with a body composition intermediate between BMI-matched CMs and CFs. These changes in body composition may have consequences for the cardiometabolic health of transgender adolescents. CLINICALTRIALS.GOV NCT02550431.
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Affiliation(s)
- Natalie J Nokoff
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Center for Women's Health Research, University of Colorado Anschutz Medical Campus
| | - Sharon L Scarbro
- Department of Community and Behavioral Health, University of Colorado School of Public Health
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS)
- Rocky Mountain Prevention Research Center, University of Colorado Anschutz Medical Campus School of Public Health
| | - Kerrie L Moreau
- Center for Women's Health Research, University of Colorado Anschutz Medical Campus
- Department of Medicine, University of Colorado Anschutz Medical Campus
- Eastern Colorado Veteran Affairs (VA) Geriatric Research Education and Clinical Center (GRECC)
| | - Philip Zeitler
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
| | - Kristen J Nadeau
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Center for Women's Health Research, University of Colorado Anschutz Medical Campus
| | - Elizabeth Juarez-Colunga
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS)
- Department of Biostatistics and Informatics, University of Colorado School of Public Health
| | - Megan M Kelsey
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Center for Women's Health Research, University of Colorado Anschutz Medical Campus
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Perng W, Ringham BM, Smith HA, Michelotti G, Kechris KM, Dabelea D. A prospective study of associations between in utero exposure to gestational diabetes mellitus and metabolomic profiles during late childhood and adolescence. Diabetologia 2020; 63:296-312. [PMID: 31720734 PMCID: PMC8327857 DOI: 10.1007/s00125-019-05036-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/08/2019] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS This study aimed to: (1) identify metabolite patterns during late childhood that differ with respect to exposure to maternal gestational diabetes mellitus (GDM); (2) examine the persistence of GDM/metabolite associations 5 years later, during adolescence; and (3) investigate the associations of metabolite patterns with adiposity and metabolic biomarkers from childhood through adolescence. METHODS This study included 592 mother-child pairs with information on GDM exposure (n = 92 exposed), untargeted metabolomics data at age 6-14 years (T1) and at 12-19 years (T2), and information on adiposity and metabolic risk biomarkers at T1 and T2. We first consolidated 767 metabolites at T1 into factors (metabolite patterns) via principal component analysis (PCA) and used multivariable regression to identify factors that differed by GDM exposure, at α = 0.05. We then examined associations of GDM with individual metabolites within factors of interest at T1 and T2, and investigated associations of GDM-related factors at T1 with adiposity and metabolic risk throughout T1 and T2 using mixed-effects linear regression models. RESULTS Of the six factors retained from PCA, GDM exposure was associated with greater odds of being in quartile (Q)4 (vs Q1-3) of 'Factor 4' at T1 after accounting for age, sex, race/ethnicity, maternal smoking habits during pregnancy, Tanner stage, physical activity and total energy intake, at α = 0.05 (OR 1.78 [95% CI 1.04, 3.04]; p = 0.04). This metabolite pattern comprised phosphatidylcholines, diacylglycerols and phosphatidylethanolamines. GDM was consistently associated with elevations in a subset of individual compounds within this pattern at T1 and T2. While this metabolite pattern was not related to the health outcomes in boys, it corresponded with greater adiposity and a worse metabolic profile among girls throughout the follow-up period. Each 1-unit increment in Factor 4 corresponded with 0.17 (0.08, 0.25) units higher BMI z score, 8.83 (5.07, 12.59) pmol/l higher fasting insulin, 0.28 (0.13, 0.43) units higher HOMA-IR, and 4.73 (2.15, 7.31) nmol/l higher leptin. CONCLUSIONS/INTERPRETATION Exposure to maternal GDM was nominally associated with a metabolite pattern characterised by elevated serum phospholipids in late childhood and adolescence at α = 0.05. This metabolite pattern was associated with greater adiposity and metabolic risk among female offspring throughout the late childhood-to-adolescence transition. Future studies are warranted to confirm our findings.
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Affiliation(s)
- Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Room 208, 12474 E. 19th Ave, Aurora, CO, 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Brandy M Ringham
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Room 208, 12474 E. 19th Ave, Aurora, CO, 80045, USA
| | - Harry A Smith
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Room 208, 12474 E. 19th Ave, Aurora, CO, 80045, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Katerina M Kechris
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Room 208, 12474 E. 19th Ave, Aurora, CO, 80045, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Li Y, Feng D, Esangbedo IC, Zhao Y, Han L, Zhu Y, Fu J, Li G, Wang D, Wang Y, Li M, Gao S, Willi SM. Insulin resistance, beta-cell function, adipokine profiles and cardiometabolic risk factors among Chinese youth with isolated impaired fasting glucose versus impaired glucose tolerance: the BCAMS study. BMJ Open Diabetes Res Care 2020; 8:8/1/e000724. [PMID: 32049638 PMCID: PMC7039594 DOI: 10.1136/bmjdrc-2019-000724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 01/08/2020] [Accepted: 01/19/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) may convey disparate risks of metabolic consequences. Fasting plasma glucose (FPG), while an expedient screening procedure, may not adequately assess metabolic risk, particularly among youths. In order to inform a strategy for screening Chinese youth for pre-diabetes, we examined the relative value of IFG versus IGT to define metabolic risk by assessing their association with insulin resistance, beta-cell dysfunction, adverse adipokine profiles and other cardiometabolic risk factors. RESEARCH DESIGN AND METHODS We recruited 542 subjects (age 14-28 years) from the Beijing Child and Adolescent Metabolic Syndrome study for an in-depth assessment of cardiometabolic risk factors, including a 2-hour oral glucose tolerance test, liver ultrasound and serum levels of four adipokines. RESULTS FPG failed to identify nearly all (32/33) youths with IGT, whereas 2-hour plasma glucose (2 h PG) missed 80.8% (21/26) of subjects with IFG. Impaired beta-cell function was evident from decreased oral disposition indices in those with isolated impaired fasting glucose (iIFG) or isolated impaired glucose tolerance (iIGT) versus normal glucose tolerance (NGT) (all p<0.001), whereas reduced insulin sensitivity (Matsuda) index was most pronounced in the iIGT group (p<0.01). Moreover, alterations in adipokine levels (fibroblast growth factor 21, adiponectin and leptin/adiponectin ratio) were associated with iIGT (p<0.05) but not iIFG. Youths with iIGT had a 2-fold to 32-fold increased incidence of hypertriglyceridemia, hypertension and metabolic syndrome (MetS) compared with those with NGT. In addition, subgroup analyses of participants with normal FPG revealed that the odds of having IGT increased 3-fold to 18-fold among those with elevated TGs, hypertension, moderate-to-severe non-alcoholic fatty liver disease or MetS. CONCLUSIONS Chinese youth with iIGT exhibit a higher cardiometabolic risk profile than those with iIFG. Thus, 2 h PG is preferred over FPG to identify the pre-diabetes phenotype at greatest risk of subsequent development of cardiovascular disease. TRIAL REGISTRATION NUMBER NCT03421444.
