Abstract
BackgroundAdolescence, due to transient pubertal insulin resistance (IR), is associated with a higher risk for disturbances of glucose metabolism. The aim of our study was 1) to investigate the prevalence of disturbances of glucose metabolism, 2) to define gender specific homeostasis model assessment of insulin resistance (HOMA-IR) thresholds associated with increased cardiometabolic risks and 3) to provide predictors of HOMA-IR.MethodsThe studied cohort consisted of Czech adolescents aged 13.0-17.9 years: 1,518 individuals of general population and three studied groups according weight category (615 normal weight, 230 overweight and 683 obese). The prevalence of IR, impaired fasting glucose (IFG) and type 2 diabetes was assessed. Risky HOMA-IR thresholds based on components of metabolic syndrome were investigated. HOMA-IR prediction was calculated taking into account age, blood pressure, multiple anthropometric, biochemical and hormonal parameters.ResultsIn general population cohort, the prevalence of IFG and type 2 diabetes was 7.0% and <0.5%, respectively. Boys regardless of weight presented significantly higher levels of blood glucose and higher prevalence of IFG than girls. Obese boys were found more insulin resistant than obese girls. HOMA-IR thresholds of 3.6 for girls and 4.4 for boys were associated with increased cardiometabolic risks. For both genders, the model of HOMA-IR prediction was composed of age, BMI, ratio of free triiodthyronine to free thyroxine, gamma-glutamyltransferase activity and levels of triglycerides and sex hormone-binding globulin.ConclusionsThe type 2 diabetes in adolescents, including those who were obese, was rarely diagnosed. Obese adolescent boys were at greater risk for IR and for IFG than obese girls. In adolescence, thresholds of HOMA-IR in contrast to predictors were found gender specific.
Highlights
Insulin resistance (IR) together with an impaired insulin secretion does play a role in the pathogenesis of type 2 diabetes [1]
Significant differences in Body Mass Index (BMI) z-scores, levels of insulin, C-peptide, C-peptide to insulin ratio and homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.000) but not in blood glucose level were found when weight categories were compared between each other in analyses within each gender
HOMA-IR of 3.6 for girls and of 4.4 for boys were identified as cut-off values that corresponded to increased cardiometabolic risks defined as a presence of three components of metabolic syndrome (Table 2)
Summary
Insulin resistance (IR) together with an impaired insulin secretion does play a role in the pathogenesis of type 2 diabetes [1]. Patients with impaired fasting glucose (IFG) are referred to as having prediabetes and they are considered at risk for future development of type 2 diabetes [13]. Higher prevalence of IFG is usually found in obese adolescents than in normal weight counterparts [14]. The prevalence of type 2 diabetes in children varies across the world but an increasing trend due to obesity epidemic is observed. Adolescence, due to transient pubertal insulin resistance (IR), is associated with a higher risk for disturbances of glucose metabolism. The aim of our study was 1) to investigate the prevalence of disturbances of glucose metabolism, 2) to define gender specific homeostasis model assessment of insulin resistance (HOMA-IR) thresholds associated with increased cardiometabolic risks and 3) to provide predictors of HOMA-IR
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