Impairment of cardiovascular autonomic pattern in obese adolescents with Type 2 diabetes mellitus.
The aim of this study was to assess the behaviour of insulin sensitivity and insulin resistance (IR) indexes in a group of obese adolescents with Type 2 diabetes mellitus (T2DM) in comparison to obese adolescents without diabetes and normal controls, moreover to compare these parameters with the cardiac autonomic pattern. Seven T2DM obese (12.7 ± 0.5 yr), 18 obese without T2DM, and 10 nonobese control adolescents age matched were studied. In all subjects we performed oral glucose tolerance test (OGTT) with insulin and glucose determination, 24-h electrocardiogram Holter, blood pressure monitoring, ecohocardiogram.


RESULTS
serum lipids were significantly higher in obese and T2DM. Insulin sensitivity was significantly reduced in T2DM and obese vs controls; T2DM showed a more pronounced oral glucose insulin sensitivity (OGIS) reduction vs obese. Both obese and T2DM presented an higher IR. T2DM showed an impaired β-cell function, with insulin areas under the curve and disposition index significantly reduced in comparison to controls and obese who showed similar values. A progressive reduction of vagal indexes and an increase of sympathetic indexes were found in obese adolescents and were more pronounced in T2DM. These parameters were correlated with OGIS and β-cell function parameters in both obese and T2DM adolescents. T2DM showed a significant relative wall thickness increase suggesting a trend toward concentric remodeling. In conclusion, T2DM adolescents are characterized by a more marked IR reduced β-cell function in comparison to non-diabetic obese. These modifications may lead to an early impairment of the autonomic pattern.
Cerutti
F
F
Department of Pediatrics, University of Turin, Piazza Polonia 96, 10126 Turin, Italy. franco.cerutti@unito.it
Rabbia
F
F
Rabbone
I
I
Bobbio
A
A
Ignaccolo
M G
MG
Greco
G
G
Bertello
M C
MC
Mulatero
P
P
Veglio
F
F
Pacini
G
G
D000293:Adolescent; D001341:Autonomic Nervous System / Q000503:physiopathology; D001794:Blood Pressure; D002319:Cardiovascular System / Q000503:physiopathology*; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D050417:Insulin-Secreting Cells / Q000502:physiology*; D008055:Lipids / Q000097:blood; D009765:Obesity / Q000150:complications* / Q000503:physiopathology
D008055:Lipids