Generational change in fasting glucose and insulin among children at ages 5-16y: Modelled on the EarlyBird study (2015) and UK growth standards (1990) (EarlyBird 69)

The role of hyperinsulinaemia in screening for prediabetes in the adolescent population: A systematic literature review

BACKGROUND/AIMS

Present screening methods for Type 2 diabetes (T2DM) fall short of detecting prediabetes. This paper summarises the literature on the utility of insulin measurements (hyperinsulinemia) in detecting prediabetes in adolescents.

METHODS

A systematic literature review was conducted using EMBASE and Medline. Relevant data on hyperinsulinemia in the adolescent population is narrated.

RESULTS

The database search identified 174 potential articles; 106 underwent a full-paper review, and 36 were included.

CONCLUSION

Elevated fasting insulin is a marker of impaired insulin resistance and pending beta-cell dysfunction in at-risk adolescents and can be an early indicator of prediabetes.

Abnormal glucose in pre-school children and the association with obesity/physical activity: A large population-based study

AIM

The rise of diabetes mellitus (DM) and impaired fasting glucose (IFG) in children has become a worldwide challenge, but population-based survey targeted on pre-school children is lacking. The aim of the study was to determine the prevalence of DM and IFG in pre-school children and their association with obesity and susceptible behaviours.

METHODS

A population-based survey was conducted and 21,571 Chinese children aged 5-6 years were recruited from 66 kindergartens in Tianjin, China during the year of 2016-2018. Fasting glucose was measured for all participants. Children with fasting glucose over 7.0 mmol/L was defined as DM, and 5.6-6.9 mmol/L was defined as IFG.

RESULTS

The prevalence of DM and IFG in the current study among Chinese children aged 5-6 years old was 0.05% and 1.18%, respectively, with significant gender and regional disparities (p < 0.001). The risk of abnormal fasting glucose increased with obesity (OR 1.44, 95% CI 1.00-2.06, p < 0.05), especially with moderate/severe obesity (OR 1.84, 95% CI 1.10-3.10, p < 0.05). Further analyses found that as compared to children who had at least 2 h/day physical activity, physical activity <1 h/day increased the risk of abnormal fasting glucose independently of BMI z-score (OR 1.79, 95% CI 1.10-2.91, p < 0.05).

CONCLUSIONS

The study was the first population-based large-scale survey of DM and IFG which targeted on pre-school children, and demonstrated that moderate/severe obesity and inadequate physical activity raised the risk of DM and IFG early from pre-school. The findings highlighted the necessity of early detection for abnormal glucose and control of obesity and susceptible behaviours.

On the dynamics of the human endocrine pancreas and potential consequences for the development of type 1 diabetes

Little is known about the human islet life span, and beta-cell neogenesis is generally considered rare in adults. However, based on available data on beta-cell proliferation, calculations can be made suggesting that the dynamics of the endocrine pancreas is considerable even during adulthood, with islet neogenesis and a sustained increase in size of already formed islets. Islet-associated hemorrhages, frequently observed in most mammals including humans, could account for a considerable loss of islet parenchyma balancing the constant beta-cell proliferation. Notably, in subjects with type 1 diabetes, periductal accumulation of leukocytes and fibrosis is frequently observed, findings that are likely to negatively affect islet neogenesis from endocrine progenitor cells present in the periductal area. Impaired neogenesis would disrupt the balance, result in loss of islet mass, and eventually lead to beta-cell deficiency and compromised glucose metabolism, with increased islet workload and blood perfusion of remaining islets. These changes would impose initiation of a vicious circle further increasing the frequency of vascular events and hemorrhages within remaining islets until the patient eventually loses all beta-cells and becomes c-peptide negative.

Aetiology of type 1 diabetes: Physiological growth in children affects disease progression

The prevailing view is that type 1 diabetes (T1D) develops as a consequence of a severe decline in β-cell mass resulting from T-cell-mediated autoimmunity; however, progression from islet autoantibody seroconversion to overt diabetes and finally to total loss of C-peptide production occurs in most affected individuals only slowly over many years or even decades. This slow disease progression should be viewed in relation to the total β-cell mass of only 0.2 to 1.5 g in adults without diabetes. Focal lesions of acute pancreatitis with accumulation of leukocytes, often located around the ducts, are frequently observed in people with recent-onset T1D, and most patients display extensive periductal fibrosis, the end stage of inflammation. An injurious inflammatory adverse event, occurring within the periductal area, may have negative implications for islet neogenesis, dependent on stem cells residing within or adjacent to the ductal epithelium. This could in part prevent the 30-fold increase in β-cell mass that would normally occur during the first 20 years of life. This increase occurs in order to maintain glucose metabolism during the physiological increases in insulin production that are required to balance the 20-fold increase in body weight during childhood and increased insulin resistance during puberty. Failure to expand β-cell mass during childhood would lead to clinically overt T1D and could help to explain the apparently more aggressive form of T1D occurring in growing children when compared with that observed in affected adults.