diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12656diaendo-12656Research ArticleОригинальные исследованияOriginal StudiesУровень гликемии на 60-й минуте стандартного перорального глюкозотолерантного теста как новый критерий оценки инсулиносекреции у детей с ожирениемOne-hour postload plasma glucose levels as a new criterion for assessing insulin secretion in obese childrenhttps://orcid.org/0000-0002-9299-1053ВасюковаО. В.VasyukovaO. V.

Васюкова Ольга Владимировна, к.м.н.; eLibrary SPIN: 6432-3934117036, Москва, ул. Дмитрия Ульянова, д. 11телефон: 89168504805

Olga V. Vasyukova, MD, PhD; eLibrary SPIN: 6432-393411 Dm. Ulyanova street, 117036, Moscow

o.vasyukova@mail.ruhttps://orcid.org/0000-0001-9834-727XОкороковП. Л.OkorokovP. L.

Окороков Павел Леонидович, к.м.н.; eLibrary SPIN: 6989-2620Москва

Pavel L. Okorokov, MD, PhD; eLibrary SPIN: 6989-2620Moscow

pokorokov@gmail.comhttps://orcid.org/0000-0002-5507-4627ПетерковаВ. А.PeterkovaV. A.

Петеркова Валентина Александровна, д.м.н., профессор, академик РАН; eLibrary SPIN: 4009-2463Москва

Valentina A. Peterkova, MD, PhD; eLibrary SPIN: 4009-2463Moscow

peterkovava@hotmail.comНациональный медицинский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation202023012021236523531Copyright © Васюкова О.В., Окороков П.Л., Петеркова В.А., 20212021Васюкова О.В., Окороков П.Л., Петеркова В.А.Vasyukova O.V., Okorokov P.L., Peterkova V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12656ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Распространенность сахарного диабета 2 типа (СД2) и связанных с ним дисгликемических состояний, повышающих риск развития диабета, продолжает увеличиваться во всем мире, главным образом из-за постоянно растущей частоты ожирения. Раннее выявление лиц, подверженных риску развития СД2, имеет важное значение как для профилактики данного заболевания, так и связанных с ним кардиометаболических осложнений.

ЦЕЛЬ

ЦЕЛЬ. Изучить особенности инсулиносекреции и инсулиночувствительности у детей и подростков с ожирением в зависимости от уровня гликемии на 60-й минуте (Гл60) стандартного перорального глюкозотолерантного теста (ПГТТ).

МЕТОДЫ

МЕТОДЫ. В открытое сравнительное одномоментное исследование включены 613 детей в возрасте от 6 до 17,9 года c конституционально-экзогенным ожирением, разделенных на 2 группы: 173 пациента с уровнем Гл60 ≥8,6 ммоль/л и 440 детей с уровнем Гл60 <8,6 ммоль/л. Проведен скрининг дислипидемии, неалкогольной жировой болезни печени, артериальной гипертензии, нарушения толерантности к глюкозе (НТГ). Инсулиносекрецию оценивали по максимальному (ИРИ max), среднему уровню (ИРИ сред) инсулина в ходе ПГТТ и инсулиногенному индексу (ИГИ), инсулинорезистентность (ИР) — по индексу Matsuda.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Группы сопоставимы по возрасту, полу, стадии полового развития и степени ожирения. Дети с Гл60 ≥8,6 ммоль/л отличаются большей ИР (Matsuda 2,8±2,3 vs 3,5±2,2, р<0,01), гиперинсулинемией (ИРИ max 190,0±59,5 vs 157,1±63,4 мкЕд/мл, р<0,001, ИРИ сред 115,3±59,7 vs 90,2±54,1 мкЕд/мл, p<0,001) и вместе с тем низким значением ИГИ (1,84±1,62 vs 2,61±1,3, р<0,01), что свидетельствует о нарушении первой фазы секреции инсулина. Наименьшие значения ИГИ выявлены у пациентов группы «Гл60 ≥8,6» с НТГ (1,4±0,9). Также пациенты с Гл60 ≥8,6 ммоль/л характеризуются большей частотой метаболических осложнений в виде нарушения толерантности к глюкозе, артериальной гипертензии, жирового гепатоза и стеатогепатита.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Уровень Гл60 ≥8,6 ммоль/л может быть использован в качестве дополнительного маркера метаболически осложненного ожирения у детей и подростков с высоким риском прогрессирования нарушений углеводного обмена.

BACKGROUND

BACKGROUND: Incidence of Type 2 Diabetes Mellitus (T2DM) and associated dysglycemic conditions, increasing the risk of diabetes development, continues to rise worldwide, most notably due to ever-growing obesity rate. Early identification of the persons who are exposed to the risk of T2DM development holds much significance for prevention of both this disease and associated cardiometabolic complications.

AIM

AIM: To study characteristics of insulin secretion and insulin sensitivity among obese children and adolescents versus the glycemic level 60 minutes (GL60) after the standard oral glucose tolerance test (OGTT).

METHODS

METHODS: This open-label comparative cross-sectional study involved 613 children in the age between 6 and 17.9 years old with constitutive-exogenous obesity, divided into 2 groups: 173 patients with GL60 level ≥ 8.6 mmol/L and 440 children with GL60 level < 8.6 mmol/L. They underwent a screening for dyslipidemia, non-alcoholic fatty liver disease, arterial hypertension and impaired glucose tolerance (IGT). Insulin secretion was evaluated on the basis of maximal (IRI max), average level (IRI avg) of insulin in the course of OGTT and insulinogenic index (IGI), insulin resistance (IG) — by Matsuda index.

RESULTS

RESULTS: The groups were comparable in the terms of age, sex, sexual maturation stage and obesity level. Children with GL60 level ≥ 8.6 mmol/L were characterized by higher IR (Matsuda 2.8 ± 2.3 vs 3.5 ± 2.2, р < 0.01), hyperinsulinemia (IRI max 190.0 ± 59.5 vs 157.1 ± 63.4 μU/ml, р < 0.001, IRI avg 115.3 ± 59.7 vs 90.2 ± 54.1 μU/ml, p < 0.001) along with low IGI value (1.84 ± 1.62 vs 2.61 ± 1.3, р < 0.01), which is indicative of the first phase insulin secretion impairment. The lowest IGI values were found among the "GL60 level ≥ 8.6 mmol/L" group patients with IGT (1.4 ± 0.9). Besides, the patients with GL60 level ≥ 8.6 mmol/L are characterized by the higher rate of metabolic complications in the form of impaired glucose tolerance, arterial hypertension, fatty hepatosis and steatohepatitis.

CONCLUSIONS

CONCLUSIONS: GL60 level ≥ 8.6 mmol/L can be used as an additional marker for metabolically complicated obesity among children and adolescents with a high risk of the carbohydrate metabolism disorder development.

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The authors declare that there are no conflicts of interest present.