The incidence of insulin resistance based on indices calculated using the HOMA and Belfiore methods and its impact on the occurrence of metabolic complications in prepubertal children born small for gestational age.

INTRODUCTION: Children born small for gestational age (SGA) are predisposed to obesity, insulin resistance (IR), and lipid disorders. The HOMA-IR index is commonly used to assess IR (IRIHOMA), calculated from fasting glucose and insulin. However, sometimes, during the oral glucose tolerance test (OGTT), elevated and prolonged postprandial insulin secretion is observed despite normal fasting insulin levels. IRIBelfiore is an IR index that analyses glucose and insulin levels during OGTT according to the method proposed by Belfiore. THE AIM OF THE STUDY: was to assess the frequency of IR based on IRIHOMA and IRIBelfiore results in SGA children aged 6-8 years, after catch-up phenomenon, to determine the usefulness of IRIBelfiore in diagnosis of IR and in predicting future metabolic complications. MATERIAL AND METHODS: In 129 SGA normal-height children, aged 6-8 years, height, weight, waist circumference, blood pressure, as well as lipids, IGF-1, cortisol, C-peptide, leptin, adiponectin, and resistin concentrations were measured. The glucose and insulin concentrations were evaluated at 0, 60, and 120 minutes of OGTT. RESULTS: IRIHOMA was normal in all children, while elevated IRIBelfiore was found in 22.5% of them. Children with IR diagnosed by IRIBelfiore were taller, had higher blood pressure, higher leptin, and lower HDL-cholesterol concentrations. CONCLUSIONS: It seems worth recommending IRIBelfiore derived from OGTT as a valuable diagnostic tool for identifying IR in SGA prepubertal children. Abnormal IRIBelfiore is related to higher blood pressure and lower HDL-cholesterol concentration in this group.

Ghrelin, insulin-like growth factor I and adipocytokines concentrations in born small for gestational age prepubertal children after the catch-up growth.

BACKGROUND: In children born small for gestational age (SGA) with catch-up growth, a higher risk of insulin resistance (IR) and cardiovascular diseases is noted. Ghrelin stimulates a growth hormone (GH) secretion and regulates lipid and carbohydrate metabolism. We assessed gherlin's influence on achieving normal height and the occurrence of metabolic complications in SGA children. METHODS: Ghrelin, insulin-like growth factor type I (IGF-I), leptin, adiponectin, resistin, glucose, insulin and lipid concentrations were analysed in 134 prepubertal children in four groups: normal-height SGA, short SGA, normal-height born appropriate for gestational age (AGA) and short AGA. RESULTS: Ghrelin and IGF-I concentrations were significantly higher while adiponectin - lower in normal-height SGA comparing to others. CONCLUSIONS: The increased production of ghrelin and IGF-I seems to be an adaptive mechanism to achieve normal growth in SGA children. The significance of high ghrelin and low adiponectin concentrations, observed in normal-height prepubertal SGA children, requires elucidation, with reference to the development of metabolic complications.

Psychiatric Disorders and Health-Related Quality of Life in Children With Type 1 Diabetes Mellitus.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is a chronic condition with major effect on health-related quality of life (HRQoL) and mental health. In 1990s, high rates of psychiatric disorders were reported among children with T1DM. Little is known, however, about current prevalence of psychiatric disorders in children with T1DM and the relation between psychiatric diagnosis and HRQoL. OBJECTIVE: The aim of the study was to determine the prevalence of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) psychiatric disorders and the association between psychiatric comorbidity and HRQoL in the pediatric population with T1DM. METHODS: We conducted a cross-sectional study of 207 children, aged 8-18 years, diagnosed with T1DM. The presence of psychiatric disorders has been assessed by the standard diagnostic interview according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria. HRQoL was measured by the general and diabetes mellitus-specific modules of the Paediatric Quality of Life Inventory. RESULTS: Of the evaluated patients, 26.6% (N = 55) met the criteria for psychiatric disorders at the time of evaluation. The most common diagnoses were anxiety (N = 32; 15.5%) and mood disorders (N = 8; 3.9%). One-third of the patients (N = 66, 31.9%) met the criteria for at least 1 psychiatric diagnosis in their lifetime. The presence of psychiatric disorders was related to an elevated hemoglobin A1c level (8.6% vs 7.6%) and a lowered HRQoL level in the general pediatric quality of life inventory. In the diabetes mellitus-specific pediatric quality of life inventory, children with psychiatric disorders revealed more symptoms of diabetes mellitus, treatment barriers, and lower adherence than children without psychiatric disorders. CONCLUSIONS: T1DM in children is associated with a very high prevalence of psychiatric comorbidity, which is related to elevated hemoglobin A1c and lower HRQoL levels.

