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Impaired glucose tolerance and type 2 diabetes mellitus: a new field for pediatrics in Europe

Abstract

OBJECTIVE:

Several studies have shown that obese children and adolescence seem to have an increased risk to develop a disturbed glucose metabolism as already known for obese adults. This might result in the same disastrous outcomes of cardiovascular diseases as it has been shown for adult obese patients. The most sensitive measurement for detecting changes in glucose metabolism in obese children seems to be an oral glucose tolerance test (OGGT) which is not practical for all daily outpatient clinics.

DESIGN:

Cross-sectional study.

SUBJECTS AND MEASUREMENTS:

We therefore made a preselection from a cohort of 491 subjects according to the American Diabetes Association (ADA) criteria for the diagnosis of diabetes. In the selected high-risk subgroup (n=102) of obese pediatric subjects, we measured the prevalence of impaired glucose tolerance (IGT) by OGTT.

RESULTS:

We diagnosed six patients with type 2 diabetes and 37 patients with impaired glucose tolerance. In addition, we found a close correlation of IGT to disturbances of triglyceride and cholesterol parameters. This prevalence was comparable to a similar study group that was screened without preselection.

CONCLUSIONS:

These prevalence data further underline the need to diagnose children with obesity-associated risk factors in terms of an insulin resistance syndrome. The preselection of a high-risk subgroup by ADA criteria might be a practical approach.

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References

  1. Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL . Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995; 149: 1085–1091.

    Article  CAS  Google Scholar 

  2. Chinn S, Rona RJ . Can the increase in body mass index explain the rising trend in asthma in children? Thorax 2001; 56: 845–850.

    Article  CAS  Google Scholar 

  3. Deckelbaum RJ, Williams CL . Childhood obesity: the health issue. Obes Res 2001; 9 (Suppl 4): 239S–243S.

    Article  Google Scholar 

  4. Delekat D, Kis A . Gesundheitsberichterstattung Berlin - Zur gesundheitlichen Lage von Kindern in Berlin -. Berlin: Senatsverwaltung Arbeit Soziales Frauen 2003; 2: 52–66.

    Google Scholar 

  5. Rosenbloom AL, Joe JR, Young RS, Winter WE . Emerging epidemic of type 2 diabetes in youth. Diabetes Care 1999; 22: 345–354.

    Article  CAS  Google Scholar 

  6. Fagot-Campagna A . Emergence of type 2 diabetes mellitus in children: epidemiological evidence. J Pediatr Endocrinol Metab 2000; 13: 1395–1402.

    Article  Google Scholar 

  7. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S . Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002; 346: 802–810.

    Article  CAS  Google Scholar 

  8. Invitti C, Guzzaloni G, Gilardini L, Morabito F, Viberti G . Prevalence and concomitants of glucose intolerance in European obese children and adolescents. Diabetes Care 2003; 26: 118–124.

    Article  Google Scholar 

  9. Drake AJ, Smith A, Betts PR, Crowne EC, Shield JP . Type two diabetes in obese white children. Arch Dis Child 2002; 86: 207–208.

    Article  CAS  Google Scholar 

  10. Polonsky KS, Sturis J, Bell GI . Seminars in Medicine of the Beth Israel Hospital, Boston. Non-insulin-dependent diabetes mellitus—a genetically programmed failure of the beta cell to compensate for insulin resistance. N Engl J Med 1996; 334: 777–783.

    Article  CAS  Google Scholar 

  11. Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK . Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 1990; 263: 2893–2898.

    Article  CAS  Google Scholar 

  12. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343–1350.

    Article  CAS  Google Scholar 

  13. Type 2 diabetes in children and adolescents. American Diabetes Association. Pediatrics 2000; 105: 671–680.

    Article  Google Scholar 

  14. Cole F, Preece MA . The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990; 44: 45–60.8.

    CAS  PubMed  Google Scholar 

  15. Kromeyer-Hausschild W, Kunze D, Wabitsch M, Geller K . Perzentile für den Body-mass-Index für das Kindes-und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd 2001; 149: 807–818.

