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Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany

International Journal of Obesity volume 28, pages 307–313 (2004)Cite this article

Abstract

BACKGROUND: Recent studies reported an increased prevalence of type II diabetes mellitus in obese children and adolescents, especially in specific ethnic subgroups. The aim of this study was to determine the prevalence of type II diabetes mellitus and impaired glucose regulation in a large group of Caucasian children and adolescents with obesity living in Germany.

PATIENTS AND METHODS: A total of 520 subjects (237 boys, 283 girls) (mean age: 14.0±2.0 y (range 8.9–20.4 y)) with a BMI>97th percentile, BMI-SDS: 2.7±0.5 (range 1.9–4.6), who were consecutively admitted to an in-patient obesity unit participated in the study. A 2-h oral glucose tolerance test (1.75 mg of glucose per kilogram of body weight) was performed before entering a weight-loss program and capillary blood glucose concentrations were measured. Patients were categorized into normal glucose regulation, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes. In addition, fasting venous blood was taken to determine the circulating insulin, C-peptide and lipids. Insulin resistance was estimated by homeostatic model assessment.

RESULTS: Type II diabetes was present in 1.5% (n=8) of the patients, two patients were admitted with already diagnosed type II diabetes and six patients were identified with yet unknown diabetes. IFG was detected in 3.7% (n=19) and IGT in 2.1% (n=11) of the patients. All together, in 6.7% (n=35) (95% confidence interval: 4.7–9.2%) of the patients, impaired glucose regulation (IFG, IGT) or diabetes was identified. These patients had a higher BMI-SDS, higher levels of fasting insulin and C-peptide and a higher insulin resistance index than the patients with normal glucose regulation. Risk factors for the occurrence of impaired glucose regulation were a BMI-SDS>2.5 as well as a positive parents' history for diabetes.

CONCLUSIONS: This is the first report on the prevalence of type II diabetes in a large cohort of Caucasian children and adolescents with obesity living in Europe. Impaired glucose regulation and type II diabetes were present in a substantial proportion of the patients studied. Screening for diabetes in severely obese children and adolescents (BMI-SDS>2.5) is therefore recommended. Patients identified with impaired glucose regulation need specific treatment programs in order to prevent progression to diabetes.

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References

  1. Rocchini AP . Childhood obesity and a diabetes epidemic. N Engl J Med 2002; 346: 802–810.

    Article  Google Scholar 

  2. WHO. Obesity. Preventing and managing the global epidemic. Report of a WHO consultation on obesity, WHO technical report Series 894, 2000.

  3. Rosenbloom AL, Joe JR, Young RS, Winter NE . Emerging epidemic of type 2 diabetes in youth. Diabetes Care 1999; 22: 345–354.

    Article  CAS  Google Scholar 

  4. Fagot-Campagna A, Pettitt DJ, Engelgau MM, Burrows NR, Geiss LS, Valdez R, Beckles GL, Saadine J, Gregg EW, Williamson DF, Narayan KM . Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr 2000; 136: 644–672.

    Article  Google Scholar 

  5. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000; 23: 381–389.

  6. Dabelea D, Hanson RL, Bennett PH, Roumain J, Knowler WC, Pettitt DJ . Increasing prevalence of type II diabetes in American Indian children. Diabetologia 1998; 41: 904–910.

    Article  CAS  Google Scholar 

  7. Dabelea D, Pettitt DJ, Jones KL, Arslanian SA . Type 2 diabetes mellitus in minority children and adolescents. An emerging problem. Endocrinol Metab Clin N Am 1999; 28: 709–729.

    Article  CAS  Google Scholar 

  8. Glaser NS, Jones KL . Non-insulin dependent diabetes mellitus in Mexican-American children. W J Med 1998; 168: 11–16.

    CAS  Google Scholar 

  9. Harris SB, Gittelson J, Hanley A, Barnie A, Wolever T, Gao J . The prevalence of NIDDM in native Canadians. Diabetes Care 1997; 20: 185–187.

    Article  CAS  Google Scholar 

  10. Fagot-Campagna A, Saaddine JB, Flegal KM, Beckles GLA . Diabetes, impaired fasting glucose, and elevated HbA1c in US adolescents: the third National Health and Nutrition Examination Survey. Diabetes Care 2001; 24: 834–837.

    Article  CAS  Google Scholar 

  11. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S . Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002; 346: 802–810.

    Article  CAS  Google Scholar 

  12. Livingstone B . Epidemiology of childhood obesity in Europe. Eur J Pediatr 2001; 159 (Suppl 1): S14–S34.

    Google Scholar 

  13. Kromeyer-Hauschild K, Zellner K, Jaeger U, Hoyer H . Prevalence of overweight and obesity among school children in Jena (Germany). Int J Obes Relat Metab Disord 1999; 23: 1143–1150.

