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Clinical Research

“IGT-like” status in normoglucose tolerant obese children and adolescents: the additive role of glucose profile morphology and 2-hours glucose concentration during the oral glucose tolerance test

International Journal of Obesity volume 43, pages 1363–1369 (2019)Cite this article

Subjects

Abstract

Objective

To assess whether combining glucose shape and 2-h glucose concentration during an oral glucose tolerance test (OGTT) may help identifying normal glucose tolerant obese children/adolescents with an impaired glucose tolerant (IGT)-like metabolic profile in term of insulin sensitivity (Matsuda index) and β-cell function (disposition index: DI).

Subjects, methods, and main outcome measure

In total, 654 non-diabetic obese children/adolescents underwent a 2 h OGTT. The whole population was classified according to 2-hour plasma glucose ( < 100, 100–119, 120–139, 140–200 mg/dL) and glucose shape (monophasic or biphasic). Monophasic morphology was characterized by an increase in OGTT glucose concentration followed by a decline of at least 4.5 mg/dL, a biphasic response was defined as a decrease in glucose after an initial increase, followed by a second increase of ≥ 4.5 mg/dL. A subset of 69 participants had also a prolonged OGTT to estimate β-cell function in “biphasic” versus “monophasic” patients.

Results

Matsuda index and DI decreased across 2-h glucose categories (both p < 0.001) and were lower in monophasic compared with biphasic children, independently of 2-h glucose category (both p < 0.001, both p for glucose category×shape interaction > 0.05). Normal glucose tolerant children with 2-h glucose of 120–139 mg/dl and monophasic glucose shape did not differ from IGT children, as regards Matsuda index and DI (both p > 0.05). Among children undergoing a prolonged OGTT, those with a monophasic glucose shape had worse β-cell function, modeled as proportional control, than those with a biphasic shape (p = 0.031).

Conclusions

A monophasic OGTT glucose shape is associated with unfavorable glucose metabolism independently of 2-h glucose concentration. Children combining monophasic shape and normal-high 2-h glucose have an IGT-like glucose metabolism.

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Acknowledgements

We are sincerely indebted to the children and adolescents who participated in the study and to their families. We thank the dedicated staff of the Pediatric Diabetes and Metabolic Disorders Unit of the University Hospital in Verona for their support during the clinical study. Supported by grants (FURMAF2015, FURMAF2016) from the University of Verona to CM and by grants from University of Parma to RCB.

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Author notes

  1. These authors contributed equally: Francesca Olivieri and Chiara Zusi

Authors and Affiliations

  1. Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy

    Francesca Olivieri, Chiara Zusi, Anita Morandi, Massimiliano Corradi, Elena Fornari & Claudio Maffeis

  2. Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University Hospital of Verona, Verona, Italy

    Maria L. Boselli

  3. Department of Medicine and Surgery, University of Parma, Parma, Italy

    Riccardo C. Bonadonna

  4. Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy

    Riccardo C. Bonadonna

Authors
  1. Francesca Olivieri
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  2. Chiara Zusi
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  3. Anita Morandi
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  4. Massimiliano Corradi
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  5. Maria L. Boselli
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  6. Elena Fornari
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  7. Riccardo C. Bonadonna
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  8. Claudio Maffeis
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Contributions

FO, CZ, and AM researched and analyzed data and wrote the manuscript. MC researched data and discussed the manuscript. MLB carried out mathematical modeling of the data. EF researched data. RCB developed the mathematical models, supervised mathematical modeling, edited the manuscript, and provided substantial contribution to the overall discussion. CM designed the study, researched data, co-wrote, and edited the manuscript. CM is the guarantor of this work and, as such, had full access to all the data in the study and take responsibility for the integrity and the accuracy of the data analysis.

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Correspondence to Claudio Maffeis.

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Olivieri, F., Zusi, C., Morandi, A. et al. “IGT-like” status in normoglucose tolerant obese children and adolescents: the additive role of glucose profile morphology and 2-hours glucose concentration during the oral glucose tolerance test. Int J Obes 43, 1363–1369 (2019). https://doi.org/10.1038/s41366-018-0297-5

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