Alternative Methods of Insulin Sensitivity Assessment in Obese Children and Adolescents

  1. Sophia M. Rössner, MD1,
  2. Martin Neovius, PHD2,
  3. Scott M. Montgomery, PHD345,
  4. Claude Marcus, MD, PHD6 and
  5. Svante Norgren, MD, PHD1
  1. 1Division of Pediatrics, Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden
  2. 2Department of Medicine, Karolinska Institute, Stockholm, Sweden
  3. 3Clinical Epidemiology Unit, Karolinska Institute, Stockholm, Sweden
  4. 4Clinical Research Centre, Örebro University Hospital, Örebro, Sweden
  5. 5Department of Primary Care and Social Medicine, Charing Cross Hospital, Imperial College, London, U.K.
  6. 6National Childhood Obesity Centre, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institute, Stockholm, Sweden
  1. Address correspondence and reprint requests to Dr. Sophia Rössner, B57, Karolinska Universitetssjukhuset Huddinge, SE-141 86 Stockholm, Sweden. E-mail: sophia.rossner{at}karolinska.se

Abstract

OBJECTIVE—To validate fasting indexes against minimal model analysis (MMOD) of the frequently sampled intravenous glucose tolerance test (FSIVGTT) in an obese pediatric population.

RESEARCH DESIGN AND METHODS—FSIVGTT-MMOD results were compared with homeostasis model assessment of insulin resistance (HOMA-IR) and fasting insulin with the sample stratified by sex, puberty, and sensitivity index (Si) median in 191 children (82 males and 109 females, 13.9 ± 2.9 years of age, BMI 36.9 ± 6.2 kg/m2, BMI SD score 6.1 ± 1.6).

RESULTS—Across pubertal groups, correlation coefficients between Si and HOMA-IR ranged from −0.43 to −0.78 in males and from −0.53 to −0.57 in females (age and BMI adjusted, P < 0.05 in all instances). Similar results were seen for fasting insulin. In females, the relationship was significantly weaker in more-insulin-resistant subjects.

CONCLUSIONS—The validity of fasting indexes in explaining Si was sex dependent, varied with pubertal stage, and in females was influenced by degree of insulin sensitivity. In obese pediatric populations, we generally discourage the use of fasting indexes, although the validity varies within subgroups.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 17 January 2008. DOI: 10.2337/dc07-1655.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted January 4, 2008.
    • Received August 22, 2007.
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  1. Published online before print January 17, 2008, doi: 10.2337/dc07-1655 Diabetes Care April 2008 vol. 31 no. 4 802-804
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