The influence of INS VNTR class III allele on auxological parameters, glucose, insulin, lipids, and adipocytokines secretion in prepubertal children born small for gestational age.

INTRODUCTION: The insulin gene variable number of tandem repeats (INS VNTR) class III allele has been implicated in lower birth weight, obesity, and insulin resistance. We assessed its influence on birth weight in the Polish population and on the current body mass and metabolic profile in prepubertal children born small for gestational age (SGA). MATERIAL AND METHODS: DNA for genotyping of INS VNTR was available for 123 subjects born SGA and 132 born appropriate for gestational age (AGA). We identified two alleles: class I and class III. Next, in 112 prepubertal (aged: 6.8 ± 1.38 years) SGA children, the auxological measurements, fasting serum C-peptide, triglycerides, cholesterol, ghrelin, leptin, adiponectin, resistin, cortisol, and insulin-like growth factor type I (IGF-I) concentrations, as well as glucose and insulin during oral glucose tolerance test (OGTT), were assessed and insulin resistance indices were calculated. The results were analysed depending on INS VNTR variants. RESULTS: The occurrence of individual INS VNTR variants were similar in the SGA and AGA groups. In prepubertal SGA children, we did not observe any statistical differences as regards birth weight, body mass, lipids, or adipocytokine concentrations among I/I, I/III, and III/III class groups. The concentration of insulin in 120' of OGTT was significantly higher in class III homozygous than in class I homozygous individuals. CONCLUSIONS: Variant INS VNTR class III was shown not to be associated in any essential way with birth weight in the Polish population. Among prepubertal SGA children, the presence of INS VNTR class III is related to higher insulin secretion during OGTT. (Endokrynol Pol 2016; 67 (6): 585-591).

Frequency of the E23K polymorphism of the KCNJ11 gene in children born small for gestational age and its influence on auxological and metabolic parameters in the prepubertal period.

BACKGROUND: The E23K variant of the KCNJ11 gene is possibly responsible for changes in insulin secretion during the fetal life. We tried to assess the influence of the E23K variant on birth weight and metabolic profile in prepubertal children born small for gestational age (SGA). SUBJECTS: One hundred and twenty-three SGA and 132 born appropriate for gestational age (AGA) children were genotyped for the E23K variant. Lipids, glucose, and insulin concentrations during oral glucose tolerance test were assessed in 112 SGA prepubertal children. RESULTS: There were no significant differences between the frequency of the E23K variant in SGA and AGA children. In SGA children with E23K, the mean birth weight was significantly higher than in the E23E group. Body mass index, glucose, insulin, and lipids were not different between the E23K, E23E, and K23K groups. CONCLUSIONS: The higher birth weight in SGA children with the E23K variant may be related to higher insulin concentrations in the fetal period. The E23K variant did not affect metabolic disorders in prepubertal SGA children.

Metabolic syndrome components among children born small for gestational age: analysis of the first decade of life.

INTRODUCTION AND AIM OF THE STUDY: In children born small for gestational age (SGA), some of the metabolic syndrome (MS) components are observed. The goal of the study was an evaluation of the incidence of particular components of MS in 5-9-years-old SGA children. MATERIAL AND METHODS: Ninety-one prepubertal SGA children (34 boys and 57 girls) were qualified into the study, aged 4.78-9.75 yrs (6.9±1.37 yrs). In each child, the actual height, weight and waist circumference, as well as blood pressure were measured. Fasting triglyceride and HDL-cholesterol levels were assessed. Glucose and insulin concentrations were estimated at fasting state and during the oral glucose tolerance test (OGTT). On the basis of the obtained results, BMI SDS, waist-to-height ratio and the insulin resistance indices (IRI), as defined by HOMA and Belfiore, were calculated. RESULTS: Visceral obesity was diagnosed in 14 cases, out of which, 5 cases additionally presented with, at least, two other components of MS, while in 5 other cases, one component of MS was additionally confirmed, most frequently as arterial hypertension (HA). In all the analysed SGA children, normal glucose tolerance was observed. Insulin resistance was identified in 13 children, acc. to IRIBelfiore, but not in any child, acc. to IRIHOMA. HA was diagnosed in 30 (33%) prepubertal SGA children, emphasising the fact that its concomitance with visceral obesity was observed in a half of the cases only. Children with HA were taller and heavier, more frequently demonstrating insulin resistance. CONCLUSIONS: In 5-9-year-old SGA children, a high frequency of particular diagnostic criteria for the MS is observed.

Association of Trp64Arg polymorphism of beta3-adrenergic receptor with insulin resistance in Polish children with obesity.