    Article  CAS  Google Scholar 

  14. Drake AJ, Smith A, Betts PR, Crowne EC, Shield JP . Type 2 diabetes in obese white children. Arch Dis Child 2002; 86: 207–208.

    Article  CAS  Google Scholar 

  15. The DECODE Study Group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 1999; 354: 617–621.

  16. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hamalainen H, Hanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343–1350.

    Article  CAS  Google Scholar 

  17. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403.

  18. Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Ziegler A, Geiß HC, Hesse V, Hippel V, Jäger U, Johnsen D, Kiess W, Korte W, Menner K, Müller M, Niemann-Pilatus A, Remer T, Schäfer F, Wittchen HU, Zabransky S, Zellenr K, Hebebrand J . Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd 2001; 149: 807–818.

    Article  Google Scholar 

  19. Marshall WA, Tanner JM . Variations in pattern of pubertal changes in girls. Arch Dis Child 1969; 44: 291.

    Article  CAS  Google Scholar 

  20. Marshall WA, Tanner JM . Variations in pattern of pubertal changes in boys. Arch Dis Child 1970; 45: 13.

    Article  CAS  Google Scholar 

  21. Alberti K . Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation. Diabetes Med 1999; 15: S39–S53.

    Google Scholar 

  22. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2002; 25 (Suppl 1): S5–S20.

  23. Cole TJ . The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990; 44: 45–60.

    CAS  PubMed  Google Scholar 

  24. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC . Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.

    Article  CAS  Google Scholar 

  25. Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Targher G, Alberiche M, Bonadonna RC, Muggeo M . Prevalence of insulin resistance in metabolic disorders: the Bruneck Study. Diabetes 1998; 47: 1643–1649.

    Article  CAS  Google Scholar 

  26. Velho G, Froguel P . Genetic metabolic and clinical characteristics of maturity onset diabetes of the young. Eur J Endocrinol 1998; 138: 233–239.

    Article  CAS  Google Scholar 

  27. Stride A, Vaxillaire M, Tuomi T, Barbetti F, Niolstad PR, Hansen T, Costa A, Conget I, Pedersen O, Sovik O, Lorini R, Groop L, Froguel P, Hattersley AT . The genetic abnormality in the beta cell determines the response to an oral glucose load. Diabteologia 2002; 45: 427–435.

    Article  CAS  Google Scholar 

  28. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC . Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994; 17: 961–969.

    Article  CAS  Google Scholar 

  29. Colditz GA, Willett WC, Rotnitzky A, Manson JE . Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995; 22: 481–486.

    Article  Google Scholar 

  30. Edelstein SL, Knowler WC, Bain RP, Anders R, Barrett-Connor EL, Dowse GK, Haffner SM, Pettitt DJ, Sorkin JD, Muller DC, Collins VR, Hamman RF . Predictors of progression from impaired glucose tolerance to NIDDM: an analysis of six prospective studies. Diabetes 1997; 46: 701–710.

    Article  CAS  Google Scholar 

  31. Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK . Cardiovascular risk factors in confirmed prediabetic individuals: does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 1990; 263: 2893–2899.

    Article  CAS  Google Scholar 

  32. Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmever HM, Byrd-Holt DD . Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults. The Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care 1998; 21: 518–524.

    Article  CAS  Google Scholar 

  33. Lim S, Tai E, Tan B, Chew S, Tan C . Cardiovascular risk profile in individuals with borderline glycaemia: the effect of the 1997 American Diabetes Association diagnostic criteria and the 1998 World Health Organization Provisional Report. Diabetes Care 2000; 23: 278–282.

    Article  CAS  Google Scholar 

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Acknowledgements

We gratefully acknowledge the support of the doctors, nurses and assistants of the Children's Hospital Hochried. We thank Christian Denzer, Alexandra Kessler and Dorothee Ultsch for their kind assistance. This study was supported in part by a grant of the Foundation ‘Das zuckerkranke Kind’ of the German Diabetes Association.

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Authors and Affiliations

  1. Department of Pediatrics, University of Ulm, Germany

    M Wabitsch, M Hertrampf, K-M Debatin & E Heinze

  2. German Diabetes Research Institute, University of Duesseldorf, Germany

    H Hauner

  3. Department of Biometry and Medical Documentation, University of Ulm, Germany

    R Muche & B Hay

  4. Children's Hospital Hochried, Murnau, Germany

    H Mayer

  5. Department of Internal medicine, University of Ulm, Germany

    W Kratzer

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  1. M Wabitsch
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Correspondence to M Wabitsch.

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Wabitsch, M., Hauner, H., Hertrampf, M. et al. Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany. Int J Obes 28, 307–313 (2004). https://doi.org/10.1038/sj.ijo.0802555

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