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Affiliation(s)
- Yu Li
- Department of Endocrinology, NHC Key Laboratory of Endocrinolog, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dan Feng
- Department of Endocrinology, Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Issy C Esangbedo
- Health Weight Program, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yanglu Zhao
- Epidemiology Department, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Lanwen Han
- Department of Endocrinology, Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Yingna Zhu
- Department of Endocrinology, Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Junling Fu
- Department of Endocrinology, NHC Key Laboratory of Endocrinolog, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ge Li
- Department of Endocrinology, NHC Key Laboratory of Endocrinolog, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dongmei Wang
- Department of Endocrinology, NHC Key Laboratory of Endocrinolog, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yonghui Wang
- Department of Endocrinology, Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Ming Li
- Department of Endocrinology, NHC Key Laboratory of Endocrinolog, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shan Gao
- Department of Endocrinology, Beijing Chaoyang Hospital,Capital Medical University, Beijing, China
| | - Steven M Willi
- Division of Endocrinology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Yu Y, Pan F, Cui W, Tang W, Hu Y. Differences in early-phase insulin secretion and glucose disposition index between aged and middle-aged patients with newly diagnosed type 2 diabetes. Geriatr Gerontol Int 2020; 20:206-211. [PMID: 31923347 DOI: 10.1111/ggi.13861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 01/18/2023]
Abstract
AIM This cross-sectional study aimed to investigate the differences in β-cell function and insulin sensitivity between newly diagnosed aged and middle-aged type 2 diabetes mellitus (T2DM) patients. METHODS A total of 206 newly diagnosed T2DM patients aged ≥60 years (A-DM group) and 206 newly diagnosed sex- and glycated hemoglobin-matched T2DM patients aged <60 years (MA-DM group) were recruited. All patients underwent the 75-g oral glucose tolerance test. Plasma glucose, lipid profiles, liver and renal function, glycated hemoglobin, and insulin were measured. Homeostasis model assessment for insulin resistance, quantitative insulin sensitivity check index, area under the curve of glucose during 0-30 min (GluAUC30) × area under the curve of insulin during 0-30 min (InsAUC30) and β-cell function indexes were calculated. RESULTS The mean age of the total 412 patients (356 men and 56 women) was 59.76 ± 13.32 years. There were no significant differences in GluAUC120 between the two groups (106.89 ± 27.70 in A-DM vs 108.32 ± 27.58 in MA-DM; P = 0.6), but ΔI30/ΔG30, InsAUC30 and GluAUC30 × InsAUC30 levels were significantly higher in the A-DM group than in the MA-DM group (3.55 ± 4.54 vs 2.53 ± 3.83; P = 0.014, and 39.19 ± 32.19 vs 32.71 ± 28.81; P = 0.032, 675.05 ± 475.60 vs 584.56 ± 450.23; P = 0.048, respectively). The glucose disposition index (GDI) of the A-DM group was statistically higher than that of the MA-DM group (0.38 ± 0.40 vs 0.30 ± 0.35; P = 0.018). Age was positively associated with ΔI30/ΔG30 (r = 0.117; P = 0.017) and GDI (r = 0.147; P = 0.003), but had no correlation with InsAUC30, InsAUC120 or GluAUC30 × InsAUC30. After multiple adjustments for confounders, including sex, body mass index, glycated hemoglobin, triglyceride, total cholesterol and high-density lipoprotein cholesterol, age was positively associated with ΔI30/ΔG30, InsAUC30, InsAUC120, GluAUC30 × InsAUC30 and GDI. CONCLUSIONS Aged patients have relatively higher early-phase insulin secretion and GDI than middle-aged patients in newly diagnosed T2DM. Geriatr Gerontol Int 2020; ••: ••-••.
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Affiliation(s)
- Yun Yu
- Department of Geriatrics, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China.,Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Fenghui Pan
- Department of Geriatrics, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Wenxia Cui
- Department of Geriatrics, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Wei Tang
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Hu
- Department of Geriatrics, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
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Bjornstad P, Hughan K, Kelsey MM, Shah AS, Lynch J, Nehus E, Mitsnefes M, Jenkins T, Xu P, Xie C, Inge T, Nadeau K. Effect of Surgical Versus Medical Therapy on Diabetic Kidney Disease Over 5 Years in Severely Obese Adolescents With Type 2 Diabetes. Diabetes Care 2020; 43:187-195. [PMID: 31685489 PMCID: PMC6925577 DOI: 10.2337/dc19-0708] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/30/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare diabetic kidney disease (DKD) rates over 5 years of follow-up in two cohorts of severely obese adolescents with type 2 diabetes (T2D) undergoing medical or surgical treatment for T2D. RESEARCH DESIGN AND METHODS A secondary analysis was performed of data collected from obese participants of similar age and racial distribution enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) studies. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. Glycemic control, BMI, estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE), and prevalence of hyperfiltration (eGFR ≥135 mL/min/1.73 m2) and elevated UAE (≥30 mg/g) were assessed annually. RESULTS Participants with T2D from Teen-LABS (n = 30, mean ± SD age, 16.9 ± 1.3 years; 70% female; 60% white; BMI 54.4 ± 9.5 kg/m2) and TODAY (n = 63, age 15.3 ± 1.3 years; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. During 5 years of follow-up, hyperfiltration decreased from 21% to 18% in Teen-LABS and increased from 7% to 48% in TODAY. Elevated UAE decreased from 27% to 5% in Teen-LABS and increased from 21% to 43% in TODAY. Adjusting for baseline age, sex, BMI, and HbA1c, TODAY participants had a greater odds of hyperfiltration (odds ratio 15.7 [95% CI 2.6, 94.3]) and elevated UAE (27.3 [4.9, 149.9]) at 5 years of follow-up. CONCLUSIONS Compared with MBS, medical treatment of obese youth with T2D was associated with a higher odds of DKD over 5 years.
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Affiliation(s)
- Petter Bjornstad
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Kara Hughan
- University of Pittsburgh and UPMC Children's Hospital Pittsburgh, Pittsburgh, PA
| | - Megan M Kelsey
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Amy S Shah
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Jane Lynch
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Edward Nehus
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Mark Mitsnefes
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Todd Jenkins
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Peixin Xu
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Changchun Xie
- University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Thomas Inge
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Kristen Nadeau
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
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Exercise effects on arterial stiffness and heart health in children with excess weight: The SMART RCT. Int J Obes (Lond) 2019; 44:1152-1163. [PMID: 31754238 PMCID: PMC7192762 DOI: 10.1038/s41366-019-0482-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/14/2019] [Accepted: 10/31/2019] [Indexed: 12/17/2022]
Abstract
Introduction Childhood obesity and inactivity are associated with cardiovascular risk. Evidence is limited for exercise effects on arterial health in children. Methods One hundred seventy-five inactive children with overweight or obesity (8–11 years, ≥85th percentile BMI, 61% female, 87% Black, 73% with obesity) were randomized to an 8-month daily after-school aerobic exercise program (40 min/d, n=90) or a sedentary control condition (n=85). Carotid-femoral pulse wave velocity (PWV, primary outcome, arterial stiffness), fitness, adiposity, blood pressure (BP), glucose, insulin resistance, lipids, and C-reactive protein were measured at baseline and posttest (8 months). Adiposity, fitness, and BP were measured again at follow-up, 8–12 months later. Intent-to-treat analyses were conducted using mixed models. Results The study had 89% retention, with attendance of 59% in exercise and 64% in the control condition, and vigorous exercise participation (average heart rate 161±7 beats/min). Compared to controls, the exercise group had twice the improvement in fitness (VȮ2 peak, 2.7 (95% CI 1.8, 3.6) vs. 1.3 (0.4, 2.3) ml/kg/min) and adiposity (−1.8 (−2.4, −1.1) vs. −0.8 (−1.5, -0.1)%), each p=0.04, and a large improvement in HDL-cholesterol (0.13 (0.075, 0.186) vs. -0.028 (−0.083, 0.023) mmol/l, p<0.0001). There was no group×time effect on other outcomes at 8 months, or on any outcomes at follow-up. The change in PWV at 8 months correlated with changes in insulin and insulin resistance (both r=0.32), diastolic BP (r=0.24), BMI (r=0.22) and adiposity (r=0.18). Conclusions Eight months of aerobic exercise training improved fitness, adiposity, and HDL-cholesterol levels, but did not reduce arterial stiffness in children with excess weight. PWV improved as a function of insulin resistance, BP, BMI and adiposity. Weight loss may be required to improve arterial stiffness. Exercise benefits waned after discontinuing the program. Trial Registration This study is registered at www.clinicaltrials.govNCT02383485.
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Early testing of insulin resistance: a tale of two lipid ratios in a group of 5th graders screened by the Coronary Artery Risk Detection in Appalachian Communities Project (CARDIAC Project). World J Pediatr 2019; 15:398-404. [PMID: 31055781 PMCID: PMC7409539 DOI: 10.1007/s12519-018-00225-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/27/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND In West Virginia (WV), 47% of fifth-grade children are either overweight or obese. There is no clear consensus regarding the definition of insulin resistance in children, and directly measuring insulin on the population level is costly. Two proposed measures examined further in this study include triglyceride (TRIG)/high-density lipoprotein cholesterol (HDL-C) ratio and TRIG/low-density lipoprotein (LDL-C) ratio. The purpose of this study is to examine the relationship between TRIG/HDL-C ratio, TRIG/LDL-C ratio and insulin resistance in fifth-graders with acanthosis nigricans (AN). METHODS Between 2007 and 2016, 52,545 fifth-grade students in WV were assessed for AN. Fasting glucose and insulin levels were collected only for a sub-group of students who were AN-positive and was used to determine insulin resistance using the Homeostatic Model for Insulin Resistance (HOMA-IR) equation. Statistical analysis included t tests and logistic regression with receiver operating characteristic curves. RESULTS Of the students assessed for AN, 4.5% (n = 2360) tested positive. The prevalence of insulin resistance was 79% (n = 814) among 1030 with AN and complete HOMA-IR. TRIG/HDL-C ratio and TRIG/LDL-C ratio were significantly associated with insulin resistance (TRIG/HDL-C:Est. = 0.36, P < 0.0001, AUC = 0.68; TRIG/LDL-C: Est. = 0.87, P < 0.0001, AUC = 0.69). Multivariate analysis showed that increased body mass index (Est. = 0.05, P < 0.0001), gender (Est. = 0.49, p < 0.0001) and TRIG/HDL-C ratio (Est. = 0.21, P < 0.0001) were significantly associated with insulin resistance. CONCLUSIONS TRIG/HDL-C is a better surrogate marker of insulin resistance in AN-positive children compared to TRIG/LDL-C ratio; so, on a population-level, cholesterol rather than insulin may be obtained for preliminary testing of early insulin resistance in children.
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Frithioff-Bøjsøe C, Lund MAV, Kloppenborg JT, Nielsen TTH, Fonvig CE, Lausten-Thomsen U, Hedley PL, Hansen T, Pedersen OB, Christiansen M, Baker JL, Hansen T, Holm JC. Glucose metabolism in children and adolescents: Population-based reference values and comparisons to children and adolescents enrolled in obesity treatment. Pediatr Diabetes 2019; 20:538-548. [PMID: 31074070 DOI: 10.1111/pedi.12859] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/03/2019] [Accepted: 04/15/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Alterations in glucose metabolism that lead to the development of metabolic and cardiovascular disease may begin already in childhood. OBJECTIVE This study aims to generate pediatric age and sex-specific reference values for fasting concentrations of glucose, hemoglobin A1c (HbA1c), insulin, C-peptide, and homeostasis model assessment: insulin resistance (HOMA-IR) in Danish/North-European white children and adolescents from a population-based cohort and to compare values from children and adolescents with overweight/obesity with this reference. METHODS The population- and obesity clinic-based cohorts consisted of 2451 and 1935 children and adolescents between 6 and 18 years of age. Anthropometric measurements and blood samples were obtained and percentile curves were calculated. RESULTS In the population-based cohort, glucose, insulin, and HOMA-IR values increased before the expected onset of puberty (P < .05). Thereafter, all variables decreased in girls (P < .05) and HbA1c decreased in boys (P < .05). Concentrations of all measured markers of glucose metabolism were higher in the obesity clinic-based cohort than the population-based cohort (both sexes P < .001). Specifically, insulin and HOMA-IR continued to increase to 18 years in the clinic-based cohort, particularly among boys. CONCLUSIONS Fasting glucose, insulin, and HOMA-IR change during childhood, making pediatric reference values essential for timely identification of derangements in glucose metabolism. Children and adolescents with obesity exhibit increased concentrations of these biomarkers.
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Affiliation(s)
- Christine Frithioff-Bøjsøe
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - Morten A V Lund
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie T Kloppenborg
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Department of Pediatrics, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Tenna T H Nielsen
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Department of Pediatrics, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Cilius E Fonvig
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.,Department of Pediatrics, Kolding Hospital a part of Lillebaelt Hospital, Kolding, Denmark
| | - Ulrik Lausten-Thomsen
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Paula L Hedley
- Department for Congenital Disorders, Danish National Biobank and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Tina Hansen
- Department of Dental Care, Holbaek Municipality, Holbaek, Denmark
| | - Oluf B Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - Michael Christiansen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department for Congenital Disorders, Danish National Biobank and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Jennifer L Baker
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.,University of Southern Denmark, Faculty of Health Sciences, Odense, Denmark
| | - Jens-Christian Holm
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.,Department of Dental Care, Holbaek Municipality, Holbaek, Denmark.,University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Bjornstad P, Laffel L, Lynch J, El Ghormli L, Weinstock RS, Tollefsen SE, Nadeau KJ. Elevated Serum Uric Acid Is Associated With Greater Risk for Hypertension and Diabetic Kidney Diseases in Obese Adolescents With Type 2 Diabetes: An Observational Analysis From the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study. Diabetes Care 2019; 42:1120-1128. [PMID: 30967435 PMCID: PMC6609951 DOI: 10.2337/dc18-2147] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Elevated serum uric acid (SUA) is increasingly recognized as a risk factor for kidney disease in adults with diabetes, but data in youth are limited. We hypothesized that elevated SUA predicts development of elevated urinary albumin excretion (UAE) and hypertension over time in teens with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Serum creatinine, cystatin C, SUA, and the urine albumin-to-creatinine ratio (UACR) were assessed in 539 obese youth, ages 12-17 years, with T2D duration <2 years at baseline in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Estimated glomerular filtration rate (eGFR) was calculated using creatinine and cystatin C. Hypertension was defined as systolic or diastolic blood pressure ≥130/80 mmHg and elevated UAE as UACR ≥30 mg/g. Cox proportional hazards models evaluated the relationship between SUA and outcome variables longitudinally over an average follow-up of 5.7 years, adjusting for age, sex, race/ethnicity, BMI, HbA1c, eGFR, ACE inhibitor/angiotensin receptor blocker use, and TODAY treatment group assignment. RESULTS At baseline, hyperuricemia (≥6.8 mg/dL) was present in 25.6% of participants, hypertension in 18.7%, and elevated UAE in 6.1%. During follow-up of up to 7 years, hypertension developed in 37.4% and UAE in 18.0%. Higher baseline SUA increased the risk of incident hypertension (hazard ratio [HR] 1.19, 95% CI 1.03-1.38, per 1 mg/dL increase in SUA) and elevated UAE (HR 1.24, 95% CI 1.03-1.48) in adjusted models. CONCLUSIONS Hyperuricemia was common in youth with T2D. Higher baseline SUA independently increased the risk for onset of hypertension and elevated UAE. Research is needed to determine whether SUA-lowering therapies can impede development of diabetic kidney disease and hypertension in T2D youth.
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Affiliation(s)
- Petter Bjornstad
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | | | - Jane Lynch
- The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Laure El Ghormli
- George Washington University Biostatistics Center, Rockville, MD
| | - Ruth S Weinstock
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY
| | - Sherida E Tollefsen
- Department of Pediatrics, Saint Louis University Health Sciences Center, St. Louis, MO
| | - Kristen J Nadeau
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
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Shomaker LB, Pivarunas B, Annameier SK, Gulley L, Quaglia J, Brown KW, Broderick P, Bell C. One-Year Follow-Up of a Randomized Controlled Trial Piloting a Mindfulness-Based Group Intervention for Adolescent Insulin Resistance. Front Psychol 2019; 10:1040. [PMID: 31133946 PMCID: PMC6517501 DOI: 10.3389/fpsyg.2019.01040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/23/2019] [Indexed: 01/11/2023] Open
Abstract
Introduction To explore if a brief mindfulness-based intervention (MBI) leads to sustained, improved clinical outcomes in adolescents at-risk for type 2 diabetes (T2D). Methods Participants were 12–17y girls with overweight/obesity, elevated depression symptoms, and T2D family history participating in a randomized, controlled pilot trial of a six-session MBI vs. cognitive-behavioral therapy (CBT) group. At baseline and 1-year, mindfulness, depression, insulin resistance (IR), and body composition were assessed with validated instruments. Results One-year retention was 71% (n = 12) in MBI; 81% (n = 13) in CBT. At 1-year, depression decreased (Cohen’s d = 0.68) and IR decreased (d = 0.73) in adolescents randomized to MBI compared to those in CBT. There were no significant between-condition differences in mindfulness, adiposity, or BMI. Discussion One-year outcomes from this randomized, controlled pilot trial suggest that brief MBI may reduce depression and IR in at-risk adolescents. Replication and exploration of mechanisms within the context of a larger clinical trial are necessary. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT02218138.
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Affiliation(s)
- Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States.,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, United States.,Section of Endocrinology, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Bernadette Pivarunas
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States
| | - Shelly K Annameier
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States
| | - Lauren Gulley
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States.,Section of Endocrinology, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Jordan Quaglia
- Department of Contemplative Psychology, Naropa University, Boulder, CO, United States
| | - Kirk Warren Brown
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Patricia Broderick
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, United States
| | - Christopher Bell
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
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Kim JY, Bacha F, Tfayli H, Michaliszyn SF, Yousuf S, Arslanian S. Adipose Tissue Insulin Resistance in Youth on the Spectrum From Normal Weight to Obese and From Normal Glucose Tolerance to Impaired Glucose Tolerance to Type 2 Diabetes. Diabetes Care 2019; 42:265-272. [PMID: 30455334 PMCID: PMC6341282 DOI: 10.2337/dc18-1178] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/25/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Adipose tissue insulin resistance is one of the pathophysiological components of type 2 diabetes. Herein we investigated: 1) adipose insulin resistance index (Adipose-IR) (calculated as fasting insulin × free fatty acids [FFAs]) in youth across the spectrum of adiposity from normal weight to obese and the spectrum from normal glucose tolerance (NGT) to impaired glucose tolerance (IGT) to type 2 diabetes, 2) the relationship of Adipose-IR with physical and metabolic characteristics, and 3) the predictive power of Adipose-IR for determining dysglycemia in youth. RESEARCH DESIGN AND METHODS A total of 205 youth had fasting glucose, insulin, FFA, Adipose-IR, body composition, visceral adipose tissue (VAT), leptin, and adiponectin evaluated. RESULTS Adipose-IR was 2.2-fold higher in obese NGT, 4.3-fold higher in IGT, and 4.6-fold higher in type 2 diabetes compared with that in normal-weight peers (all P < 0.05). Females with dysglycemia (IGT and type 2 diabetes) had higher Adipose-IR than their male counterparts (P < 0.001). Adipose-IR correlated positively with total body and visceral adiposity, fasting glucose, HOMA-IR, and leptin and negatively with adiponectin. Receiver operating characteristic curve analysis yielded an optimal cutoff for Adipose-IR of 9.3 μU/mL × mmol/L for determining dysglycemia with 80% predictive power. CONCLUSIONS Adipose-IR is a simple surrogate estimate that reflects pathophysiological alterations in adipose tissue insulin sensitivity in youth, with progressive deterioration from normal weight to obese and from NGT to IGT to type 2 diabetes. Adipose-IR can be applied in large-scale epidemiological/observational studies of the natural history of youth-onset type 2 diabetes and its progression or reversal with intervention strategies.
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Affiliation(s)
- Joon Young Kim
- Center for Pediatric Research in Obesity and Metabolism, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Fida Bacha
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Hala Tfayli
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara F Michaliszyn
- Department of Kinesiology and Sport Science, Youngstown State University, Youngstown, OH
| | - Shahwar Yousuf
- Center for Pediatric Research in Obesity and Metabolism, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
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Aiswarya Y, Shivaprasad C, Anish K, Sridevi A, Anupam B, Amit G. Assessment of insulin sensitivity and secretion in patients with fibrocalculous pancreatic diabetes. Diabetes Metab Syndr Obes 2019; 12:779-788. [PMID: 31190936 PMCID: PMC6535669 DOI: 10.2147/dmso.s204254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/17/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Fibrocalculous pancreatic diabetes (FCPD) is a secondary form of diabetes seen in patients with tropical chronic pancreatitis. Insulin deficiency plays a major role in the etiopathogenesis of FCPD. Limited data suggest a possible role of insulin resistance (IR) in the pathogenesis of FCPD. Sparse data exist on measures of insulin sensitivity (IS) and secretion in patients with FCPD and its comparison to type 2 diabetes mellitus (T2D) patients. Method: Eighty patients with FCPD, 36 patients with T2D and 36 healthy subjects were included. A 75 g oral glucose tolerance test (OGTT) was performed in the morning after an overnight fast. We evaluated IS and secretion using indices derived from fasting (homeostasis model assessment of insulin resistance [HOMA-IR], quantitative insulin sensitivity check index [QUICKI] and homeostasis model assessment of beta-cell function [HOMA-ß]) and OGTT (Matsuda, insulin sensitivity index by Kanauchi [ISI-K], oral glucose insulin sensitivity index [OGIS], Stumvoll, insulinogenic index and oral disposition index [ODI]) measurements of glucose and insulin. Results: HOMA-IR was significantly higher and QUICKI significantly lower in patients with FCPD and T2D than in healthy controls (P<0.001). Matsuda, ISI-K, OGIS and Stumvoll were significantly lower in patients with FCPD and T2D than in healthy controls (P<0.001), indicating reduced IS in both FCPD and T2D patients. HOMA-ß, insulinogenic index and ODI were significantly lower in patients with FCPD and T2D compared to healthy controls (P<0.001). Conclusion: FCPD is associated with reduced IS as assessed by fasting and OGTT-based indices. FCPD is also associated with a greater degree of impairment in insulin secretion than in T2D. IR may play a role in the pathogenesis of FCPD.
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Affiliation(s)
- Yalamanchi Aiswarya
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Channabasappa Shivaprasad
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
- Correspondence: Channabasappa ShivaprasadDepartment of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore, Karnataka560066, IndiaTel +91 802 841 3381Email
| | - Kolly Anish
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Atluri Sridevi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Biswas Anupam
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Goel Amit
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India
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Arslanian S, El Ghormli L, Young Kim J, Bacha F, Chan C, Ismail HM, Levitt Katz LE, Levitsky L, Tryggestad JB, White NH. The Shape of the Glucose Response Curve During an Oral Glucose Tolerance Test: Forerunner of Heightened Glycemic Failure Rates and Accelerated Decline in β-Cell Function in TODAY. Diabetes Care 2019; 42:164-172. [PMID: 30455329 PMCID: PMC6300703 DOI: 10.2337/dc18-1122] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/18/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Obese youth without diabetes with monophasic oral glucose tolerance test (OGTT) glucose response curves have lower insulin sensitivity and impaired β-cell function compared with those with biphasic curves. The OGTT glucose response curve has not been studied in youth-onset type 2 diabetes. Here we test the hypothesis that the OGTT glucose response curve at randomization in youth in the TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study forecasts heightened glycemic failure rates and accelerated decline in β-cell function. RESEARCH DESIGN AND METHODS OGTTs (n = 662) performed at randomization were categorized as monophasic, biphasic, or incessant increase. Demographics, insulin sensitivity (1/fasting insulin), C-peptide index (△C30/△G30), and β-cell function relative to insulin sensitivity (oral disposition index [oDI]) were compared among the three groups. RESULTS At randomization, 21.7% had incessant increase, 68.6% monophasic, and 9.7% biphasic glucose response curves. The incessant increase group had similar insulin sensitivity but significantly lower C-peptide index and lower oDI, despite similar diabetes duration, compared with the other two groups. Glycemic failure rates were higher in the incessant increase group (58.3%) versus the monophasic group (42.3%) versus the biphasic group (39.1%) (P < 0.0001). The 6-month decline in C-peptide index (32.8% vs. 18.1% vs. 13.2%) and oDI (32.2% vs. 11.6% vs. 9.1%) was greatest in incessant increase versus monophasic and biphasic with no difference in insulin sensitivity. CONCLUSIONS In the TODAY study cohort, an incessant increase in the OGTT glucose response curve at randomization reflects reduced β-cell function and foretells increased glycemic failure rates with accelerated deterioration in β-cell function independent of diabetes duration and treatment assignment compared with monophasic and biphasic curves. The shape of the OGTT glucose response curve could be a metabolic biomarker prognosticating the response to therapy in youth with type 2 diabetes.
