title: Insulin sensitivity and secretory response in adults born preterm: the Helsinki Study of Very Low Birth Weight Adults.
abstract: BACKGROUND
  Preterm birth is associated with an increased risk of type 2 diabetes in adult life. The mechanisms are poorly known.
  
  
  OBJECTIVE
  We studied insulin sensitivity and secretion in adults born preterm at very low birth weight (VLBW; < 1500 g).
  
  
  METHODS
  Longitudinal Birth Cohort Study (Helsinki Study of Very Low Birth Weight Adults).
  
  
  METHODS
  The study was conducted at Uusimaa, Finland.
  
  
  METHODS
  One hundred seven adults born at VLBW and 100 controls born at term not small for gestational age (SGA), group-matched for sex, age, and birth hospital. The mean age was 25.0 years.
  
  
  METHODS
  We performed a 14-sample intravenous glucose tolerance test and calculated insulin sensitivity (Si), insulin secretory response (AIR), and disposition index, by Minimal Model (Minmod Millennium®).
  
  
  RESULTS
  Compared with controls, VLBW adults had lower Si (mean difference -11.9%, 95% CI -22.1 to -0.4%, adjusted for sex, age, and body mass index) and higher AIR (19.9%; 4.4-37.7%). The association with Si attenuated when further adjusted for height, parental diabetes, parental education, smoking, maternal smoking, hormonal contraception, and physical activity, but the association with AIR remained. Disposition index was similar. There was no difference between the 40 VLBW adults born SGA and the remaining VLBW adults.
  
  
  CONCLUSIONS
  Adults born preterm at VLBW have lower insulin sensitivity than their term-born peers with a similar body size. In young adulthood, this remains compensated by higher insulin secretion. We suggest that this represents an early stage in the pathway leading to type 2 diabetes. Our results underline the importance of a healthy lifestyle and prompt vigilance in the screening of type 2 diabetes and impaired glucose tolerance in adults born preterm.
authors.affiliation: National Institute for Health and Welfare (E.K., P.H., K.W., N.K., J.G.E.), Diabetes Prevention Unit, 00271 Helsinki, Finland; Children's Hospital (E.K., S. S-K., P.H., K.W., N.K., A-L.J., S.A.), Helsinki University Central Hospital and University of Helsinki, 00029 HUS, Helsinki, Finland; Department of Obstetrics and Gynecology (E.K.), MRC Oulu, Oulu University Hospital and University of Oulu, 90029 OYS, Oulu, Finland; Department of Behavioral Sciences (J.L., K.R.), University of Helsinki, 00014 Helsinki, Finland; Folkhälsan Research Centre (J.L., J.G.E.,), 00014 Helsinki, Finland; Department of General Practice and Primary Health Care (J.G.E.), University of Helsinki, 00014 Helsinki, Finland; Unit of General Practice (J.G.E.), Helsinki University Central Hospital, 00029 HUS, Helsinki, Finland; and Vasa Central Hospital (J.G.E.), 65130 Vasa, Finland.
authors.forename: Eero
authors.initials: E
authors.lastname: Kajantie
authors.forename: Sonja
authors.initials: S
authors.lastname: Strang-Karlsson
authors.forename: Petteri
authors.initials: P
authors.lastname: Hovi
authors.forename: Karoliina
authors.initials: K
authors.lastname: Wehkalampi
authors.forename: Jari
authors.initials: J
authors.lastname: Lahti
authors.forename: Nina
authors.initials: N
authors.lastname: Kaseva
authors.forename: Anna-Liisa
authors.initials: AL
authors.lastname: Järvenpää
authors.forename: Katri
authors.initials: K
authors.lastname: Räikkönen
authors.forename: Johan G
authors.initials: JG
authors.lastname: Eriksson
authors.forename: Sture
authors.initials: S
authors.lastname: Andersson
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology* / Q000378:metabolism; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D019102:Infant, Very Low Birth Weight / Q000378:metabolism*; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male