Weiss Ram, Gillis David
Department of Human Nutrition and Metabolism, Hebrew University School of Medicine, Jerusalem, Israel.
Int J Pediatr Obes. 2008;3 Suppl 1:15-20. doi: 10.1080/17477160801896499.
The significant rise in the prevalence of obesity in children and adolescents over the past three decades has led to a rise in the incidence of severe insulin resistance and consequently of type 2 diabetes in this age group. Type 2 diabetes is caused by a combination of increased insulin resistance and decreased insulin secretion. Peripheral insulin resistance is associated with lipid partitioning in specific compartments, i.e., viscera, muscle and liver, more than with obesity per se. The development of an insulin secretory defect is probably a secondary event evolving gradually. Initially only the first phase of insulin secretion is reduced, but later, in overt type 2 diabetes, poor early and late phase insulin secretion are noted as well as defective pro-insulin processing. As glucose metabolic defects deteriorate more rapidly in children than in adults, early identification of children with altered glucose metabolism is important in order to quantify public health needs and to allocate resources for appropriate prevention programs.
在过去三十年中，儿童和青少年肥胖患病率显著上升，导致该年龄组严重胰岛素抵抗的发病率上升，进而导致2型糖尿病的发病率上升。2型糖尿病是由胰岛素抵抗增加和胰岛素分泌减少共同引起的。外周胰岛素抵抗与特定部位（即内脏、肌肉和肝脏）的脂质分配有关，而不仅仅与肥胖本身有关。胰岛素分泌缺陷的发展可能是一个逐渐演变的继发事件。最初只有胰岛素分泌的第一阶段减少，但后来，在显性2型糖尿病中，早期和晚期胰岛素分泌均减少，同时胰岛素原加工也存在缺陷。由于儿童葡萄糖代谢缺陷比成人恶化得更快，因此早期识别葡萄糖代谢改变的儿童对于量化公共卫生需求和为适当的预防计划分配资源非常重要。
