Background: Insulin resistance (IR) plays a key role in the pathogenesis of type 2 diabetes (T2D). In neurologically impaired (NI) children unfavorable cardio-metabolic risk profile with high prevalence of IR has been reported. We evaluated the prevalence of T2D in NI children and adolescents, in order to define if a dedicated glucose monitoring may be recommended in these subjects.
Patients and Methods: We retrospectively evaluated 63 patients (11.4±4.0) with severe disabilities. Auxological parameters were recorded. Metabolic blood assays included fasting blood glucose (FBG), fasting insulin, triglycerides (TG). IR was detected with the homeostasis model assessment for insulin resistance (HOMA-IR>97.5th percentile for age and sex) and triglyceride-glucose index (TyG index>7.88). Elevated FBG was defined with values >100 mg/dl. T2D was defined according to ADA criteria.
Results: ISI, pathological TyG index and elevated FBG were observed respectively in 41.3%, 63.5% and 11.1% patients. No significant correlation between HOMA-IR and TyG was found (r= 0.17 P=0.20). T2D was diagnosed in 2/63 patients (3.2%; 1 male and female) at the age of 4 and 8 years respectively. Both patients were asymptomatic and diabetes was incidentally detected during a routine checkup. Clinical and biochemical data and treatment following diagnosis was reported in table 2. In both patients, IR or surrogate markers of IR were detected. The prevalence of diabetes was higher in prepubertal compared to pubertal subjects (P=0.03), similarly in males and females (P=0.8).
Conclusions: T2D in NI children and adolescents could represent a new emerging entity in subjects without obesity. Insulin resistance and/or surrogate marker of insulin resistance index may be useful for the early screening of these at-risk disabled populations
19 - 21 Sep 2019
European Society for Paediatric Endocrinology