Phenotypic Type 2 Diabetes in Obese Youth

Abstract

OBJECTIVE— Some obese youth with a clinical diagnosis of type 2 diabetes have evidence of islet cell autoimmunity with positive autoantibodies. In this study, we investigated the differences in insulin sensitivity and secretion between autoantibody-negative (Ab − ) and -positive (Ab + ) youth with clinically diagnosed type 2 diabetes in comparison with control subjects. RESEARCH DESIGN AND METHODS— Sixteen Ab − and 26 Ab + clinically diagnosed type 2 diabetic patients and 39 obese control youth underwent evaluation of insulin sensitivity (3-h hyperinsulinemic-euglycemic clamp), substrate oxidation (indirect calorimetry), first- and second-phase insulin secretion (2-h hyperglycemic clamp), body composition and abdominal adiposity (dual energy X-ray absorptiometry and computed tomography scan, respectively), and glucose disposition index (first-phase insulin secretion × insulin sensitivity). RESULTS— Insulin-stimulated total, oxidative, and nonoxidative glucose disposal, and suppression of fat oxidation during hyperinsulinemia were significantly lower in Ab − compared with Ab + clinically diagnosed type 2 diabetic and control subjects with no difference between the latter two. First- and second-phase insulin secretion and C-peptide were lower in Ab + compared with Ab − type 2 diabetes. Glucose disposition index was not different between the Ab − and Ab + clinically diagnosed type 2 diabetic patients, but both were significantly lower than that in control subjects. Systolic blood pressure and alanine aminotransferase were higher in Ab − versus Ab + clinically diagnosed type 2 diabetic patients, whereas the frequency of ketonuria at diagnosis was higher in Ab + versus Ab − patients. CONCLUSIONS— Islet-cell Ab − clinically diagnosed type 2 diabetic youth are characterized by severe insulin resistance and relative insulin deficiency, whereas Ab + youth have severe insulin deficiency and β-cell failure. The former group has additional features of insulin resistance. These important metabolic differences could influence the natural history of hyperglycemia, insulin dependence, and clinical outcomes in these youth.

Antidiabetic effect of Merremia emarginata Burm. F. in streptozotocin induced diabetic rats

“…The activities of both glucose-6-phosphatase and fructose-1, 6-bisphosphatase are increased in the liver during the diabetic condition [43] . Treatment with M. emarginata has appreciably normalized the activity of these enzymes.…”

“…The high concentration of blood glucose and other biochemical abnormalities result from a deficiency of 毬-cells of the endocrine pancreas and/or from a sub sensitivity to insulin in target cells [4][5][6] . A worldwide survey reported that the estimated incidence of diabetes and projection for year 2030 is 350 million [7,8] .…”

Breakthrough in Diabetes Therapy ... Just Around the Corner?

“…In contrast, type 2 diabetes is another syndrome, most frequently seen in obese adults, and is a consequence of the development over time of a target cell resistance to the action of the natively produced insulin. Now this distinction is becoming unclear again since an increased incidence of sedentary lifestyles, synergized with excessive calorific intake, has led to an increase in the frequency of obese children becoming type 1 diabetics [1]. In their review presented in this issue, Coppieters and von Herrath propose a "continuous spectrum", with type 1 and type 2 diabetes positioned at opposite ends.…”

The Physiological Effects of Dandelion (Taraxacum Officinale) in Type 2 Diabetes

“…Failure of β-cells to produce adequate amounts of insulin is attributed to high levels of free fatty acids present in the plasma. This results in a decrease of glucose transportation into the muscle cells, thereby increasing levels of glucose and fat in the blood plasma, eventually causing hyperglycemia and lipid oxidation, which can be controlled by the anti-oxidative property of dandelion [93,94]. In a study evaluating the effects of anti-oxidant on C57BL/6J mice fed a high-fat and -cholesterol diet using leafy mixed vegetable extracts (including dandelion), a significant drop in lipid peroxidation in various organs including the liver was observed [95].…”