Alternative Methods of Insulin
Sensitivity Assessment in Obese Children and
Adolescents
Sophia M Rössner, MD1,
Martin Neovius, PhD2,
Scott M Montgomery, PhD3,,4,,5,
Claude Marcus, MD, PhD6 and
Svante Norgren, MD, PhD1
1
Division of Pediatrics, Department of Woman and
Child Health, Karolinska Institute, Stockholm,
Sweden
2 Department of Medicine, Karolinska
Institute, Stockholm, Sweden
3 principal research fellow, Clinical
Epidemiology Unit, Karolinska Institute, Stockholm
Sweden
4 Clinical Research Centre, Örebro
University Hospital, Sweden
5 Department of Primary Care and Social
Medicine, Charing Cross Hospital, Imperial College,
London, UK
6 National Childhood Obesity Centre,
Department for Clinical Science, Intervention and
Technology, Division of Pediatrics, Karolinska
Institute, Stockholm, Sweden
sophia.rossner@karolinska.se
ABSTRACT
Objective:
To validate fasting indices against minimal model
analysis of the frequently sampled
intravenous glucose tolerance test (FSIVGTT-MMOD)
in an obese pediatric population.
Research
Design and Methods: FSIVGTT-MMOD results were
compared to HOMA-IR and fasting insulin
with sample stratified by sex, puberty and Si
median in 191 children (82 males;
13.9±2.9y, BMI 36.9±6.2 kg/m2,
BMI-SDS 6.1±1.6).
Results:
Across pubertal groups correlation coefficients
between Si and HOMA-IR ranged
from -0.43 to -0.78 in males, and from -0.53
to -0.57 in females (age and BMI adjusted,
p<0.05 in all instances). Similar results
were seen for fasting insulin. In females
the relationship was significantly weaker in more
insulin resistant subjects.
Conclusions:
The validity of fasting indices in explaining Si
was sex dependent, varied with pubertal
stage, and in females influenced by degree
of insulin sensitivity. In obese pediatric
populations we generally discourage the
use of fasting indices, although the validity
varies within subgroups.
What's the Connection?
People with
diabetes are twice as likely to develop heart
disease than the rest of the population. Among
diabetics, heart disease can progress quicker
than normal.
Why? Diabetes
speeds up hardening of the arteries (also known
as atherosclerosis). This can occur when
cholesterol levels get too high. You may have
heard of LDLs and HDLs. These are the
lipoproteins that carry the cholesterol that
circulates in your body. LDLs, or low-density
proteins, take the cholesterol through the
circulatory system to where it is needed. HDL's,
or high-densitiy proteins, carry what isn't used
back to the liver.
When there is
too much cholesterol, the LDLs deposit the left-over
cholesterol into the blood vessels. Even though
the HDLs try to carry the excess back to the
liver, they can't take it all. The extra
cholesterol that gets left behind forms plaque
on the vessels walls, which makes them less
flexible and more narrow. This raises the risk
for blood clots, heart attacks and strokes.
Diabetics Should Watch
Cholesterol Closely
When someone
has diabetes, the glucose in the blood can slow
down the LDLs and make them "sticky," which
makes the cholesterol build up much faster on
the blood vessel walls. That's why people with
diabetes have to watch their cholesterol levels
more closely and start cholesterol lowering
medications sooner than people who do not have
diabetes.
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