Evaluation of glycaemic status in young people with clinical insulin resistance; fasting glucose, fasting insulin or an oral glucose tolerance test?

Garnett, Sarah P.; Srinivasan, Shubha; Birt, Stewart G.; Ambler, Geoffrey; Lawrie, Elizabeth A.; Cowell, Chris; Craig, Maria E.

doi:10.1111/j.1365-2265.2009.03677.x

Cited by 15 publications

(16 citation statements)

References 30 publications

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“…An oral glucose tolerance test was performed after an overnight fast at baseline, 3 and 12 months [26] and whole body insulin sensitivity index (ISI) calculated using the Matsuda equation [27]. Fasting blood drawn at baseline, 3, 6 and 12 months was analyzed using standard techniques for glucose, insulin and blood lipids as previously described [16].…”

Section: Measurementsmentioning

confidence: 99%

Sustained improvements in fitness and exercise tolerance in obese adolescents after a 12 week exercise intervention

Gow

Doorn

Broderick

et al. 2016

Obesity Research & Clinical Practice

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Section: Measurementsmentioning

confidence: 99%

Sustained improvements in fitness and exercise tolerance in obese adolescents after a 12 week exercise intervention

Gow

Doorn

Broderick

et al. 2016

Obesity Research & Clinical Practice

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“…It remains unclear whether the same cutoffs should apply to youth, and whether mild elevations during the increased insulin resistance of puberty will persist [41 ▪ ,52,53 ▪ ,54,55 ▪ ]. Both fasting and OGTT-based measures can be problematic for early diagnosis [17 ▪▪ ,26,56 ▪ ,57 ▪ ,58,59], HbA1c and OGTT values are poorly correlated [41 ▪ ], repeated OGTT’s have poor reproducibility in youth [60] and HbA1 can vary substantially depending on method, making diagnosis of prediabetes and early T2DM difficult. One recent proposal was to conduct OGTTs in children with a HbA1c more than 5.5% [61], whereas others recently proposed an algorithm including glucose, triglycerides and BMI; HbA1c did not add to the predictive value of this method [62 ▪▪ ].…”

Section: Prevalence and Diagnosis Of Pediatric Type 2 Diabetes Mellitusmentioning

confidence: 99%

Insulin resistance in type 2 diabetic youth

Mizokami-Stout

Cree-Green

Nadeau

2012

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review This review focuses on recent literature on insulin resistance in youth with type 2 diabetes mellitus (T2DM). Insulin resistance is associated with a variety of cardiometabolic problems leading to increased morbidity and mortality across the lifespan. Recent findings Functional pancreatic β-cell changes play a role in the transition from obesity to impaired glucose tolerance (IGT). Insulin resistance drives islet cell upregulation, manifested by elevated glucagon and c-peptide levels, early in the transition to IGT. Surrogate measurements of insulin resistance and insulin secretion exist but their accuracy compared to clamp data is imperfect. Recent large longitudinal studies provide detailed information on the progression from normoglycemia to T2DM and on the phenotype of T2DM youth. Defining prediabetes and T2DM remains a challenge in youth. Lifestyle interventions do not appear as effective in children as in adults. Metformin remains the only oral hypoglycemic agent approved for T2DM in youth. Summary New insights exist regarding the conversion from insulin resistance to T2DM, measurement of insulin resistance and phenotypes of insulin resistance youth, but more information is needed. Surrogate measurements of insulin resistance, additional treatment options for insulin resistance and individualization of treatment options for T2DM adolescents in particular require further investigation.

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“…33 Although with some well-recognized limitations, most current publications suggest the HOMA-IR index to classify IR. 36 , 37 Studies in adults have defined a value ≥2.5 as the cut-off for IR. 38-40 Studies in different geographic populations, however, have proposed a higher or lower cut-off.…”

Section: Discussionmentioning

confidence: 99%

Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance

González-Saldivar

Rodríguez-Gutiérrez

Treviño-Alvarez

et al. 2018

Dermato-Endocrinology

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Any clinical/biochemical marker revealing obesity or diabetes before their appearance is valuable. Insulin resistance (IR) is present in both disorders many years before occurrence. Accordingly, we determined whether acanthosis nigricans (AN) in the knuckles is associated to higher insulin and homeostasis model assessment for estimated insulin resistance (HOMA-IR) index values, and assessed the influence of body-mass index (BMI) and the diagnostic performance of AN in the knuckles to detect IR. In this cross-sectional controlled study, we included men or women, 18 to 23 years old, with or without AN in the knuckles. In 149 cases with AN in the knuckles and 145 controls, fasting insulin was higher in cases (13.45 µU/mL ± 7.8 vs. 8.59 µU/mL ± 3.63, P < .001, respectively). Mean HOMA-IR index was also higher (2.86 ± 1.68 vs. 1.78 ± 0.77, P < .001). A significant increase in fasting insulin and HOMA-IR values between and within BMI groups from normal through obese category was identified in controls and cases. By multivariate regression analysis, cases with normal BMI were significantly associated to a HOMA-IR ≥2.5 (OR = 3.09, CI95% = 1.75–5.48, P = .001). A model of AN in the knuckles, normal BMI, and increased waist circumference allowed identifying 2 out of 3 cases with HOMA-IR index ≥2.5. AN in the knuckles could be addressed with two aims: as an easy, accessible, and costless diagnostic tool suggesting hyperinsulinemia secondary to IR, and, an early marker of IR even in the absence of overweight or obesity.

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Evaluation of glycaemic status in young people with clinical insulin resistance; fasting glucose, fasting insulin or an oral glucose tolerance test?

Abstract: Fasting glucose and insulin levels should be measured in young people with insulin resistance before undertaking a time- and resource-intensive OGTT.

Cited by 15 publications

References 30 publications

Sustained improvements in fitness and exercise tolerance in obese adolescents after a 12 week exercise intervention

Sustained improvements in fitness and exercise tolerance in obese adolescents after a 12 week exercise intervention

Insulin resistance in type 2 diabetic youth

Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance

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