title: Persistence of pre-diabetes in overweight and obese Hispanic children: association with progressive insulin resistance, poor beta-cell function, and increasing visceral fat.
abstract: OBJECTIVE
  To examine changes in risk factors in overweight and obese Hispanic children at high risk of developing type 2 diabetes.
  
  
  METHODS
  We recruited 128 overweight/obese Hispanic children with a family history of type 2 diabetes primarily from clinics in East Los Angeles. Children were evaluated annually for 4 years with an oral glucose tolerance test, applying American Diabetes Association criteria to define diabetes and pre-diabetes. Insulin sensitivity (S(i)), acute insulin response (AIR) to glucose, and beta-cell function (BCF) were determined from frequently sampled intravenous glucose tolerance tests, and total body fat by dual-energy X-ray absorptiometry and intra-abdominal and subcutaneous abdominal adipose tissue (IAAT and SAAT) by magnetic resonance imaging were assessed in years 1, 2, and 4.
  
  
  RESULTS
  No subjects developed type 2 diabetes, 40% never had pre-diabetes, 47% had intermittent pre-diabetes with no clear pattern over time, and 13% had persistent pre-diabetes. At baseline, those with persistent pre-diabetes had lower BCF and higher IAAT. In repeated measures, S(i) deteriorated regardless of pre-diabetes, and there was a significant effect of pre-diabetes on AIR (42% lower in pre-diabetes; P = 0.01) and disposition index (34% lower in pre-diabetes; P = 0.021) and a significant interaction of pre-diabetes and time on IAAT (greater increase over time in those with pre-diabetes; P = 0.034).
  
  
  CONCLUSIONS
  In this group of Hispanic children at high risk of type 2 diabetes, 1) pre-diabetes is highly variable from year to year; 2) the prevalence of persistent pre-diabetes over 3 years is 13%; and 3) children with persistent pre-diabetes have lower BCF, due to a lower AIR, and increasing visceral fat over time.
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. goran@usc.edu
authors.forename: Michael I
authors.initials: MI
authors.lastname: Goran
authors.forename: Christianne
authors.initials: C
authors.lastname: Lane
authors.forename: Claudia
authors.initials: C
authors.lastname: Toledo-Corral
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Weigensberg
mesh_terms: D000704:Analysis of Variance; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000235:genetics / Q000503:physiopathology; D005192:Family Health; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D050417:Insulin-Secreting Cells / Q000378:metabolism* / Q000502:physiology; D050152:Intra-Abdominal Fat / Q000378:metabolism*; D015141:Los Angeles; D008297:Male; D009765:Obesity / Q000503:physiopathology; D050177:Overweight / Q000503:physiopathology*; D011236:Prediabetic State / Q000503:physiopathology