Surveillance of Insulin Resistance in Children

Recent case-series studies and smaller cross-sectional samples have reported alarming observations among youth: once a disease of middle age and older adulthood, type 2 diabetes now represents nearly one-half of newly diagnosed diabetes cases in some obese adolescent African-American and Hispanic populations (1). Furthermore, the metabolic syndrome, also known as syndrome X or the insulin resistance syndrome, has recently been documented in youth (2). The cornerstone of this syndrome is obesity and insulin resistance, giving rise to a plethora of risk factors for type 2 diabetes and cardiovascular disease, including impaired glucose tolerance, dyslipidemia, hypertension, impaired fibrinolytic activity, and a heightened state of systemic inflammation (3).In this issue of the journal, Allard et al. (4) describe fasting blood concentrations of glucose, insulin, and free fatty acids (FFAs) in children and adolescents. These timely data, from a carefully conducted population-based study in Quebec, Canada, contribute to our understanding of the potential public health impact of the pediatric obesity epidemic. As expected for a typical population of youth, the distribution of fasting glucose was quite narrow, whereas that of fasting insulin was quite broad. The difference between the 5th and 95th percentiles for fasting insulin (∼390%) was ∼15 times greater than that of fasting glucose (∼25%). Concentrations of fasting glucose were somewhat higher for boys than for girls, whereas fasting insulin concentrations were somewhat higher for girls than for boys. As such, the homeostasis model of insulin resistance (HOMA), the product …