PubMed · 16121435
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Gary Scheiner. Getting down to basals.. https://pubmed.ncbi.nlm.nih.gov/16121435/
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RATIONALE: In adults, obstructive sleep apnea (OSA) is associated with metabolic dysfunction that improves with treatment of OSA. No equivalent studies exist in children. OBJECTIVE: To examine the relationship between metabolic markers and OSA with time and treatment in children. METHODS: Metabolic markers measured on a fasting morning blood sample at diagnostic polysomnography and follow-up 1.3 +/- 0.6 yr later. MEASUREMENTS AND MAIN RESULTS: Forty-five children (34 males), aged 6.9 +/- 3.5 yr, and including 12 obese subjects, were in the final analysis. There were no differences in metabolic markers between children with and without OSA at initial study; however, obese children had significantly higher insulin (106.1 +/- 72.1 vs. 66.7 +/- 37.6 pmol/L; p = 0.028), insulin/glucose ratio (23.7 +/- 14.3 vs. 14.7 +/- 8.0; p = 0.02), and significantly lower high-density lipoprotein cholesterol (1.3 +/- 0.2 vs. 1.6 +/- 0.4 nmol/L; p = 0.005) than nonobese children. Twenty children underwent surgical removal of adenotonsillar tissue, whereas 12 children with OSA elected not to have treatment. OSA persisted after treatment in five children, and resolved in 27. Thirteen children did not have OSA on initial or follow-up studies. At follow-up, there was a small but significant improvement in total cholesterol in those children whose OSA was resolved (4.8 +/- 0.8 to 4.7 +/- 0.6 nmol/L; p = 0.005) and a trend for obese children with persisting OSA to have elevated insulin levels compared with obese children without OSA (p = 0.07). CONCLUSION: Obesity appears to be the major influence on metabolic dysfunction in children with OSA, but these preliminary data also suggest that resolution or persistence of OSA may affect changes in metabolic function over time.
Evaluation of a patient's pancreatic beta-cell function is important in both diagnosis and treatment of diabetes. We sought to determine beta-cell function with a single sampling of blood. Examination of fasting blood glucose (F-BG, mM) and C-peptide (F-CPR, nM) levels in seven post-islet-transplanted states of four patients revealed a linear relationship between F-BG and F-CPR. Assuming that normal subjects aged <40 years have 100% pancreatic beta-cell function, we developed the secretory units of islets in transplantation (SUIT) as an index of beta-cell function by the formula: 250 x F-CPR/(F-BG-3.43). The SUIT index was correlated with the stimulated C-peptide levels not only in islet-transplanted patients (R2 = 0.68, P < 0.05) but also in type 2 patients (R2 = 0.34, P < 0.001). Since the SUIT index can be calculated from data obtained at a single fasting blood sampling and predict the pancreatic beta-cell function, the formula may be a useful tool in clinical management of diabetes.
OBJECTIVE: Polynesians in New Caledonia have an increased risk for developing diabetes, compared to Melanesians or Europeans. They are also more prone to obesity. The aim of this study was to analyse differences in the pre-diabetic state that may explain the varying susceptibility to diabetes between these three ethnic groups, focusing on the balance between insulin resistance and capacity of pancreatic cells to secrete insulin. DESIGN AND SUBJECTS: The CALDIA Study is a population-based cross-sectional survey of diabetes prevalence conducted in New Caledonia. All participants who did not have diabetes, according to the results of a 0-2 h oral glucose tolerance test (n=392), were selected for analysis. RESULTS: Compared to Europeans, Polynesians and Melanesians had significantly higher body mass indices (BMI) and waist-to-hip ratios (WHRs). Polynesians had higher fasting plasma glucose values than Europeans or Melanesians (6.03 mmol/l, vs 5.78 and 5.46, respectively; P<0.0001). Fasting plasma insulin level and the estimate of insulin resistance by homeostasis model assessment were not significantly different between the three ethnic groups. Homeostasis model assessment estimate of beta-cell secretory capacity was lower in Polynesians compared to the two other ethnic groups (83.1 mU/mmol, vs 119.3 and 125.2, respectively; P<0.02). CONCLUSION: Despite a high prevalence of central obesity, as judged by high BMI and WHR, in Polynesians of New Caledonia, their high risk of diabetes may be more strongly related to a defect in insulin secretion capacity than to insulin resistance.