Department of Pediatrics, Division of Pediatric Neurology, Ankara City Hospital, Ankara, Turkey.
Üniversiteler Mahallesi Bilkent Cad, No: 1, Ankara Şehir Hastanesi, Çocuk Hastanesi, B1 katı, Çocuk Nörolojisi Departmanı, Çankaya, Ankara, Turkey.
J Pediatr Endocrinol Metab. 2020 Jul 28;33(7):859-864. doi: 10.1515/jpem-2020-0012.
Objectives To determine the clinical utility of the estimated glucose disposal rate (eGDR) for predicting metabolic syndrome (MetS) in children and adolescents with type-1 diabetes (T1D). Methods Modified criteria of the International Diabetes Federation were used to determine MetS in children and adolescents between 10 and 18 years of age with T1D. The eGDR, a validated marker of insulin sensitivity, was calculated in two different ways using either the waist-to-hip ratio (WHR) or waist circumference (WC). Receiver operating characteristic (ROC) curve analysis was performed to ascertain cut-off levels of the eGDR to predict MetS. Results A total of 200 patients (52% male) with T1D were enrolled in the study. The prevalence of MetS was 10.5% (n: 21). Lower eGDR levels, indicating greater insulin resistance, were found in T1D patients with MetS when compared to those without (6.41 ± 1.86 vs. 9.50 ± 1.34 mg/kg/min) (p < 0.001). An eGDRWHR cut-off of 8.44 mg/kg/min showed 85.7% sensitivity and 82.6% specificity, while an eGDRWC cut-off of 8.16 mg/kg/min showed 76.1% sensitivity and 92.1% specificity for MetS diagnosis. The diagnostic odds ratio was 28.6 (7.3-131.0) for the eGDRWHR cut-off and 37.7 (10.8-140.8) for the eGDRWC cut-off. Conclusions The eGDR is a mathematical formula that can be used in clinical practice to detect the existence of MetS in children and adolescents with T1D using only the WC, existence of hypertension, and hemoglobin A1c levels. An eGDR calculated using the WC could be a preferred choice due to its higher diagnostic performance.
目的 确定估计葡萄糖处置率（eGDR）在预测 1 型糖尿病（T1D）儿童和青少年代谢综合征（MetS）中的临床实用性。
方法 使用国际糖尿病联合会的改良标准来确定 10 至 18 岁患有 T1D 的儿童和青少年的 MetS。eGDR 是胰岛素敏感性的验证标志物，使用腰臀比（WHR）或腰围（WC）以两种不同的方式计算。进行接收者操作特征（ROC）曲线分析，以确定 eGDR 的截断值来预测 MetS。
结果 共纳入 200 例（52%为男性）T1D 患者。MetS 的患病率为 10.5%（n：21）。与无 MetS 的 T1D 患者相比，患有 MetS 的 T1D 患者的 eGDR 水平更低，表明胰岛素抵抗更严重（6.41±1.86 vs. 9.50±1.34 mg/kg/min）（p<0.001）。eGDRWHR 截断值为 8.44 mg/kg/min 时，敏感性为 85.7%，特异性为 82.6%，而 eGDRWC 截断值为 8.16 mg/kg/min 时，敏感性为 76.1%，特异性为 92.1%。eGDRWHR 截断值的诊断比值比为 28.6（7.3-131.0），eGDRWC 截断值为 37.7（10.8-140.8）。
结论 eGDR 是一个数学公式，可用于临床实践中，仅使用 WC、高血压的存在和糖化血红蛋白水平来检测 T1D 儿童和青少年中 MetS 的存在。由于其更高的诊断性能，使用 WC 计算的 eGDR 可能是首选。
