Impaired Glucose Tolerance in Obese white Children and Adolescents: Three to Five year follow-up in Untreated Patients

Abstract

Objective: Impaired glucose tolerance (IGT) is a predictor of type 2 diabetes in adults. However, the converting rate from IGT to diabetes is largely unknown in obese children.

Methods: We analyzed all 128 obese white European children diagnosed with IGT at our institution in the years 2003–2006 (mean age 13.5±2.1 years, 53% female, mean BMI 31.7±6.1 kg/m²) 3.0–5.6 years (mean 3.9±0.6 years) later with an oral glucose tolerance test (oGTT).

Results: At follow-up, 20 (16%) children remained in the IGT status, 96 (75%) children converted to normal glucose metabolism, 3 (2%) children developed type 2 diabetes, and 9 (7%) children were lost to follow-up. Comparing the children according to their outcome concerning glucose metabolism at follow-up demonstrated that 2 h glucose levels in oGTT at baseline were significantly (p<0.001) higher in the children remaining IGT and highest in children developing diabetes, while the children did not differ in respect of age, gender, BMI, blood pressure, fasting glucose levels at baseline, or length of follow-up period. Apart from children developing diabetes, who increased their body weight, all the other children did not change their BMI, blood pressure, or fasting glucose levels significantly at follow-up.

Conclusions: Obese white children with IGT will likely convert to normal glucose metabolism in the next 3–5 years. Risk factors for developing type 2 diabetes in follow-up were higher 2 h glucose levels in oGTT at baseline and weight gain.

impaired glucose tolerance - type 2 diabetes - conversion rate - obesity - course of disease

References

• 1 American Diabetes Association . Type 2 diabetes in children and adolescents.  Diabetes Care. 2000;  23 381-389
• 2 Fox CS, Sullivan L, D’Agostino Sr. RB. et al . The significant effect of diabetes duration on coronary heart disease mortality: the Framingham Heart Study.  Diabetes Care. 2004;  27 704-708
• 3 Nguyen QM, Srinivasan SR, Xu JH. et al . Changes in risk variables of metabolic syndrome since childhood in pre-diabetic and type 2 diabetic subjects: the Bogalusa Heart Study.  Diabetes Care. 2008;  31 2044-2049
• 4 Reinehr T. Clinical presentation of type 2 diabetes mellitus in children and adolescents.  Int J Obes (Lond). 2005;  29 (S 02) S105-S110
• 5 Wabitsch M, Hauner H, Hertrampf M. et al . Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany.  Int J Obes Relat Metab Disord. 2004;  28 307-313
• 6 Cambuli VM, Incani M, Pilia S. et al . Oral glucose tolerance test in Italian overweight/obese children and adolescents results in a very high prevalence of impaired fasting glycaemia, but not of diabetes.  Diabetes Metab Res Rev. 2009;  25 528-534
• 7 Rotteveel J, Belksma EJ, Renders CM. et al . Type 2 diabetes in children in the Netherlands: the need for diagnostic protocols.  Eur J Endocrinol. 2007;  157 175-180
• 8 Bonora E, Kiechl S, Willeit J. et al . Population-based incidence rates and risk factors for type 2 diabetes in white individuals: the Bruneck study.  Diabetes. 2004;  53 1782-1789
• 9 Rasmussen SS, Glumer C, Sandbaek A. et al . Progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screening programme in general practice: the ADDITION Study, Denmark.  Diabetologia. 2007;  50 293-297
• 10 Rasmussen SS, Glumer C, Sandbaek A. et al . Determinants of progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screened population: 3 year follow-up in the ADDITION study, Denmark.  Diabetologia. 2008;  51 249-257
• 11 Libman IM, Barinas-Mitchell E, Bartucci A. et al . Reproducibility of the oral glucose tolerance test in overweight children.  J Clin Endocrinol Metab. 2008;  93 4231-4237
• 12 Kleber M, Lass N, Papcke S. et al . One year follow-up of untreated obese white children and adolescents with impaired glucose tolerance: high conversion rate to normal glucose tolerance.  Diabet Med. 2010;  in press
• 13 Weiss R, Taksali SE, Tamborlane WV. et al . Predictors of changes in glucose tolerance status in obese youth.  Diabetes Care. 2005;  28 902-909
• 14 http://http: www.a-g-a.de/Leitlinie.pdf Guidelines of the German working group on obese children and adolescents.  2010; 
• 15 Reinehr T, Hinney A, de SG. et al . Definable somatic disorders in overweight children and adolescents.  J Pediatr. 2007;  150 618-622
• 16 Reinehr T, Kleber M, Toschke AM. Lifestyle intervention in obese children is associated with a decrease of the metabolic syndrome prevalence.  Atherosclerosis. 2009;  207 174-180
• 17 Kromeyer-Hausschild K, Gläßer N, Zellner K. Waist Circumference percentile in Jena children (Germany) 6–18 years of age.  Aktuel Ernaehr Med. 2008;  33 116-122
• 18 Cole TJ, Bellizzi MC, Flegal KM. et al . Establishing a standard definition for child overweight and obesity worldwide: international survey.  BMJ. 2000;  320 1240-1243
• 19 National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. . The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.  Pediatrics. 2004;  114 555-576
• 20 Abdul-Ghani MA, Tripathy D, Defronzo RA. Contributions of beta-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose.  Diabetes Care. 2006;  29 1130-1139
• 21 Arslanian SA. Type 2 diabetes mellitus in children: pathophysiology and risk factors.  J Pediatr Endocrinol Metab. 2000;  13 (S 06) 1385-1394
• 22 Hannon TS, Janosky J, Arslanian SA. Longitudinal study of physiologic insulin resistance and metabolic changes of puberty.  Pediatr Res. 2006;  60 759-763
• 23 Reinehr T, Kleber M, Toschke AM. Lifestyle intervention in obese children is associated with a decrease of the metabolic syndrome prevalence.  Atherosclerosis. 2009; 
• 24 Franks PW, Hanson RL, Knowler WC. et al . Childhood predictors of young-onset type 2 diabetes.  Diabetes. 2007;  56 2964-2972
• 25 Glans F, Eriksson KF, Segerstrom A. et al . Evaluation of the effects of exercise on insulin sensitivity in Arabian and Swedish women with type 2 diabetes.  Diabetes Res Clin Pract. 2009;  85 69-74
• 26 Morrison JA, Glueck CJ, Horn PS. et al . Pre-teen insulin resistance predicts weight gain, impaired fasting glucose, and type 2 diabetes at age 18–19 y: a 10-y prospective study of black and white girls.  Am J Clin Nutr. 2008;  88 778-788

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