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Proinsulin and the proinsulin/insulin ratio in overweight and obese children and adolescents: relation to clinical parameters, insulin resistance, and impaired glucose regulation
Author(s) -
von Berghes Carlotta,
Brabant Georg,
Biebermann Heike,
Krude Heiko,
Wiegand Susanna
Publication year - 2011
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/j.1399-5448.2010.00734.x
Subject(s) - proinsulin , medicine , insulin resistance , overweight , endocrinology , insulin , obesity
von Berghes C, Brabant G, Biebermann H, Krude H, Wiegand S. Proinsulin and the proinsulin/insulin ratio in overweight and obese children and adolescents: relation to clinical parameters, insulin resistance, and impaired glucose regulation. Background: In adults with impaired glucose regulation (IGR) or type 2 diabetes mellitus (T2DM), proinsulin (PI) and its ratio to insulin (ins; PI/I ratio) are frequently elevated. Objective: Here we assessed the relationship among fasting PI, clinical parameters, and carbohydrate metabolism, a potential difference of the PI/I ratio between overweight and obese youth with or without IGR in an oral glucose tolerance test (OGTT) and the predictive power of PI levels for IGR. Design and Patients: In a cross‐sectional study, data of n = 259 children and adolescents attending our obesity clinic were studied. Methods: Fasting PI levels were determined in all patients and matched to the standard assessment of obesity. In n = 154 subjects at risk for T2DM, an OGTT was performed sampling for glucose, ins, and PI. Main outcome measures: ins, glucose, PI, PI/I ratio, insulin resistance [homeostasis model assessment of insulin resistance index (HOMA‐IR)]. Results: Puberty (by Tanner) and relative body weight [body mass index (BMI)‐standard deviation of BMI (SDS)] showed a linear relationship to fasting PI levels (p < 0.001 for Tanner I vs. II–V; p = 0.04 and p = 0.026 for BMI‐SDS <2 vs. 2–2.5 and 2–2.5 vs. >2.5, respectively). Subjects with ins resistance (HOMA‐IR >95th percentile, n = 140) had higher fasting PI levels than those without (p < 0.001), with no significant difference in fasting PI/I ratio (p > 0.05). As compared to subjects with normal glucose regulation, subjects with IGR (n = 35) had higher fasting PI (p = 0.001) and an increased PI/I ratio, both during fasting and at 30 min during OGTT (p = 0.049 and p = 0.014, respectively). Conclusions: Children and adolescents with IGR have disproportionately elevated PI levels, both during fasting and after acute glucose stimulation indicating β‐cell dysfunction.