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Affiliation(s)
| | - Laure El Ghormli
- George Washington University Biostatistics Center, Rockville, MD
| | | | - Fida Bacha
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Christine Chan
- University of Colorado Health Sciences Center, Denver, CO
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Metabolic Contrasts Between Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes: II. Observations Using the Oral Glucose Tolerance Test. Diabetes Care 2018; 41:1707-1716. [PMID: 29941498 PMCID: PMC6054494 DOI: 10.2337/dc18-0243] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare oral glucose tolerance test (OGTT) glucose, C-peptide, and insulin responses and insulin sensitivity in youth and adults with impaired glucose tolerance (IGT) or recently diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 66 youth (80.3% with IGT) and 355 adults (70.7% with IGT) underwent a 3-h OGTT to assess 1) insulin sensitivity (1/fasting insulin), 2) C-peptide index (CPI) and insulinogenic index (IGI) over the first 30 min, and 3) glucose, C-peptide, and insulin incremental areas above fasting over the 3-h post-ingestion (incremental glucose [G-iAUC], incremental C-peptide [CP-iAUC], and incremental insulin area under the curve [I-iAUC] responses, respectively). RESULTS Fasting, 2-h glucose, and G-iAUC were similar in both age-groups, but youth had ∼50% lower 1/fasting insulin (P < 0.001), 75% higher CPI (mean [95% CI] 0.703 [0.226, 2.183] vs. 0.401 [0.136, 1.183] nmol/mmol; P < 0.001), and more than twofold higher IGI (257.3 [54.5, 1,215.8] vs. 114.8 [28.0, 470.8] pmol/mmol; P < 0.001). Two-hour C-peptide and insulin concentrations, CP-iAUC, and I-iAUC were all higher in youth (all P < 0.001). C-peptide and insulin responses remained significantly greater in youth after adjustment for insulin sensitivity. Within each age-group, individuals with type 2 diabetes versus IGT had significantly lower CPI and IGI with no difference in insulin sensitivity. CONCLUSIONS The balance between insulin sensitivity and β-cell responses differs between youth and adults with IGT or recently diagnosed type 2 diabetes. Despite similar postload glucose levels, youth demonstrate greater C-peptide and insulin responses that exceed what is needed to compensate for their lower insulin sensitivity. Longitudinal studies are required to determine whether this feature contributes to a more rapid decline in β-cell function in youth with dysglycemia.
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Chen ME, Aguirre RS, Hannon TS. Methods for Measuring Risk for Type 2 Diabetes in Youth: the Oral Glucose Tolerance Test (OGTT). Curr Diab Rep 2018; 18:51. [PMID: 29909550 DOI: 10.1007/s11892-018-1023-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW The oral glucose tolerance test (OGTT) is used both in clinical practice and research to assess glucose tolerance. In addition, the OGTT is utilized for surrogate measures of insulin sensitivity and the insulin response to enteral glucose and has been widely applied in the evaluation of β-cell dysfunction in obesity, prediabetes, and type 2 diabetes. Here we review the use of the OGTT and the OGTT-derived indices for measurement of risk markers for type 2 diabetes in youth. RECENT FINDINGS Advantages of using the OGTT for measures of diabetes risk include its accessibility and the incorporation of physiological contributions of the gut-pancreas axis in the measures of insulin response to glucose. Mathematical modeling expands the potential gains from the OGTT in physiology and clinical research. Disadvantages include individual differences in the rate of glucose absorption that modify insulin responses, imperfect control of the glycemic stimulus, and poor intraindividual reproducibility. Available research suggests the OGTT provides valuable information about the development of impaired glycemic control and β-cell function in obese youth along the spectrum of glucose tolerance.
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Affiliation(s)
| | - Rebecca S Aguirre
- Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN, 46202, USA
| | - Tamara S Hannon
- Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN, 46202, USA.
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Kelsey MM, Braffett BH, Geffner ME, Levitsky LL, Caprio S, McKay SV, Shah R, Sprague JE, Arslanian SA. Menstrual Dysfunction in Girls From the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) Study. J Clin Endocrinol Metab 2018; 103:2309-2318. [PMID: 29697830 PMCID: PMC6276678 DOI: 10.1210/jc.2018-00132] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/02/2018] [Indexed: 12/14/2022]
Abstract
CONTEXT Little is known about reproductive function in girls with youth-onset type 2 diabetes. OBJECTIVES To characterize girls with irregular menses and effects of glycemic treatments on menses and sex steroids in the Treatment Options for Type 2 Diabetes in Youth (TODAY) study. DESIGN Differences in demographic, metabolic, and hormonal characteristics between regular- vs irregular-menses groups were tested; treatment group (metformin with or without rosiglitazone, metformin plus lifestyle) effect on menses and sex steroids over time in the study was assessed. This is a secondary analysis of TODAY data. SETTING Multicenter study in an academic setting. PATIENTS TODAY girls not receiving hormonal contraception and those at least 1-year postmenarche were included. Irregular menses was defined as three or fewer periods in the prior 6 months. RESULTS Of eligible participants with serum measurement of sex steroids (n = 190; mean age, 14 years), 21% had irregular menses. Those with irregular vs regular menses had higher body mass index (BMI) (P = 0.001), aspartate aminotransferase (AST) (P = 0.001), free androgen index (P = 0.0003), and total testosterone (P = 0.01) and lower sex hormone-binding globulin (SHBG) (P = 0.004) and estradiol (P = 0.01). Differences remained after adjustment for BMI. There was no treatment group effect on menses or sex steroids at 12 or 24 months, and no association of sex steroids was seen with measures of insulin sensitivity or secretion. CONCLUSIONS Menstrual dysfunction is common in girls with recently diagnosed type 2 diabetes and associated with alterations in sex steroids, SHBG, and AST but not with alteration in insulin sensitivity or β-cell function and did not improve with 2 years of antihyperglycemic treatment.
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Affiliation(s)
- Megan M Kelsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Barbara H Braffett
- Biostatistics Center, George Washington University, Washington, DC
- Correspondence and Reprint Requests: Barbara H. Braffett, PhD, 6110 Executive Boulevard Suite 750, Rockville, Maryland 20852. E-mail:
| | - Mitchell E Geffner
- The Saban Research Center, Children’s Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Lynne L Levitsky
- Division of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sonia Caprio
- Department of Pediatric Endocrinology, Yale School of Medicine, New Haven, Connecticut
| | - Siripoom V McKay
- Division of Pediatric Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Rachana Shah
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Silva A Arslanian
- University of Pittsburgh, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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45
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Perng W, Rifas-Shiman SL, Hivert MF, Chavarro JE, Oken E. Branched Chain Amino Acids, Androgen Hormones, and Metabolic Risk Across Early Adolescence: A Prospective Study in Project Viva. Obesity (Silver Spring) 2018; 26:916-926. [PMID: 29575812 PMCID: PMC5916029 DOI: 10.1002/oby.22164] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/30/2018] [Accepted: 02/14/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to examine the associations of two obesity-related metabolite patterns with changes in metabolic biomarkers during early adolescence. METHODS Multivariable linear regression was used to examine associations of branched chain amino acid (BCAA) and androgen hormone patterns with changes in glycemia (fasting glucose, insulin, homeostatic model assessment of insulin resistance), adipokines (leptin, adiponectin), inflammation (C-reactive protein, interleukin-6), lipid profile, and blood pressure during ∼5 years of follow-up among 213 children aged 6 to 10 years at baseline. Covariates included baseline age, pubertal status, biomarker level, and BMI percentile, and age at follow-up. Interactions with sex and baseline BMI percentile were also considered. RESULTS The median age at baseline was 7.7 years; 48.8% were boys. In adjusted models, each 1 unit of the BCAA pattern corresponded with a 4.82 (95% CI: 0.92 to 8.71) mg/dL decrease in fasting glucose in boys. In girls, the BCAA pattern was associated with an increase in triglycerides (4.17 [0.03 to 8.32] mg/dL). The androgen pattern was associated with decreased leptin (-2.35 [-4.34 to -0.35] ng/dL) and increased C-reactive protein (0.28 [0.03 to 0.54] mg/dL) in girls. These relationships did not differ by baseline BMI percentile. CONCLUSIONS The BCAA and androgen hormone metabolite patterns are related to changes in metabolic parameters in a sex-specific manner during early adolescence.
