Obesity in childhood is associated to several cardiovascular risk factors summarized in the definition of metabolic syndrome such as hypertension, dyslipidemia and impaired glucose tolerance. Besides others, the pathogenetic background is insulin resistance, which deteriorates in mid puberty and normalizes at end of puberty. Accordingly, blood pressure, lipids, fasting glucose and 2 h glucose in oGTT increased from prepubertal stage to pubertal stage and decreased from pubertal stage to postpubertal stage as demonstrated in a longitudinal study of 287 untreated obese children of our obesity cohort. Re-evaluating 128 obese children with impaired glucose tolerance (IGT) and without intervention demonstrated that even degree of overweight remained stable 5 years after baseline only 2% of the children suffered from type 2 diabetes (T2DM) at this timepoint, 16% of children remained in IGT state and 75% of children showed a normal glucose tolerance test, while 7% got lost to follow-up. In another 1-year follow-up study of 79 untreated obese children with IGT, 66% converted to normal glucose tolerance, while 32% remained IGT and one child was diagnosed with T2DM. Predictive factors for normalization of IGT were lower weight, HbA1c and 2 h glucose levels in oGTT, as well as late pubertal stage at baseline. However, the long-term outcome of obese pubertal children with IGT after 1020 years is unknown and they may be prone to develop T2DM at this age. Due to the normalization of insulin resistance associated comorbidity in obese children moving from pubertal to postpubertal stage the necessity of a drug treatment such as metformin is questionable especially in obese pubertal children with only slightly elevated 2 h glucose levels in oGTT. Moreover, all studies dealing with drug treatment in this age group must have an untreated control group to account for the normalization of insulin resistance at the end of puberty.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology