Insulin resistance in children with nephrotic syndrome with long-term glucocorticoid treatment and its intervention

Abstract

Objective To investigate children with nephrotic syndrome(NS) receiving long-term glucocorticoid treatment while monitoring insulin resistance(IR) index, and analyze the influencing factors, and to observe the efficacy of metformin for preventing glucocorticoid-induced obesity and diabetes mellitus type 2. Methods A total of 32 cases including 20 boys and 12 girls with mean age of 7.6 years old(2 to 14 years old), were diagnosed as NS.All children undergoing long-term treatment of prednisone>1 mg/(kg·d) for at least 3 months.The height, body weight and body mass index(BMI) were monitored.The concentrations of serum insulin and C-peptide were determined by radioimmunoassay, the concentrations of serum HbA1c were determined by high performance liquid chromatography, and the levels of fasting glucose, cholesterol and triglyceride were measured with an automatic measuring analyzer(American ABBO TT CCX-Ⅱ). The homeostasis model assessment-estimated insulin resistance(HOMA-IR) was calculated; When HOMA-IR>3.5, the patients were given metformin treatment for 12 weeks while supervising their height, weight, fasting blood glucose levels monthly. Results Out of 32 cases of NS with long-term use of prednisone, 23 cases had HOMA-IR>3.5(72%). Thus, IR group included 23 patients, and non-IR(NIR) group had 9 patients.There were significant differences between 2 groups in BMI, age, prednisone dosage and the levels of triglyceride(TG)(all P<0.05). After 12 weeks of metformin treatment, the HOMA-IR(5.24±1.82 vs 2.54±1.09, P<0.01), HbA1c levels[(6.36±0.82)% vs(5.39±0.51)%, P<0.05], BMI[(27.42±6.12) kg/m2vs(22.72±5.48) kg/m2, P<0.01], and TG levels[(2.03±1.10) mmol/L vs(1.45±0.48) mmol/L, P<0.05] were significantly reduced. Conclusions Older children with long-term use of glucocorticoid may easily lead to IR.Therefore, monitoring the HOMA-IR and early administration of metformin is helpful for prevention and treatment of glucocorticoid-induced obesity and diabetes mellitus type 2. Key words: Insulin resistance index; Nephrotic syndrome; Prednisone; Metformin; Child