Silfen M E, Manibo A M, McMahon D J, Levine L S, Murphy A R, Oberfield S E
Department of Pediatric Endocrinology, Columbia University, New York, New York 10032, USA.
J Clin Endocrinol Metab. 2001 Jun;86(6):2863-8. doi: 10.1210/jcem.86.6.7537.
Insulin resistance is a strong predictor of the development of type 2 diabetes mellitus and cardiovascular disease. Girls with premature adrenarche (PA) or obesity may be at an increased risk for the development of insulin resistance. Recently, in prepubertal girls with PA, a fasting glucose to insulin ratio (FGIR) of less than 7 was found to be predictive of insulin resistance as determined by the frequently sampled iv glucose tolerance test. We sought to compare the FGIR with 2 insulin sensitivity measures, SiM (an adjusted mean measure of insulin sensitivity based on fasting and 2 h post glucose load insulin sensitivity measures) and the composite whole body insulin sensitivity index, ISI(comp), both derived from the 2-h oral glucose tolerance test in 2 groups of children at risk: girls with PA and obese girls. We studied 25 prepubertal girls with PA and/or obesity and further classified them as insulin resistant (IR) or insulin sensitive (IS) based on the FGIR. Four simple measures of insulin sensitivity [FGIR, quantitative insulin sensitivity check index (QUICKI), fasting insulin resistance index, and fasting insulin] were compared with SiM and ISI(comp). Additionally, we characterized the subjects in terms of risk factors associated with insulin resistance according to their insulin resistance status based on the FGIR. In our subjects the strongest correlations overall appeared to be between FGIR and SiM, FGIR and ISI(comp), QUICKI and SiM, and QUICKI and ISI(comp) [correlations (r) ranged from 0.81--0.84]. Furthermore, the IR group had higher body mass index and body mass index z-scores and triglyceride levels than the IS group and were over 3 times more likely to have triglycerides greater than the 95th percentile compared with national norms. We conclude that the FGIR and QUICKI are highly correlated with oral glucose tolerance test measures of insulin sensitivity. An FGIR less than 7 in young girls with PA or obesity may be helpful in the early identification of children at risk for complications of insulin resistance.
胰岛素抵抗是2型糖尿病和心血管疾病发生的有力预测指标。患有性早熟（PA）或肥胖的女孩发生胰岛素抵抗的风险可能会增加。最近，在性早熟的青春期前女孩中，发现空腹血糖与胰岛素比值（FGIR）小于7可预测胰岛素抵抗，这是通过频繁采样静脉葡萄糖耐量试验确定的。我们试图比较FGIR与两种胰岛素敏感性指标，SiM（基于空腹和葡萄糖负荷后2小时胰岛素敏感性指标的调整后胰岛素敏感性平均指标）和复合全身胰岛素敏感性指数ISI(comp)，这两种指标均来自两组有风险儿童的2小时口服葡萄糖耐量试验：性早熟女孩和肥胖女孩。我们研究了25名青春期前患有PA和/或肥胖的女孩，并根据FGIR将她们进一步分为胰岛素抵抗（IR）或胰岛素敏感（IS）组。将四种简单的胰岛素敏感性指标[FGIR、定量胰岛素敏感性检查指数（QUICKI）、空腹胰岛素抵抗指数和空腹胰岛素]与SiM和ISI(comp)进行比较。此外，我们根据基于FGIR的胰岛素抵抗状态，对受试者与胰岛素抵抗相关的危险因素进行了特征描述。在我们的受试者中，总体上最强的相关性似乎出现在FGIR与SiM、FGIR与ISI(comp)、QUICKI与SiM以及QUICKI与ISI(comp)之间[相关性（r）范围为0.81 - 0.84]。此外，IR组的体重指数、体重指数z评分和甘油三酯水平高于IS组，与国家规范相比，甘油三酯水平高于第95百分位数的可能性是IS组的3倍多。我们得出结论，FGIR和QUICKI与口服葡萄糖耐量试验中的胰岛素敏感性指标高度相关。PA或肥胖的年轻女孩中FGIR小于7可能有助于早期识别有胰岛素抵抗并发症风险的儿童。
