Nowadays, after decades of continuously rising rates of paediatric obesity across the world, insulin resistance (IR) in children and adolescents has become a prominent health issue.
Obesity is recognised to be the most prevalent pathological cause of IR. However, corticosteroids or growth hormone therapy, genetic diseases and physiological conditions, such as puberty and pregnancy, may affect insulin sensitivity (IS) lifelong.
Early identification of IR and intervention during childhood, designed to reduce the metabolic risk in youth, are important health care issues and could influence future morbidity and mortality, as well as improve the quality of life.
The first approach to IR in children consists of lifestyle interventions (nutritional education, physical activity). These recommendations are often difficult to achieve, especially for adolescents, therefore, there is usually a lack of successful outcomes.
A pharmacological intervention in obese children may be needed in some cases, with the aim to improve the effects of these primary prevention interventions. Metformin seems to be safe and presents evident positive effects on insulin sensitivity, but long-term and consistent data are still missing to establish its role in the paediatric population and the possible effectiveness of other emergent treatments such as glucagon-like peptide-1 (GLP-1) analogues, dipeptidylpeptidase-4 (DPP-4) inhibitors, dual inhibitors of SGLT1 and SGLT2 and weight loss drugs.
Currently, there are some novel points of interest for researchers in this field, such as association between IR and sleep disturbances, hyperuricemia, adipocytokines, microRNAs, gut microbiota, as well as the possibility to use these associations in order to better understand the pathogenesis of IR.
Despite plenty of currently available information on IR in children and adolescents, there are still uncertainties regarding definition, prevention, management and treatment of IR in children.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology