Department of Pediatrics No. 1 and Neonatology, Kharkiv National Medical University, Kharkiv, Ukraine.
Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Biomédica la Princesa, Madrid, Spain.
Horm Res Paediatr. 2020;93(11-12):622-633. doi: 10.1159/000515730. Epub 2021 Apr 26.
The obesity epidemic has become one of the most important public health issues of modern times. Impaired insulin sensitivity seems to be the cornerstone of multiple obesity related comorbidities. However, there is no accepted definition of impaired insulin sensitivity.
We hypothesize that assessment of insulin resistance differs between centers.
The ESPE Obesity Working Group (ESPE ObWG) Scientific Committee developed a questionnaire with a focus on the routine practices of assessment of hyperinsulinemia and insulin resistance, which was distributed through Google Docs platform to the clinicians and researchers from the current ESPE ObWG database (n = 73). Sixty-one complete responses (84% response rate) from clinicians and researchers were analyzed: 32 from European Union (EU) centers (representatives of 14 countries) and 29 from Non-EU centers (representatives from 10 countries). Standard statistics were used for the data analysis.
The majority of respondents considered insulin resistance (IR) as a clinical tool (85.2%) rather than a research instrument. For the purpose of IR assessment EU specialists prefer analysis of the oral glucose tolerance test (OGTT) results, whereas non-EU ones mainly use Homeostatic Model Assessment of Insulin Resistance (HOMA-IR; p = 0.032). There was no exact cutoff for the HOMA-IR in either EU or non-EU centers. A variety of OGTT time points and substances measured per local protocol were reported. Clinicians normally analyzed blood glucose (88.52% of centers) and insulin (67.21%, mainly in EU centers, p = 0.0051). Furthermore, most participants (70.5%) considered OGTT insulin levels as a more sensitive parameter of IR than glucose. Meanwhile, approximately two-thirds (63.9%) of the centers did not use any cutoffs for the insulin response to the glucose load.
Since there is no standard for the IR evaluation and uniform accepted indication of performing, an OGTT the assessment of insulin sensitivity varies between EU and non-EU centers. A widely accepted standardized protocol is needed to allow comparison between centers.
肥胖症已成为现代最重要的公共卫生问题之一。胰岛素敏感性受损似乎是多种肥胖相关合并症的基石。然而，目前尚没有公认的胰岛素敏感性受损定义。
我们假设不同中心对胰岛素抵抗的评估存在差异。
ESPE 肥胖工作组（ESPE ObWG）科学委员会制定了一份问卷，重点关注评估高胰岛素血症和胰岛素抵抗的常规实践，该问卷通过 Google Docs 平台分发给来自当前 ESPE ObWG 数据库的临床医生和研究人员（n=73）。对 61 名来自欧盟（EU）中心的临床医生和研究人员（代表 14 个国家）和 29 名来自非 EU 中心的临床医生和研究人员（代表 10 个国家）的完整回复进行了分析。使用标准统计学方法进行数据分析。
大多数受访者认为胰岛素抵抗（IR）是一种临床工具（85.2%），而不是一种研究工具。对于 IR 评估，欧盟专家更喜欢分析口服葡萄糖耐量试验（OGTT）结果，而非欧盟专家主要使用稳态模型评估胰岛素抵抗（HOMA-IR；p=0.032）。在欧盟或非欧盟中心，HOMA-IR 均没有确切的截断值。报告了各种 OGTT 时间点和按当地方案测量的物质。临床医生通常分析血糖（88.52%的中心）和胰岛素（67.21%，主要在欧盟中心，p=0.0051）。此外，大多数参与者（70.5%）认为 OGTT 胰岛素水平比葡萄糖更能敏感地反映 IR。同时，大约三分之二（63.9%）的中心未对葡萄糖负荷后胰岛素反应使用任何截断值。
由于缺乏 IR 评估的标准和统一的执行指征，OGTT 评估胰岛素敏感性在欧盟和非欧盟中心之间存在差异。需要制定广泛接受的标准化方案，以实现中心之间的比较。
