Prevalence and Concomitants of Glucose Intolerance in European Obese Children and Adolescents

OBJECTIVE—The worldwide increase in the prevalence of childhood obesity is reaching epidemic proportions and is associated with a dramatic rise in cases of type 2 diabetes. The prevalence of glucose intolerance and its determinants and the relation of cardiovascular risk factors with levels of glycemia and degree of obesity were studied in grossly obese children of European origin. RESEARCH DESIGN AND METHODS—A total of 710 grossly obese Italian children (SD score [SDS] of BMI 3.8 ± 0.7) aged 6–18 years, including 345 male subjects, underwent an oral glucose tolerance test. Insulin resistance and insulin secretion were estimated using the homeostasis model assessment for insulin resistance and the insulinogenic index, respectively. Fibrinogen, C-reactive protein, lipids, and uric acid were measured. The 2-h postload glucose and degree of obesity, calculated as the SDS of weight/height2, were used as dependent variables. RESULTS—The prevalence of glucose intolerance was 4.5%. Insulin resistance (P < 0.0001), impaired insulin secretion (P < 0.0001), and diastolic blood pressure (BP) (P < 0.05) were significantly and independently related to 2-h postload glucose values. The degree of obesity did not relate to insulin resistance but was independently correlated with inflammatory proteins, uric acid, and systolic BP, variables that were often abnormal in this population. CONCLUSIONS—In these grossly obese children, both insulin resistance and impaired insulin secretion contribute to the elevation of glycemia, and the degree of obesity is related to cardiovascular risk factors independently of insulin resistance

Clustering of risk factors in hypertensive insulin-dependent diabetics with high sodium-lithium countertransport

Clustering of risk factors in hypertensive insulin-dependent diabetics with high sodium-lithium countertransport. Diabetic nephropathy is more common in patients with a positive family history of hypertension and with elevated red blood cell sodium-lithium countertransport, a marker of risk for essential hypertension. To evaluate whether there is a relationship between this cation transport system and indicators of risk of renal and cardiovascular complications in diabetic patients before the development of clinical proteinuria, we studied 31 type 1 (insulin-dependent) diabetic patients with arterial hypertension, without clinical proteinuria and 12 normotensive normoalbuminuric diabetic patients. Sodium-lithium countertransport activity was significantly higher in hypertensive patients (0.43 ± 0.03 mmol/1 RBC x hr) than in normotensive patients (0.23 ± 0.03; P < 0.001). To better explore the nature of the association between this transport system and arterial hypertension, hypertensive patients were divided in two groups, with high (>0.41 mmol/1 RBC x hr) or normal (<0.41) sodium-lithium countertransport activity. The two groups of hypertensive diabetics were similar in age, sex, body mass index and blood pressure levels. Hypertensive patients with elevated rates of sodium-lithium counter-transport compared with those with normal sodium-lithium counter-transport activity showed elevated glomerular filtration rate (130 ± 4 ml/min/1.73 m2 vs. 122 ± 3; P < 0.05), albumin excretion rate (median 26 /Lcg/min vs. 11; P < 0.001), higher fractional proximal sodium reabsorption (74 ± 1.2% vs. 71.6 ± 0.9; P < 0.01), exchangeable sodium pool (2937 ± 62 mmol/1.73 m2 vs. 2767 ± 56; P < 0.01), larger kidney volume (317 ± 7 ml/1.73 m2 vs. 270 ± 8; P < 0.05) and left ventricular mass index (122 ± 4 g/m2 vs. 107 ± 5; P < 0.05). Hypertensive patients with normal sodium-lithium countertransport activity had renal parameters similar to normotensive diabetic patients, except higher left ventricular mass index and kidney volume. Hypertensive diabetic patients with elevated sodium-lithium countertransport activity also had higher levels of plasma triglycerides, lower plasma HDL-cholesterol and impaired insulin sensitivity (assessed by euglyce-mic insulin-glucose clamp) compared with the other two groups. In conclusion, renal, cardiac and metabolic abnormalities are prominent in hypertensive type 1 (insulin-dependent) diabetic patients with higher sodium-lithium countertransport

DIABRISK - SL Prevention of cardio-metabolic disease with life style modification in young urban Sri Lankan's - study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Urban South-Asian's are predisposed to early onset of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). There is an urgent need for country specific primary prevention strategies to address the growing burden of cardio-metabolic disease in this population. The aim of this clinical trial is to evaluate whether intensive (3-monthly) lifestyle modification advice is superior to a less-intensive (12 monthly; control group) lifestyle modification advice on a primary composite cardio-metabolic end point in 'at risk' urban subjects aged between 5-40 years.</p> <p>Methods/Design</p> <p>This is an open randomised controlled parallel group clinical trial performed at a single centre in Colombo, Sri-Lanka. A cluster sampling strategy was used to select a large representative sample of subjects aged between 5-40 years at high risk of T2DM and CVD for the intervention study. We have screened 23,298 (males 47% females 53%) healthy subjects for four risk factors: obesity, elevated waist circumference, family history of diabetes and physical inactivity, using a questionnaire and anthropometry. Those with two or more risk-factors were recruited to the intervention trial. We aim to recruit 4600 subjects for the intervention trial. The primary composite cardio-metabolic end point is; new onset T2DM, impaired glucose tolerance, impaired fasting glycaemia, new onset hypertension and albuminuria, following 5 years of intervention. The effect of the intervention on pre-specified secondary endpoints will also be evaluated. The study will be conducted according to good clinical and ethical practice, data analysis and reporting guidelines.</p> <p>Discussion</p> <p>DIABRISK-SL is a large population based trial to evaluate the prevalence of diabetes, pre-diabetes and cardio-metabolic risk factors among young urban Sri-Lankans and the effect of a primary prevention strategy on cardio-metabolic disease end points. This work will enable country specific and regional cardio-metabolic risk scores to be derived. Further if the proposed intervention is successful the results of this study can be translated and implemented as a low-cost primary prevention tool in Sri-Lanka and other low/middle income developing countries.</p> <p>Trial registration</p> <p>The trial is registered with the World Health Organisation and Sri-Lanka clinical trial registry number SLCTR/2008/003</p