Insulin Dynamics Predict Body Mass Index and Z-Score Response to Insulin Suppression or Sensitization Pharmacotherapy in Obese Children - 10/08/11
, Michele L. Mietus-Snyder, MD, Peter Bacchetti, PhD, Ann A. Lazar, MS, Pedro A. Velasquez-Mieyer, MD, Michael L. Christensen, PharmD
Reprint requests: Robert H. Lustig, MD, Division of Pediatric Endocrinology, University of California San Francisco, Box 0434, 513 Parnassus Ave, San Francisco, CA 94143-0434.See editorial, p 3, and related article, p 16.
Abstract |
Objective |
To assess the use of oral glucose tolerance testing (OGTT) to predict efficacy of insulin sensitization (metformin) or suppression (octreotide) because insulin resistance and insulin hypersecretion may impact pharmacotherapeutic efficacy in obese children.
Study design |
Forty-three and 24 obese children, with and without central nervous system (CNS) insult, underwent OGTT. Insulin sensitivity was expressed as composite insulin sensitivity index (CISI), and secretion as corrected insulin response (CIRgp). Those without CNS insult received metformin (weight-based dosing) for 6 to 16 months. Those with CNS insult received octreotide SQ 15 μg/kg/d for 6 months. Body mass index (BMI) and z-score responses were modeled using CIRgp and CISI.
Results |
Metformin: With CIRgp and CISI = 1, BMI z-score in white children declined by 0.23 over the first 4 months (P < .001), and by 0.14 over the next year (P = .33). Each 2-fold increase in CIRgp or CISI attenuated BMI z-score reduction, but with wide uncertainty (P = .24). Black children exhibited little response. Octreotide: With CIRgp and CISI = 1, BMI z-score decreased by 0.23 in the first 4 months (P = .052). Efficacy was dependent on an interaction between CIRgp and CISI (P = .051).
Conclusions |
Efficacy of metformin was predicted by pretreatment insulin resistance. Efficacy of octreotide was predicted by insulin hypersecretion and sensitivity.
Le texte complet de cet article est disponible en PDF.Mots-clés : BMI, CIRgp, CISI, CNS, GLP-1, OGTT, UCSF, U.T.
Plan
| Presented in part at the North American Association for the Study of Obesity, Las Vegas, NV, November 2004. Supported in part by GCRC M01-RR00211, University of Tennessee, Memphis, and PCRC 5 M01 RR-01271, University of California, San Francisco, with funds provided by the National Center for Research Resources, U.S. Public Health Service. |
Vol 148 - N° 1
P. 23-29 - janvier 2006 Retour au numéro
Article précédent
- Longitudinal Changes in Insulin Sensitivity, Insulin Secretion, and β-Cell Function During Puberty
- Geoff D.C. Ball, Terry T.-K. Huang, Barbara A. Gower, Martha L. Cruz, Gabriel Q. Shaibi, Marc J. Weigensberg, Michael I. Goran
- Protective Effects of the Alcohol Dehydrogenase-ADH1B Allele in Children Exposed to Alcohol During Pregnancy
- Sandra W. Jacobson, Lucinda G. Carr, Julie Croxford, Robert J. Sokol, Ting-Kai Li, Joseph L. Jacobson
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