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

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

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Rocchini, A. P. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article Related Article by Goran, M. I. PubMed Citation

ABSTRACT

Background Childhood obesity, epidemic in the United States, has been accompanied by an increase in the prevalence of type 2 diabetes among children and adolescents. We determined the prevalence of impaired glucose tolerance in a multiethnic cohort of 167 obese children and adolescents.

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

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

Conclusions Impaired glucose tolerance is highly prevalent among children and adolescents with severe obesity, irrespective of ethnic group. Impaired oral glucose tolerance was associated with insulin resistance while beta-cell function was still relatively preserved. Overt type 2 diabetes was linked to beta-cell failure.

Source Information

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.

Full Text of this Article

Related Letters:

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.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:290-292, Jul 25, 2002. Correspondence

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