High normal fasting glucose level in obese youth: a marker for insulin resistance and beta cell dysregulation

Abstract

Aims/hypothesis A high but normal fasting plasma glucose level in adults is a risk factor for future development of type 2 diabetes mellitus and cardiovascular disease. We investigated whether normal fasting plasma glucose levels (<5.60 mmol/l) are associated with decreases in insulin sensitivity and beta cell function, as well as an adverse cardiovascular profile in obese youth. Methods We performed a cross-sectional analysis in a multiethnic sample of 1,020 obese youth (614 girls and 406 boys; mean age 12.9 years [CI 95% 12.7-13.1], BMI z score 2.34 [CI 95% 2.31-2.38]) with normal fasting plasma glucose. All participants had a standard OGTT, with calculation of indices of insulin sensitivity and beta cell function. For the analysis, prepubertal and pubertal participants were stratified into quartiles of normal fasting plasma glucose. Results We observed a significant increase in fasting insulin and AUC 2 h glucose across quartiles. Pronounced changes were observed in insulin sensitivity and secretion, particularly in the pubertal group. Moreover, the odds of presenting with impaired glucose tolerance increased by 4.5% with each 0.06 mmol/l increase in fasting plasma glucose. No significant differences in cardiovascular indices were seen across quartiles. Conclusions/interpretation These data suggest that in obese youth, independent of age, BMI z score, sex, family history and ethnicity, insulin sensitivity and secretion decline when moving from low to high normal fasting plasma glucose. The simple measure of fasting plasma glucose could assist clinicians in identifying children for targeted diabetes screening and subsequent lifestyle management.

Evidence Brief – Trends and projections of obesity among Canadians

“…2,3 Obese children have increased cardiometabolic risk, including dyslipidemia, insulin resistance and elevated blood pressure. 4,5,6 Excess childhood body weight that continues into adulthood can affect quality of life, educational attainment and earnings over the lifecourse. projects that obesity among Canadian children aged 6 to 17 years will stabilize after 2013, resulting in 1 in 7 children being obese (Figure 1).…”

Ageing and fasting glucose values – the role of cardiovascular events

“…With respect to the large number of participants, we have focused our evaluation on the glucose levels after an overnight fast. According to published data, high normal fasting glucose values in younger obese individuals correlate with insulin resistance and beta cell dysregulation [28]. In men without diabetes insulin resistance was of predictive value for early cardiovascular morbidity [29].…”

Perbandingan Kadar Gula Darah Puasa pada Anak Obes dengan Resistensi Insulin dan Tanpa Resistensi Insulin

“…6 Nilai kadar gula darah puasa normal, tetapi dalam rentang tinggi berisiko sebagai tahap awal anak mengalami resistensi insulin (pre-prediabetes). 7 Atas dasar pemikiran ini, maka penelitian ini dilakukan untuk mengetahui apakah ada perbedaan bermakna nilai gula darah puasa pada anak obes dengan resistensi insulin dan tanpa resistensi insulin. Hal tersebut dapat membantu skrining sederhana anak berisiko terjadinya resistensi insulin dalam upaya mencegah DM tipe-2 di kemudian hari dengan intervensi sedini mungkin.…”

“…27 Dihipotesiskan bahwa anak gemuk dengan peningkatan kadar gula darah puasa, odd rasio dari penurunan sensitivitas insulin, dan disregulasi sel beta serta profil penyakit jantung akan lebih tinggi. 7 Penelitian Samuel dkk 25 mendapatkan bahwa subyek dengan kadar nilai gula darah puasa <90 mg/dL lebih toleran terhadap glukosa, dan lebih sensitif terhadap insulin dibanding subyek dengan kadar gula darah puasa yang lebih tinggi sekalipun masih dalam batas normal. Penelitian ini juga menyatakan bahwa pada subyek yang sehat, sensitivitas insulin bisa dilihat dari kadar gula darah puasa.…”