Insulin Resistance in Children: Consensus, Perspective, and Future Directions

Institut National de la Santé et de la Recherche Médicale, Unité 690, Hôpital Robert Debré, Université Paris Diderot, 75013 Paris, France.
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.31). 12/2010; 95(12):5189-98. DOI: 10.1210/jc.2010-1047
Source: PubMed

ABSTRACT Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points.
The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants.
An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children.
The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement.
Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases.

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    ABSTRACT: Childhood obesity has followed, during the last two decades, an ascending trend. Insulin resistance (IR) is central to the pathophysiology of obesity. So far, several methods of assessing IR have been proposed. We aimed to evaluate critically some of the simplest methods used to assess IR in the pediatric population. We studied retrospectively the records of children evaluated for obesity in the " Louis Ţurcanu " Emergency Hospital for Children Timişoara, over a period of 10 years. The study population consisted of 342 children. Anthropomet-ric and metabolic variables were analyzed, and the following indices of IR were assessed: impaired glucose tolerance (IGT), Homeostatic Model of Assesment-IR (HOMA-IR), Homeostatic Model of Assesment-b (HOMA-β), Quantitative Insulin Sensitivity Check Index (QUICKI) as well as the TG/HDLc ratio. Data was expresed as frequencies, means ± standard deviations or median ± interquartile interval for or a 95% confi dence interval. The t-test for independent groups or the Mann-Whitney test to assess differences of IR indices across weight, gender and pubertal categories. HOMA-IR diagnosed the most children with IR, at the opposite pole we found QUICKI. IGT was a rare fi nding. It is necessary to reconsider how we assess the carbohydrate metabolism in children. Of the methods we evaluated, HOMA-IR is the optimal method for assessing IR children.
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    ABSTRACT: Fasting insulin concentrations are increasingly being used as a surrogate for insulin resistance and risk for type 2 diabetes (T2DM), although associations with adult outcomes are unclear. Our objective was to determine whether fasting insulin concentrations in childhood associate with later T2DM. Fasting insulin values were available from 2478 participants in the longitudinal Cardiovascular Risk in Young Finns Study at baseline age 3 to 18 years, along with data on adult T2DM (N = 84, mean age = 39.6 years). Among 3- to 6-year-olds, a 1-SD increase in fasting insulin was associated with a relative risk (RR) of 2.04 (95% confidence interval [CI], 1.54-2.70) for later T2DM, which remained significant after we adjusted for BMI and parental history of T2DM. For those aged 9 to 18 years, a 1-SD increase in insulin was associated with an RR of 1.32 (95% CI, 1.06-1.65) for T2DM, but this became nonsignificant after we adjusted for BMI and parental history of T2DM. In the latter age group, a 1-SD increase in BMI was associated with an RR of 1.45 (95% CI, 1.21-1.73) for T2DM, with adjustment for insulin and parental history of T2DM not improving this association. BMI in younger children was not associated with later T2DM. In life course analyses, those with T2DM had higher fasting insulin levels in early childhood and later adulthood but not in peripubertal years. Elevated fasting insulin concentrations in early childhood, but not adolescence, are independently associated with an elevated risk of T2DM in adulthood. Copyright © 2015 by the American Academy of Pediatrics.
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    ABSTRACT: Despite improvements in glucose, lipids and blood pressure control, vascular complications remain the most important cause of morbidity and mortality in patients with type 1 diabetes. For that reason, there is a need to identify additional risk factors to utilize in clinical practice or translate to novel therapies to prevent vascular complications. Reduced insulin sensitivity is an increasingly recognized component of type 1 diabetes that has been linked with the development and progression of both micro- and macrovascular complications. Adolescents and adults with type 1 diabetes have reduced insulin sensitivity, even when compared to their non-diabetic counterparts of similar adiposity, serum triglycerides, high-density lipoprotein cholesterol, level of habitual physical activity, and in adolescents, pubertal stage. Reduced insulin sensitivity is thought to contribute both to the initiation and progression of macro- and microvascular complications in type 1 diabetes. There are currently clinical trials underway examining the benefits of improving insulin sensitivity with regards to vascular complications in type 1 diabetes. Reduced insulin sensitivity is an increasingly recognized component of type 1 diabetes, is implicated in the pathogenesis of vascular complications and is potentially an important therapeutic target to prevent vascular complications. In this review, we will focus on the pathophysiologic contribution of insulin sensitivity to vascular complications and summarize related ongoing clinical trials.

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May 17, 2014