ESPE Abstracts

Introduction: The increasing prevalence of obesity in children and adolescents is contributing to the increasing diagnosis of insulin resistance (IR) in these individuals. However, it remains a worldwide problem to establish diagnostic criteria of IR in the developmental-age population. IRIHOMA and the IRIBelfiore are the well-known indices used in clinical practice. The aim of the study was to compare the usefulness of IRIBelfiore and IRIHOMA in the early diagnosis of IR in children and its metabolic complications.

Patients and Methods: The study group consisted of 553 children aged 2-17.9 years; mean±SD: 12.03±4.2 yr, including 374 girls (67.5%) and 180 boys (32.5%) hospitalized in 2005-2020 at our Department. Based on fasting glucose and insulin - the IRIHOMA, while on results of glucose and insulin during OGTT (0’, 60’ and 120’) - IRIBelfiore were calculated. IRIBelfiore higher than 1.27 was considered as abnormal. IR with respect to IRIHOMA was diagnosed using three criteria: IRIHOMA >2.5 (group A), IRIHOMA >2.67 in prepubertal boys and >2.22 in prepubertal girls and >5.22 and >3.82, respectively, during puberty (group B), and using available centile charts for this index (group C). Next, the IR indices values were compared with clinical data such as TSH, FT4, FT3, ALT, AST, bilirubin and lipids.

Results: In the study group, a normal IRIBelfiore value was found in 184 children (33.2%), while an elevated value was found in 370 children (66.8%). Insulin resistance assessed by IRIHOMA was diagnosed in 40.1% of children in group A, 21.3% in group B and 19.2% in group C. When abnormal IRIHOMA values are found regardless of the criteria used, more than 90% of the participants are also found to have abnormal IRIBelfiore values. Using criteria A and B despite normal IRIHOMA values, insulin resistance can be diagnosed in about 50% based on IRIBelfiore, while according to criterion C in 26.6%. Children with normal IRIHOMA and simultaneously elevated IRIBelfiore had statistically significantly higher levels of triglycerides, HDL-cholesterol, HDL/total cholesterol ratio, AST.

Conclusions: In patients with diagnosed IR based on elevated IRIHOMA, it is not necessary to calculate IRIBelfiore. However, normal IRIHOMA values do not exclude insulin resistance and its associated metabolic complications. It appears that the implementation of adult-accepted IRIHOMA standards (>2.5) may contribute to the overdiagnosis of insulin resistance in pediatric patients.