AIM: To establish the influence of the Trp64Arg variant of the beta3-adrenergic receptor (Trp64Arg- beta3AR) on body mass index (BMI) and insulin resistance (IR) in obese children. METHODS: BMI, presence of the Trp64Arg mutation, plasma glucose and insulin concentrations during an oral glucose tolerance test (OGTT) and IR were determined in 60 obese and 33 normal weight children. RESULTS: The frequency of Trp64Arg was similar in normal weight and obese children. BMI, glucose and insulin concentrations during an OGTT in children with Trp64Argbeta3AR were not different from those with Trp64Trpbeta3AR. IR was confirmed in 42.8% of children with Trp64Argbeta3AR and in 45.6% of children with Trp64Trpbeta3AR (NS). CONCLUSIONS: 1. The similar frequency of the Trp64Argbeta3AR variant in normal weight and obese children suggests that it is not a susceptibility gene for obesity in Polish children. 2. The presence of the Trp64Argbeta3AR variant does not have an unfavourable influence on BMI, glucose or insulin concentrations during OGTT or on IR frequency in Polish obese children.

[Glucose and insulin concentrations during oral glucose tolerance test in healthy children--application of insulin resistance index according to Belfiore in the developmental age]. / Stezenie glukozy i insuliny podczas doustnego testu obciazenia glukoza u zdrowych dzieci--zastosowanie wskaznika insulinoopornosci wedlug Belfiore w wieku rozwojowym.

INTRODUCTION: Sensitivity to insulin changes during puberty. It is necessary to distinguish physiological insulin resistance (IR) from pathological one. In children the IR index proposed by Belfiore (IRI(Belfiore)) could be used. Application of this formula is possible, when the reference values of the area under curve of glucose (GLU(AUC)) and insulin (INS(AUC)) concentration during oral glucose tolerance test (OGTT) are available for the studied population. Derivation of such reference values was the goal of this study. MATERIAL AND METHODS: Forty healthy children, aged 8-18.2 years, were enrolled in the study. Regarding the stages of puberty, the children were divided into 3 groups: A--stage I, B--stage II or III and C--stage IV or V. Serum glucose and insulin concentrations were measured for each child during OGTT and GLU(AUC) and INS(AUC) were calculated. The obtained mean values of GLU(AUC) and INS(AUC) for each group were used to calculate IRIBelfiore. To determine the cut-off point between physiological and pathological IR, receiver operating characteristic (ROC) analysis was performed for 40 studied children and 50 obese and insulin resistant children (according to QUICKY and/or elevated insulin concentration during OGTT), matched for age, sex and stages of puberty with the study group. RESULTS: The following mean values of GLU(AUC) and INS(AUC) were obtained in particular groups: A--189.3 mg/dL and 37.1 ulU/mL; B--207.4 mg/dL and 54.5 ulU/mL; C--188.8 mg/dL and 59.4 ulU/mL, respectively. The cut-off point value between physiological and pathological IR at the level 1.27 for IRI Belfiore was calculated. CONCLUSIONS: 1. The mean values of GLU(AUC) and INS(AUC) obtained during OGTT could be used to calculate IRI Belfiore in children. 2. IRI(Belfiore) values above 1.27 indicate pathological IR in developmental age.

[Overweight and obesity as common risk factors for gestational diabetes mellitus (GDM), perinatal macrosomy in offspring and type-2 diabetes in mothers]. / Nadwaga i otyltosc--ogniwem laczacym cukrzyce ciazowa, makrosomie urodzeniowa i cukrzyce typu 2.

