Calcaterra Valeria, Cena Hellas, De Silvestri Annalisa, Girgenti Vincenza, Bommarito Denisia, Pelizzo Gloria
Pediatric and Adolescence Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.
Pediatric Unit, Department of the Mother and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Front Neurol. 2019 Aug 29;10:947. doi: 10.3389/fneur.2019.00947. eCollection 2019.
Insulin resistance (IR) plays a key role in the pathogenesis of type 2 diabetes (T2D). In neurologically impaired (NI) children unfavorable cardio-metabolic risk profile with high prevalence of IR has been reported. We evaluated the prevalence of T2D in NI children and adolescents, in order to define if a dedicated glucose monitoring may be recommended in these subjects. We retrospectively evaluated 63 patients (11.4 ± 4.0 years) with severe disabilities. Auxological parameters were recorded. Metabolic blood assays included fasting blood glucose (FBG), fasting insulin, triglycerides (TG). IR was detected with the homeostasis model assessment for insulin resistance (HOMA-IR > 97.5th percentile for age and sex) and triglyceride-glucose index (TyG index > 7.88). Elevated FBG was defined with values >100 mg/dl. T2D was defined according to American Diabetes Association criteria. Impaired insulin sensitivity, pathological TyG index and elevated FBG were observed, respectively, in 41.3, 63.5, and 11.1% patients. T2D was diagnosed in 3.2% asymptomatic patients. The prevalence of diabetes was higher in pre-pubertal compared to pubertal subjects ( = 0.03). T2D in NI children and adolescents without obesity could represent a new emerging entity. IR and/or surrogate markers of IR index may be useful for the primary screening of this at-risk disabled population so as to prevent diabetes.
胰岛素抵抗（IR）在2型糖尿病（T2D）的发病机制中起关键作用。据报道，在神经功能受损（NI）的儿童中，存在不良的心脏代谢风险特征，且IR患病率较高。我们评估了NI儿童和青少年中T2D的患病率，以确定是否建议对这些受试者进行专门的血糖监测。我们回顾性评估了63例严重残疾患者（年龄11.4±4.0岁）。记录了人体测量学参数。代谢血液检测包括空腹血糖（FBG）、空腹胰岛素、甘油三酯（TG）。采用胰岛素抵抗稳态模型评估（HOMA-IR>年龄和性别的第97.5百分位数）和甘油三酯-葡萄糖指数（TyG指数>7.88）检测IR。FBG值>100mg/dl定义为升高。T2D根据美国糖尿病协会标准定义。分别在41.3%、63.5%和11.1%的患者中观察到胰岛素敏感性受损、病理性TyG指数和FBG升高。在3.2%无症状患者中诊断出T2D。青春期前患者的糖尿病患病率高于青春期患者（P = 0.03）。NI儿童和青少年中无肥胖的T2D可能代表一种新出现的疾病实体。IR和/或IR指数的替代标志物可能有助于对这一高危残疾人群进行初步筛查，以预防糖尿病。