    Article  Google Scholar 

  16. Institute NH . Task force on blood pressure control in children. Pediatrics 1987; 79: 1–25.

    Google Scholar 

  17. Marshall T . Variations in patterns of pubertal changes in girls. Arch Dis Child 1979; 44: 291–303.

    Article  Google Scholar 

  18. Marshall T . Variations in patterns of pubertal changes in boys. Arch Dis Child 1979; 45: 13–23.

    Article  Google Scholar 

  19. Alberti Z . New diagnostic criteria and classification of diabetes-again? Diabetes Med 1998; 15: 535–536.

    Article  CAS  Google Scholar 

  20. Alberti KG, Zimmet PZ . Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetes Med 1998; 15: 539–553.

    Article  CAS  Google Scholar 

  21. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC . Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.

    Article  CAS  Google Scholar 

  22. Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MB, Monauni T, Muggeo M . Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 2000; 23: 57–63.

    Article  CAS  Google Scholar 

  23. Matsuda M, DeFronzo RA . Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999; 22: 1462–1470.

    Article  CAS  Google Scholar 

  24. Phillips C, Hales CN, Osmond C . Understanding oral glucose tolerance: comparison of glucose or insulin measurements during the oral glucose tolerance test with specific measurements of insulin resistance and secretion. Diabetes Med 1993; 11: 286–292.

    Article  Google Scholar 

  25. Efendic L . Aspects of the pathogenesis of type 2 diabetes. Endocr Rev 1984; 5: 395–410.

    Article  CAS  Google Scholar 

  26. Haffner SM, Miettinen H, Gaskill SP, Stern MP . Decreased insulin secretion and increased insulin resistance are independently related to the 7-year risk of NIDDM in Mexican-Americans. Diabetes 1995; 44: 1386–1391.

    Article  CAS  Google Scholar 

  27. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20: 1183–1197.

  28. Reaven GM . Role of insulin resistance in human disease. Diabetes 1988; 37: 1595–1607.

    Article  CAS  Google Scholar 

  29. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis OF Diagnostic Criteria in Europe. Lancet 1999; 354: 617–621.

  30. Wabitsch M, Hauner H, Hertrampf M, Muche R, Hay B, Mayer H, Kratzer W, Debatin k, Heinze E . Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany. Int J Obes Relat Metab Disord 2004; 28: 307–313.

    Article  CAS  Google Scholar 

  31. Fagot-Campagna A, Saaddine JB, Engelgau MM . Is testing children for type 2 diabetes a lost battle? Diabetes Care 2000; 23: 1442–1443.

    Article  CAS  Google Scholar 

  32. Ehtisham B, Barret TG, Shaw NJ . Type 2 diabetes mellitus in UK children—an emerging problem. Diabetes Med 2000; 17: 867–871.

    Article  CAS  Google Scholar 

  33. Arslanian S, Suprasongsin C . Insulin sensitivity, lipids, and body composition in childhood: is ‘syndrome’ present? J Clin Endocrinol Metab 1996; 81: 1058–1062.

    Article  CAS  Google Scholar 

  34. Young-Hyman D, Schlundt DG, Herman L, De Luca F, Counts D . Evaluation of insulin resistance syndrome in 5- to 10-year old overweight/obese African-American children. Diabetes Care 2001; 24: 1359–1364.

    Article  CAS  Google Scholar 

  35. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS . Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics 2001; 108: 712–718.

    Article  CAS  Google Scholar 

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Wiegand, S., Dannemann, A., Krude, H. et al. Impaired glucose tolerance and type 2 diabetes mellitus: a new field for pediatrics in Europe. Int J Obes 29 (Suppl 2), S136–S142 (2005). https://doi.org/10.1038/sj.ijo.0803081

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