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Affiliation(s)
- Wei Perng
- Department of Nutritional Sciences, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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46
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Kloppenborg JT, Gamborg M, Fonvig CE, Nielsen TRH, Pedersen O, Johannesen J, Hansen T, Holm JC. The effect of impaired glucose metabolism on weight loss in multidisciplinary childhood obesity treatment. Pediatr Diabetes 2018; 19:366-374. [PMID: 29159854 DOI: 10.1111/pedi.12605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/30/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate whether children and adolescents exhibiting an impaired glucose metabolism are more obese at treatment entry and less likely to reduce their degree of obesity during treatment. METHODS The present study is a longitudinal observational study, including children and adolescents from the Children's Obesity Clinic, Holbaek, Denmark. Anthropometrics, pubertal development, socioeconomic status (SES), and fasting concentrations of plasma glucose, serum insulin, serum C-peptide, and whole blood glycosylated hemoglobin (HbA1c) were collected at treatment entry and at follow-up. Proxies of Homeostasis Model Assessment 2-insulin sensitivity (HOMA2-IS) and Homeostasis Model Assessment 2-β-cell function (HOMA2-B) were calculated with the Homeostasis Model Assessment 2 program. RESULTS In total, 569 (333 boys) patients, median 11.5 years of age (range 6-22 years), and median body mass index (BMI) z-score 2.94 (range 1.34-5.54) were included. The mean BMI z-score reduction was 0.31 (±0.46) after 13 months (range 6-18) of treatment. At treatment entry, patients with impaired estimates of glucose metabolism were more obese than normoglycemic patients. Baseline concentration of C-peptide was associated with a lower weight loss during treatment in girls (P = .02). Reduction in the insulin concentrations was associated with reduction in BMI z-score in both sexes (P < .0001, P = .0005). During treatment, values of glucose, HbA1c, HOMA2-IS, and HOMA2-B did not change or impact the treatment outcome, regardless of age, sex, SES, or degree of obesity at treatment entry. CONCLUSION The capability to reduce weight during multidisciplinary treatment in children and adolescents with overweight/obesity is not influenced by an impaired glucose metabolism at study entry or during the course of treatment.
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Affiliation(s)
- Julie T Kloppenborg
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Department of Pediatrics, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Michael Gamborg
- Institute of Preventive Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cilius E Fonvig
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Tenna R H Nielsen
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Johannesen
- Department of Pediatrics, Copenhagen University Hospital Herlev, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Christian Holm
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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47
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Kloppenborg JT, Fonvig CE, Nielsen TRH, Mollerup PM, Bøjsøe C, Pedersen O, Johannesen J, Hansen T, Holm JC. Impaired fasting glucose and the metabolic profile in Danish children and adolescents with normal weight, overweight, or obesity. Pediatr Diabetes 2018; 19:356-365. [PMID: 29193487 DOI: 10.1111/pedi.12604] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/25/2017] [Accepted: 10/03/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Whether the definitions of impaired fasting glucose (IFG) from the American Diabetes Association (ADA) and the World Health Organization (WHO) differentially impact estimates of the metabolic profile and IFG-related comorbidities in Danish children and adolescents is unknown. METHODS Two thousand one hundred and fifty four (979 boys) children and adolescents with overweight or obesity (median age 12 years) and 1824 (728 boys) children with normal weight (median age 12 years) from The Danish Childhood Obesity Biobank were studied. Anthropometrics, blood pressure, puberty, and fasting concentrations of glucose, insulin, glycosylated hemoglobin (HbA1c), and lipids were measured. RESULTS About 14.1% of participants with overweight or obesity exhibited IFG according to the ADA and 3.5% according to the WHO definition. Among individuals with normal weight, the corresponding prevalences were 4.3% and 0.3%. IFG was associated with a higher systolic blood pressure, higher concentrations of HbA1c, insulin, C-peptide (P < .0001) and triglycerides (P = .03), and lower HOMA2-IS and HOMA2-B (P < .0001) independent of sex, age, puberty, waist-to-height ratio, and degree of obesity. Furthermore, IFG was associated with a higher risk for hypertension (OR = 1.66 [95%CI: 1.21; 2.28], P = .002) and dyslipidemia (OR = 1.90 [95%CI: 1.38; 2.56], P < .0001) compared with the group without IFG independent of age, sex, and puberty. CONCLUSIONS The prevalence of IFG, when applying the ADA criterion compared with the WHO criterion, was 4 times higher in individuals with overweight and obesity and 14 times higher in individuals with normal weight in this study sample of children and adolescents. IFG was associated with a higher risk of hypertension and dyslipidemia compared with their normoglycemic peers regardless of the definition applied.