UNLABELLED: Gestational diabetes mellitus (GDM) affects about 5% of all pregnancies and results in an increased incidence of Caesarean sections, perinatal traumas and neonatal complications. Macrosomy, i.e., an excessive birth-weight is observed in newborns from these pregnancies. In the majority of cases, diabetes regression is observed directly after pregnancy termination, however, in 15-60% of these patients, diabetes mellitus develops in later years of life. The goal of the study was an assessment of the risk factors for GDM development in gestation, perinatal macrosomy in offspring from GDM-affected pregnancies and overt diabetes mellitus in women after GDM. MATERIAL AND METHODS. The study involved 146 women with GDM and 1806 women with normal carbohydrate metabolism during pregnancy, 506 newborns of gestational diabetic mothers and 993 newborns of healthy mothers, as well as 200 women with a history of GDM during the years 1990-1999 (the mean time period after GDM - 3.1 +/- 6.0 years). The recognized risk factors of GDM and perinatal macrosomy were evaluated, together with the incidence of overt diabetes mellitus after GDM-affected pregnancy. RESULTS: An analysis of multifactor logistic regression demonstrated that the independent risk factors for GDM include: BMI 3 25 kg/m2 before pregnancy (OR - 2.38), the history of diabetes in family (OR - 1.67), and the third pr further pregnancy (OR - 1.81) - p < 0.05. In turn, experienced obstetric failures and delivery of child with macrosomy features revealed insignificant - p > 0.05. Perinatal macrosomy correlated with mother's BMI and glycaemia during the 2nd hour of diagnostic test (75 g OGTT). No correlations were observed among mother's age, fasting glycaemia levels and HbA1c in mothers. In the group of GDM-affected women, diabetes mellitus type 2 was diagnosed in 34 (17.0%) patients. The the actual BMI > 25 kg/m2 and glycaemia values in the 2nd hour of diagnostic test in the course of GDM diagnosis (p < 0.05). The risk of diabetes was not enhanced in that group of women by family history of diabetes, the age of GDM onset (< 25 years of life), the week of gestation when GDM was diagnosed (< 25 hbd), and the type of GDM therapy (insulin vs. diet) p > 0.05 CONCLUSIONS: Overweight and obesity are both risk factors of gestational diabetes mellitus, delivery of child with macrosomy features and of overt diabetes mellitus later in life.

[Risks factors for the development of diabetes in women with history of gestational diabetes mellitus]. / Czynniki ryzyka zaburzen gospodarki weglowodanowej u kobiet po przebytej cukrzycy ciezarnych.

UNLABELLED: Women who suffered from impaired carbohydrate metabolism during pregnancy are more likely to develop different types of diabetes later in their lives. The aim of this paper was to study the risk factors for the development of diabetes in group of women with gestational diabetes mellitus (GDM) in anamnesis. MATERIALS AND METHODS: 200 women took part in this study, who had gestational diabetes diagnosed between 1980-1998. All women were divided into 4 groups depending on the type of disorders occurring at the moment of examination: DM1 - women diagnosed with type I diabetes, DM2 - women diagnosed with type 2 diabetes, IGT-women with glucose levels in OGTT, which applied to impaired glucose tolerance (acc. to WHO criteria), NDM - women with no clinical signs of diabetes, with normal result of OGTT. RESULTS: The risk of diabetes development is significantly higher (independently of the clinical type) in women who had had GDM include: high glucose levels at the time of GDM diagnosis, early onset of symptoms - related to weeks of gestation, and the insulin treatment during pregnancy. However multifactor analysis indicates that the only significant risk factors for DM 1 are early onset of diabetes during pregnancy and high glucose levels 2 hours after OGTT during pregnancy (p < 0.05). High levels of glucose 2 hours after OGTT and high Body Mass Index (BMI) turned out to be the independent risk factors of diabetes type 2 (p < 0.05). CONCLUSIONS: Knowledge of risk factors allows to recognize a diabetes high risk group among women who suffered from diabetes during pregnancy.

Pregnancy complications and perinatal outcome in diabetic women treated with Humalog (insulin lispro) or regular human insulin during pregnancy.

BACKGROUND: Pregnancy outcome in diabetic women is strictly related to glycemic control during pregnancy. The aim of our study was to compare pregnancy outcome between patients subjected to intensive insulin therapy using regular human insulin and those treated with insulin lispro (Humalog). MATERIAL/METHODS: Group A (n=25) was treated with Humalog, and the control group B (n=46) with regular human insulin. Mean age, duration of diabetes, presence of chronic diabetic complications (according to the White classification) parity, and BMI did not differ between groups. RESULTS: The mean HbA1c concentrations in groups A and B were respectively: 7.8+/-1.4% vs. 7.5+/-1.5% in the first trimester, 6.4+/-0.8% vs. 6.5+/-1.6% in the second, and 6.7+/-0.7% vs. 6.3+/-1.2% in the third (no significant differences). The duration of pregnancy was 36.4+/-3.9 weeks in group A and 37.1+/-1.9 weeks in group B, while the mean neonatal birth weight was 3467+/-790 and 3367+/-666 g, respectively. Neither the frequency of preterm labor and cesarean section nor the frequency of fetal macrosomia and hypoglycemia differed between groups. There was only one malformed infant in the human insulin-treated group, and no statistical difference in the rate of spontaneous abortion between groups. Also, there were no differences in the frequencies of occurrence of hypertension (essential and pregnancy induced) and urinary tract infections. CONCLUSIONS: The course of pregnancy and perinatal outcome is comparable in intensively treated diabetic women regardless of the short-acting insulin used. Humalog appears to be a safe alternative to human insulin in the treatment of diabetes during pregnancy.