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Progressive deterioration of β-cell function in obese youth with type 2 diabetes

Authors

  • Fida Bacha,

    Corresponding author
    1. Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
    2. Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
    • Division of Weight Management and Wellness, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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  • Neslihan Gungor,

    1. Division of Pediatric Endocrinology, LSUHSC-Shreveport, Shreveport, LA, USA
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  • SoJung Lee,

    1. Division of Weight Management and Wellness, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
    2. Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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  • Silva A Arslanian

    1. Division of Weight Management and Wellness, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
    2. Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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Corresponding author: Fida Bacha, MD, Children's Nutrition Research Center, Baylor College of Medicine

1100 Bates Street, Houston, TX 77030, USA.

Tel: (713) 798-7166

fax: (713) 798-7119

e-mail: fbacha@bcm.edu

Abstract

Objective

In adults, type 2 diabetes (T2DM) is characterized with progressive deterioration in insulin secretion. Data are scanty in youth. We investigated prospectively the change in β-cell function and in insulin sensitivity in youth with T2DM.

Research Design and Methods

Six adolescents with T2DM [hemoglobin A1c (HbA1c) 6.6 ± 1.0%] underwent evaluation of hepatic glucose production (HGP; [6,6-2H2] glucose), insulin-stimulated glucose disposal (Rd; hyperinsulinemic-euglycemic clamp), first- and second-phase insulin/C-peptide secretion (hyperglycemic clamp), body composition dual energy X-ray absorptiometry (DEXA), and abdominal adiposity (computed tomography) within 3 yr of the diagnosis of diabetes and after 12–16 months of follow-up.

Results

Weight, body mass index (37.1 ± 6.9), HbA1c (6.3 ± 0.7%), HGP (2.8 ± 1.2 mg/kg/min), and Rd (4.9 ± 3.4 mg/kg/min) did not change significantly from baseline. However, first-phase insulin and C-peptide declined (152.6 ± 261.2 vs. 75.9 ± 108.5 μU/mL, p = 0.028; 8.0 ± 6.3 vs. 5.9 ± 4.4 ng/mL, p = 0.048, respectively) with no significant change in second-phase insulin/C-peptide. The rate of decline in β-cell function was ∼20% per year.

Conclusions

After a median duration of 20 months of diabetes, youth with T2DM manifest a rapid decline in β-cell function with no significant changes in peripheral or hepatic insulin sensitivity. Interventions to retard this deterioration in β-cell function should be investigated.

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