Type 2 diabetes and impaired glucose tolerance in European children and adolescents with obesity -- a problem that is no longer restricted to minority groups.
BACKGROUND
The incidence of childhood obesity and type 2 diabetes is an increasing problem in Europe. We determined the prevalence of impaired glucose regulation in a predominantly Caucasian cohort of 491 children and adolescents with obesity.


METHODS
Fasting glucose and insulin levels were determined in all 491 subjects. Patients with an abnormal fasting glucose or with additional risk factors (positive family history of type 2 diabetes, acanthosis nigricans, hyperlipidemia; n=102) underwent an oral glucose tolerance test (OGTT; 1.75 g glucose/kg body weight). Homeostasis model assessment was used to estimate insulin resistance in all subjects. The insulin sensitivity index was determined in those subjects who underwent an OGTT. Screening for mutations in the melanocortin 4 receptor (MC4R) gene and the coding region of the brain-derived neutrophic factor (BDNF) in 37 patients with an impaired glucose tolerance was performed by WAVE analysis.


RESULTS
Out of the total of 491 patients, 12 had an abnormal fasting glucose level. Of the 102 patients who underwent an OGTT, 37 had impaired glucose tolerance; 6 out of the 102 patients were diagnosed with type 2 diabetes. Eighty-eight per cent of patients with abnormal glucose tolerance and 66% of patients with type 2 diabetes were Caucasian. Insulin resistance indices correlated well with the degree of abnormal glucose tolerance. Using the screening algorithm for type 2 diabetes as advocated by the American Diabetes Association, 68% of patients with impaired glucose tolerance and 66% of patients with type 2 diabetes would have been missed. No abnormalities in the MC4R and BDNF genes were detected.


CONCLUSIONS
Impaired glucose tolerance and type 2 diabetes are far more common in obese European children of Caucasian origin than previously thought. Using fasting glucose levels as the main screening tool appears to be insufficient in detecting these children.
Paediatric Endocrinology, Charite Children's Hospital, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. susanna.wiegand@charite.de
Susanna
S
Wiegand
Ursula
U
Maikowski
Oliver
O
Blankenstein
Heike
H
Biebermann
Patrick
P
Tarnow
Annette
A
Grüters
D000052:Acanthosis Nigricans / Q000453:epidemiology / Q000235:genetics; D000293:Adolescent; D017677:Age Distribution; D001786:Blood Glucose; D019208:Brain-Derived Neurotrophic Factor / Q000235:genetics; D002648:Child; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000235:genetics; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000235:genetics; D005060:Europe / Q000453:epidemiology; D005215:Fasting; D005260:Female; D005820:Genetic Testing; D018149:Glucose Intolerance / Q000208:ethnology* / Q000235:genetics; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000097:blood; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data*; D009765:Obesity; D015995:Prevalence; D011627:Puberty; D044105:Receptor, Melanocortin, Type 4 / Q000235:genetics; D012307:Risk Factors; D017678:Sex Distribution; D044465:White People / Q000235:genetics / Q000706:statistics & numerical data*; D014944:World Health Organization
D001786:Blood Glucose; D019208:Brain-Derived Neurotrophic Factor; D007328:Insulin; D044105:Receptor, Melanocortin, Type 4