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Affiliation(s)
- Julie T Kloppenborg
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Department of Pediatrics, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Cilius E Fonvig
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Tenna R H Nielsen
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Pernille M Mollerup
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Christine Bøjsøe
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Oluf Pedersen
- Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Johannesen
- Department of Pediatrics, Copenhagen University Hospital Herlev, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Christian Holm
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,Section of Metabolic Genetics, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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48
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Arslanian S, Kim JY, Nasr A, Bacha F, Tfayli H, Lee S, Toledo FGS. Insulin sensitivity across the lifespan from obese adolescents to obese adults with impaired glucose tolerance: Who is worse off? Pediatr Diabetes 2018; 19:205-211. [PMID: 28726334 DOI: 10.1111/pedi.12562] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/06/2017] [Accepted: 06/20/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Youth type 2 diabetes mellitus (T2DM) occurs decades earlier than adult T2DM and is characterized by high therapeutic failure rates and decreased response to insulin sensitizers suggesting a more severe disease process than in adults. To explain these observations, we hypothesized that insulin resistance is worse in obese youth than adults with impaired glucose tolerance (IGT), a state of high-risk for T2DM. As proof-of-concept, we compared insulin sensitivity between BMI-, sex-, and race-matched obese youth vs adults with IGT. METHODS This retrospective analysis of IGT youth and adults included 34 obese adolescents matched (2:1) for BMI, sex, and race to 17 adults. Hepatic and peripheral insulin sensitivity were measured by [6,6-2 H2 ]glucose and hyperinsulinemic-euglycemic clamp. Body composition (DEXA) and serum lipid profile were examined. RESULTS Despite similar percent body fat, obese adolescents had 2-fold higher fasting insulin concentration, lower hepatic (~53%) and peripheral (~42%) insulin sensitivity and lower HDL compared with adults (all P < .01). Surrogate estimate of insulin sensitivity, 1/fasting insulin was lower and HOMA-IR was higher in adolescents vs adults. Adults had a more atherogenic lipid profile with higher total-, LDL-, and non-HDL cholesterol. CONCLUSIONS Obese youth and adults with IGT differ in that youth are more insulin resistant than adults in spite of similar adiposity. This could potentially explain the earlier onset of T2DM in youth through an early and amplified burden on a β-cell destined to decompensate, and explicate their lower therapeutic response to insulin sensitizers.
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Affiliation(s)
- Silva Arslanian
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joon Young Kim
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexis Nasr
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fida Bacha
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Hala Tfayli
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - SoJung Lee
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frederico G S Toledo
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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49
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Hannon TS, Watson SE, Jalou HE, Chakravorty S, Mather KJ, Arslanian SA. Characteristics of Obstructive Sleep Apnea Across the Spectrum of Glucose Tolerance in Obese Adolescents. Front Endocrinol (Lausanne) 2018; 9:281. [PMID: 29910773 PMCID: PMC5992282 DOI: 10.3389/fendo.2018.00281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/14/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND It is not known if dysglycemia and sleep-disordered breathing are linked in adolescents, as in adults. OBJECTIVE To perform a pilot study evaluating measures of sleep-disordered breathing across the spectrum of glucose tolerance in obese adolescents. We hypothesized that dysglycemia would be associated with sleep-disordered breathing. PARTICIPANTS/METHODS This was a prospective, cross-sectional clinical pilot study that included 57 adolescents [body mass index (BMI) 38.9 ± 8.4 kg/m2] aged 12-18 years (14.5 ± 1.6) with normal glucose tolerance (NGT), or dysglycemia [impaired glucose tolerance (IGT) or type 2 diabetes (T2D)]. MEASURES Anthropometrics, overnight polysomnogram, and oral glucose tolerance tests were performed. Participant characteristics and outcome measures were compared by glucose tolerance status. Correlational analyses were conducted to assess the associations between variables of interest. RESULTS Participants with dysglycemia (n = 21) were not different from those with NGT (n = 36) for BMI, waist circumference, body fat, or sleep characteristics. Nocturnal oxygen desaturation was associated with higher BMI (r = -0.334, p = 0.012). The apnea-hypopnea index (AHI) was not associated with physical and metabolic parameters. Although participants with dysglycemia tended to have higher AHIs (median 3.2, 2.2, and 1.6 events/h for T2D, IGT, and NGT, respectively), there was not a linear relationship between measures of glycemia and AHI. CONCLUSION Further study with a larger proportion of youth with prediabetes and T2D is necessary to determine whether evaluation for sleep-disordered breathing is uniformly warranted.
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Affiliation(s)
- Tamara S. Hannon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Tamara S. Hannon,
| | - Sara E. Watson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - Hasnaa E. Jalou
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sangeeta Chakravorty
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Kieren J. Mather
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Silva A. Arslanian
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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50
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Bjornstad P, Nehus E, El Ghormli L, Bacha F, Libman IM, McKay S, Willi SM, Laffel L, Arslanian S, Nadeau KJ. Insulin Sensitivity and Diabetic Kidney Disease in Children and Adolescents With Type 2 Diabetes: An Observational Analysis of Data From the TODAY Clinical Trial. Am J Kidney Dis 2017; 71:65-74. [PMID: 29157731 DOI: 10.1053/j.ajkd.2017.07.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/25/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetic kidney disease is a major cause of premature mortality in type 2 diabetes mellitus (T2DM). Worsening insulin sensitivity independent of glycemic control may contribute to the development of diabetic kidney disease. We investigated the longitudinal association of insulin sensitivity with hyperfiltration and increased albumin excretion in adolescents with T2DM. STUDY DESIGN Observational prospective cohort study. SETTING & PARTICIPANTS 532 TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) participants aged 12 to 17 years with T2DM duration less than 2 years at baseline. The TODAY Study was a multicenter randomized clinical trial that examined the efficacy of 3 treatment regimens (metformin monotherapy, metformin plus rosiglitazone, or metformin plus an intensive lifestyle intervention program) to achieve durable glycemic control. PREDICTORS Natural log-transformed estimated insulin sensitivity (reciprocal of fasting insulin), hemoglobin A1c concentration, age, race-ethnicity, treatment group, body mass index, loss of glycemic control, and hypertension. OUTCOMES Hyperfiltration was defined as 99th percentile or higher of estimated glomerular filtration rate (≥140mL/min/1.73m2) when referenced to healthy adolescents (NHANES 1999-2002) and albumin-creatinine ratio ≥ 30μg/mg at 3 consecutive annual visits. RESULTS Hyperfiltration was observed in 7.0% of participants at baseline and in 13.3% by 5 years, with a cumulative incidence of 5.0% over 5 years. The prevalence of increased albumin excretion was 6% at baseline and 18% by 5 years, with a cumulative incidence of 13.4%. There was an 8% increase in risk for hyperfiltration per 10% lower estimated insulin sensitivity in unadjusted and adjusted models (P=0.01). Increased albumin excretion was associated with hemoglobin A1c concentration, but not estimated insulin sensitivity. LIMITATIONS Longer follow-up is needed to capture the transition from hyperfiltration to rapid glomerular filtration rate decline in youth-onset T2DM. CONCLUSIONS Lower estimated insulin sensitivity was associated with risk for hyperfiltration over time, whereas increased albumin excretion was associated with hyperglycemia in youth-onset T2DM.
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Affiliation(s)
- Petter Bjornstad
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Edward Nehus
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Laure El Ghormli
- George Washington University Biostatistics Center, Rockville, MD.
| | - Fida Bacha
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Ingrid M Libman
- Children's Hospital University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Steven M Willi
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Silva Arslanian
- Children's Hospital University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kristen J Nadeau
- University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
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