NEW YORK (Reuters Health) Mar 13 – Researchers from the Yale University School of Medicine report a high prevalence of impaired glucose tolerance in severely obese children and adolescents. In addition, the investigators found that glucose tolerance testing is an effective method for identifying obese children at high risk of type 2 diabetes.
Writing in the March 14th issue of The New England Journal of Medicine, Dr. Sonia Caprio and colleagues from New Haven, Connecticut, report the results of glucose tolerance testing among a multiethnic cohort of 167 obese children, 4 to 10 years of age, and adolescents 11 to 18 years of age. The subjects also had glucose, insulin and C-peptide levels measured.
Among the 55 obese children, 25% had impaired glucose tolerance, as did 21% of the 112 obese adolescents. Additionally, 4% of the adolescents were diagnosed with silent type 2 diabetes, Dr. Caprio's team notes.
Insulin and C-peptide levels were elevated in the subjects with impaired glucose tolerance, but not in the adolescents with silent type 2 diabetes, whose levels were similar to subjects without impaired glucose tolerance. Insulin resistance, which was higher in subjects with impaired glucose tolerance, was the best predictor of impaired glucose tolerance, after controlling for body mass index, the investigators add
"I never thought the incidence of impaired glucose tolerance would have been this high," Dr. Caprio told Reuters Health. "These children are at very high risk for developing type 2 diabetes if they do not reduce their weight and increase their exercise; they are already in a prediabetic stage."
Dr. Caprio's group concludes that "this cross-sectional study suggests that insulin resistance, initially associated with hyperinsulinemia and hyperproinsulinemia, is the most important risk factor linked to the development of impaired glucose tolerance in severe childhood obesity. In the presence of established diabetes, beta-cell failure becomes fully manifest."
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