Jaruratanasirikul Somchit, Thammaratchuchai Sudarat, Puwanant Maneerat, Mo-Suwan Ladda, Sriplung Hutcha
J Pediatr Endocrinol Metab. 2016 Nov 1;29(11):1267-1275. doi: 10.1515/jpem-2016-0195.
Childhood obesity is associated with abnormal glucose metabolism and type 2 diabetes mellitus (T2DM). This study evaluated the prevalence of abnormal glucose metabolism in asymptomatic obese children and adolescents, and determined the percentage of T2DM development after 3-6 years of follow-up.
During 2007-2013, 177 obese children and adolescents who had normal fasting plasma glucose (FPG<100 mg/dL) were given an oral glucose tolerance test (OGTT). The participants were classified into four groups: normal glucose tolerance (NGT), NGT-hyperinsulinemia (NGT-HI), impaired glucose tolerance (IGT), and diabetes mellitus (DM). Blood chemistries, including FPG, glycated hemoglobin, and lipid profiles, and liver function test were performed every 6-12 months or when the patient developed any symptom or sign indicative of diabetes.
Glucose metabolism alterations were detected in 81.4% of the participants: 63.8% with NGT-HI, 15.3% with IGT, and 2.3% with T2DM. The median levels of homeostasis model assessment-insulin resistance (HOMA-IR) in patients with IGT (8.63) were significantly greater than those in the patients with NGT (4.04) (p<0.01). During the follow-up, 22 patients (14.4%) developed T2DM significantly more from the IGT group (nine of 33 cases, 27.3%) than the NGT-HI group (12 of 108 cases, 11.1%) (p=0.022). The predicting parameters for T2DM conversion were weight status, body mass index (BMI), FBG, fasting insulin, alanine transaminase (ALT) levels, and HOMA-IR.
Glucose metabolism alteration was commonly found among obese adolescents. Factors associated with T2DM development were greater weight status and the severity of insulin resistance as shown by higher HOMA-IR levels.
儿童肥胖与糖代谢异常及2型糖尿病（T2DM）相关。本研究评估了无症状肥胖儿童和青少年糖代谢异常的患病率，并确定了随访3至6年后T2DM的发病百分比。
在2007年至2013年期间，对177名空腹血糖正常（FPG<100 mg/dL）的肥胖儿童和青少年进行口服葡萄糖耐量试验（OGTT）。参与者被分为四组：糖耐量正常（NGT）、糖耐量正常-高胰岛素血症（NGT-HI）、糖耐量受损（IGT）和糖尿病（DM）。每6至12个月或当患者出现任何提示糖尿病的症状或体征时，进行包括FPG、糖化血红蛋白和血脂谱在内的血液生化检查以及肝功能检查。
81.4%的参与者检测到糖代谢改变：63.8%为NGT-HI，15.3%为IGT，2.3%为T2DM。IGT患者的稳态模型评估-胰岛素抵抗（HOMA-IR）中位数水平（8.63）显著高于NGT患者（4.04）（p<0.01）。随访期间，22名患者（14.4%）发展为T2DM，IGT组（33例中的9例，27.3%）比NGT-HI组（108例中的12例，11.1%）显著更多（p=0.022）。T2DM转化的预测参数为体重状况、体重指数（BMI）、空腹血糖（FBG）、空腹胰岛素、丙氨酸转氨酶（ALT）水平和HOMA-IR。
肥胖青少年中常见糖代谢改变。与T2DM发展相关的因素是更高的体重状况以及更高HOMA-IR水平所显示的胰岛素抵抗程度。
