Progressive deterioration of β‐cell function in obese youth with type 2 diabetes
Pediatric diabetes, 2013•Wiley Online Library
Objective In adults, type 2 diabetes (T2DM) is characterized with progressive deterioration in
insulin secretion. Data are scanty in youth. We investigated prospectively the change in β‐
cell function and in insulin sensitivity in youth with T2DM. Research Design and Methods Six
adolescents with T2DM [hemoglobin A1c (HbA1c) 6.6±1.0%] underwent evaluation of
hepatic glucose production (HGP;[6, 6‐2H2] glucose), insulin‐stimulated glucose disposal
(Rd; hyperinsulinemic‐euglycemic clamp), first‐and second‐phase insulin/C‐peptide …
insulin secretion. Data are scanty in youth. We investigated prospectively the change in β‐
cell function and in insulin sensitivity in youth with T2DM. Research Design and Methods Six
adolescents with T2DM [hemoglobin A1c (HbA1c) 6.6±1.0%] underwent evaluation of
hepatic glucose production (HGP;[6, 6‐2H2] glucose), insulin‐stimulated glucose disposal
(Rd; hyperinsulinemic‐euglycemic clamp), first‐and second‐phase insulin/C‐peptide …
Objective
In adults, type 2 diabetes (T2DM) is characterized with progressive deterioration in insulin secretion. Data are scanty in youth. We investigated prospectively the change in β‐cell function and in insulin sensitivity in youth with T2DM.
Research Design and Methods
Six adolescents with T2DM [hemoglobin A1c (HbA1c) 6.6 ± 1.0%] underwent evaluation of hepatic glucose production (HGP; [6,6‐2H2] glucose), insulin‐stimulated glucose disposal (Rd; hyperinsulinemic‐euglycemic clamp), first‐ and second‐phase insulin/C‐peptide secretion (hyperglycemic clamp), body composition dual energy X‐ray absorptiometry (DEXA), and abdominal adiposity (computed tomography) within 3 yr of the diagnosis of diabetes and after 12–16 months of follow‐up.
Results
Weight, body mass index (37.1 ± 6.9), HbA1c (6.3 ± 0.7%), HGP (2.8 ± 1.2 mg/kg/min), and Rd (4.9 ± 3.4 mg/kg/min) did not change significantly from baseline. However, first‐phase insulin and C‐peptide declined (152.6 ± 261.2 vs. 75.9 ± 108.5 μU/mL, p = 0.028; 8.0 ± 6.3 vs. 5.9 ± 4.4 ng/mL, p = 0.048, respectively) with no significant change in second‐phase insulin/C‐peptide. The rate of decline in β‐cell function was ∼20% per year.
Conclusions
After a median duration of 20 months of diabetes, youth with T2DM manifest a rapid decline in β‐cell function with no significant changes in peripheral or hepatic insulin sensitivity. Interventions to retard this deterioration in β‐cell function should be investigated.