title: [Insulin resistance in type 1 diabetic children and adolescents -- a simplified method of estimation].
abstract: OBJECTIVE
  Our own studies confirm the hypothesis, that insulin resistance of various degree is often observed in children and adolescents with type 1 diabetes mellitus (T1DM). The knowledge of this parameter characterizing individual patients may be of great value not only for better understanding of the disease course but also as a potential source of specific treatment. Reliable estimation of insulin resistance with hyperinsulinemic euglycemic clamp is a complex, laborious and costly procedure. These facts were enough to motivate us to make an attempt to elaborate an indirect, simplified method of insulin resistance assessment in T1DM children, that would be based on patients characteristics and on clinical parameters of the disease course.
  
  
  METHODS
  142 children and adolescents with T1DM (79 boys, 63 girls) aged 7.7-20.3 years (mean age - 13.7+/-3.3 years) were included into the study. Duration of diabetes was 0.5-12.5 years (mean 2.7+/-2.3 years). The stage of puberty was assessed by the Tanner scale. Euglycemic-hyperinsulinemic clamp by de Fronzo was performed to estimate insulin resistance. Glucose disposal rate (M index) determined during the last 30 min of the test estimated insulin resistance. Looking for clinical and metabolic factors characterizing insulin resistance: a) the plasma cholesterol, HDL-Ch, triglycerides and HbA1c were examined, b) the height, weight, waist circumference and blood pressure were measured, c) body mass index and daily dose of insulin were calculated. For statistical analysis the multiple regression was used (forward stepwise method).
  
  
  RESULTS
  In the study group M index ranged from 2.1 to 17.4 mg/kg/min (mean 7.27+/-2.62 mg/kg/min). The boys presented better insulin sensitivity than girls (7.79 vs. 6.62, p=0.008). The insulin resistance depended on the patients' age (r=-0.46, p<0.001) and stage of puberty (p<0.001). A correlation between M index and insulin dose (r=-0.34, p<0.05) and HbA1c (r=-0.17; p=0.04) were found. There was a significant relationship between M index and parameters of adiposity, lipids and blood pressure. All significant clinical parameters of insulin resistance were subjected to the analysis. Multiple linear regression analysis was performed. The model with the strongest correlation with index M was used to work out the formula: M index = 17.065 + 1.547 x (gender: boys=1, girls=0) - 0,183 x (age) - 0,117 x (Waist circumference) - 2,019 x (Daily insulin dose) - 0,016 x (LDL-CH) + 0,041 x (DBP).
  
  
  CONCLUSIONS
  In T1DM children and adolescents it is possible to estimate for daily use extent of insulin resistance on the basis of clinical features.
authors.affiliation: Klinika Chorób Dzieci Katedry Pediatrii UM w Łodzi. agnieszka.szadkowska@wp.pl
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Szadkowska
authors.forename: Iwona
authors.initials: I
authors.lastname: Pietrzak
authors.forename: Beata
authors.initials: B
authors.lastname: Mianowska
authors.forename: Leszek
authors.initials: L
authors.lastname: Markuszewski
authors.forename: Joanna
authors.initials: J
authors.lastname: Bodalska-Lipińska
authors.forename: Jerzy
authors.initials: J
authors.lastname: Bodalski
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D008076:Cholesterol, HDL / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology*; D000078790:Insulin Secretion; D020738:Leptin / Q000378:metabolism; D008297:Male; D015999:Multivariate Analysis; D011627:Puberty / Q000097:blood; D012737:Sex Factors; D014280:Triglycerides / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D007328:Insulin; D020738:Leptin; D014280:Triglycerides