Prevalence of Impaired Glucose Tolerance among Children and Adolescents with Marked Obesity

doi:10.1056/NEJMoa012578

A correction has been published: N Engl J Med 2002;346(22):1756.

A correction has been published: N Engl J Med 2002;347(4):290.

Volume 346:802-810		March 14, 2002		Number 11

Prevalence of Impaired Glucose Tolerance among Children and Adolescents with Marked Obesity

Ranjana Sinha, M.D., Gene Fisch, Ph.D., Barbara Teague, R.N., William V. Tamborlane, M.D., Bruna Banyas, R.N., Karin Allen, R.N., Mary Savoye, R.D., Vera Rieger, M.D., Sara Taksali, M.P.H., Gina Barbetta, R.D., Robert S. Sherwin, M.D., and Sonia Caprio, M.D.

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ABSTRACT

Background Childhood obesity, epidemic in the United States,has been accompanied by an increase in the prevalence of type2 diabetes among children and adolescents. We determined theprevalence of impaired glucose tolerance in a multiethnic cohortof 167 obese children and adolescents.

Methods All subjects underwent a two-hour oral glucose-tolerancetest (1.75 mg of glucose per kilogram of body weight), and glucose,insulin, and C-peptide levels were measured. Fasting levelsof proinsulin were obtained, and the ratio of proinsulin toinsulin was calculated. Insulin resistance was estimated byhomeostatic model assessment, and beta-cell function was estimatedby calculating the ratio between the changes in the insulinlevel and the glucose level during the first 30 minutes afterthe ingestion of glucose.

Results Impaired glucose tolerance was detected in 25 percentof the 55 obese children (4 to 10 years of age) and 21 percentof the 112 obese adolescents (11 to 18 years of age); silenttype 2 diabetes was identified in 4 percent of the obese adolescents.Insulin and C-peptide levels were markedly elevated after theglucose-tolerance test in subjects with impaired glucose tolerancebut not in adolescents with diabetes, who had a reduced ratioof the 30-minute change in the insulin level to the 30-minutechange in the glucose level. After the body-mass index had beencontrolled for, insulin resistance was greater in the affectedcohort and was the best predictor of impaired glucose tolerance.

Conclusions Impaired glucose tolerance is highly prevalent amongchildren and adolescents with severe obesity, irrespective ofethnic group. Impaired oral glucose tolerance was associatedwith insulin resistance while beta-cell function was still relativelypreserved. Overt type 2 diabetes was linked to beta-cell failure.

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From the Departments of Pediatrics (R.S., W.V.T., V.R., S.T., G.B., S.C.) and Internal Medicine (R.S.S.), the Children's General Clinical Research Center (G.F., B.T., B.B., K.A., M.S.), and the Division of Biostatistics, Department of Epidemiology and Public Health (G.F.), Yale University School of Medicine, New Haven, Conn.

Address reprint requests to Dr. Caprio at the Department of Pediatrics, Yale University School of Medicine, 333 Cedar St., P.O. Box 208064, New Haven, CT 06520, or at sonia.caprio{at}yale.edu.

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Impaired Glucose Tolerance in Obese Children and Adolescents
Goran M. I., Uwaifo G. I., Elberg J., Yanovski J. A., Invitti C., Gilardini L., Viberti G., Speiser P. W., Gaenzer H., Caprio S., Rocchini A. P.
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N Engl J Med 2002; 347:290-292, Jul 25, 2002. Correspondence

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