Kostopoulou Eirini, Skiadopoulos Spyridon, Partsalaki Ioanna, Rojas Gil Andrea Paola, Spiliotis Bessie E
Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University of Patras School of Medicine, Patras 26504, Greece.
Department of Medical Physics, School of Medicine, University of Patras, Patras 26504, Greece.
World J Clin Pediatr. 2021 May 9;10(3):29-39. doi: 10.5409/wjcp.v10.i3.29.
Data regarding the most suitable diagnostic method for the diagnosis of glucose impairment in asymptomatic children and adolescents are inconclusive. Furthermore, limited data are available on the reproducibility of the oral glucose tolerance test (OGTT) in children and adolescents who are obese (OB).
To investigate the usefulness of the OGTT as a screening method for glucose dysregulation in children and adolescents.
Eighty-one children and adolescents, 41 females, either overweight (OW), OB or normal weight (NW) but with a strong positive family history of type 2 diabetes mellitus (T2DM), were enrolled in the present observational study from the Outpatient Clinic of Paediatric Endocrinology of the University Hospital of Patras in Greece. One or two 3-h OGTTs were performed and glucose, insulin and C-peptide concentrations were measured at several time points ( = 0 min, = 15 min, = 30 min, = 60 min, = 90 min, = 120 min, = 180 min).
Good repetitiveness was observed in the OGTT response with regard to T2DM, while low repetitiveness was noted in the OGTT response with regard to impaired glucose tolerance (IGT) and no repetitiveness with regard to impaired fasting glucose (IFG). In addition, no concordance was observed between IFG and IGT. During the 1 and 2 OGTTs, no significant difference was found in the glucose concentrations between NW, OW and OB patients, whereas insulin and C-peptide concentrations were higher in OW and OB compared to NW patients at several time points during the OGTTs. Also, OW and OB patients showed a worsening insulin and C-peptide response during the 2 OGTT as compared to the 1 OGTT.
In mild or moderate disorders of glucose metabolism, such as IFG and IGT, a diagnosis may not be reached using only one OGTT, and a second test or additional investigations may be needed. When glucose metabolism is profoundly impaired, as in T2DM, one OGTT is probably more reliable and adequate for establishing the diagnosis. Excessive weight and/or a positive family history of T2DM possibly affect the insulin and C-peptide response in the OGTT from a young age.
关于无症状儿童和青少年葡萄糖耐量受损最合适诊断方法的数据尚无定论。此外，关于肥胖（OB）儿童和青少年口服葡萄糖耐量试验（OGTT）重复性的数据有限。
研究OGTT作为儿童和青少年葡萄糖调节异常筛查方法的实用性。
从希腊帕特雷大学医院儿科内分泌门诊招募了81名儿童和青少年，其中41名女性，体重超重（OW）、肥胖（OB）或体重正常（NW），但有2型糖尿病（T2DM）的强烈阳性家族史。进行了一次或两次3小时OGTT，并在几个时间点（0分钟、15分钟、30分钟、60分钟、90分钟、120分钟、180分钟）测量血糖、胰岛素和C肽浓度。
观察到OGTT对T2DM的反应具有良好的重复性，而对糖耐量受损（IGT）的OGTT反应重复性较低，对空腹血糖受损（IFG）则无重复性。此外，未观察到IFG和IGT之间的一致性。在第一次和第二次OGTT期间，NW、OW和OB患者的血糖浓度无显著差异，而在OGTT期间的几个时间点，OW和OB患者的胰岛素和C肽浓度高于NW患者。此外，与第一次OGTT相比，OW和OB患者在第二次OGTT期间的胰岛素和C肽反应更差。
在轻度或中度糖代谢紊乱（如IFG和IGT）中，仅使用一次OGTT可能无法做出诊断，可能需要进行第二次检查或其他调查。当糖代谢严重受损时，如在T2DM中，一次OGTT可能更可靠且足以确立诊断。超重和/或T2DM的阳性家族史可能从年轻时就影响OGTT中的胰岛素和C肽反应。
