Progressive deterioration of β-cell function inobese youth with type 2 diabetes

Bacha F, Gungor N, Lee S, Arslanian SA. Progressive deterioration of beta-cell function in obese youth with type 2 diabetes. Pediatric Diabetes 2013: 14: 106-111. Objective In adults, type 2 diabetes (T2DM) is characterized with progressive deterioration in insulin secretion. Data are scanty in youth. We investigated prospectively the change in -cell function and in insulin sensitivity in youth with T2DM. Research Design and Methods Six adolescents with T2DM [hemoglobin A1c (HbA1c) 6.6 +/- 1.0%] underwent evaluation of hepatic glucose production (HGP; [6,6-2H2] glucose), insulin-stimulated glucose disposal (Rd; hyperinsulinemic-euglycemic clamp), first- and second-phase insulin/C-peptide secretion (hyperglycemic clamp), body composition dual energy X-ray absorptiometry (DEXA), and abdominal adiposity (computed tomography) within 3 yr of the diagnosis of diabetes and after 1216 months of follow-up. Results Weight, body mass index (37.1 +/- 6.9), HbA1c (6.3 +/- 0.7%), HGP (2.8 +/- 1.2 mg/kg/min), and Rd (4.9 +/- 3.4 mg/kg/min) did not change significantly from baseline. However, first-phase insulin and C-peptide declined (152.6 +/- 261.2 vs. 75.9 +/- 108.5 U/mL, p=0.028; 8.0 +/- 6.3 vs. 5.9 +/- 4.4 ng/mL, p=0.048, respectively) with no significant change in second-phase insulin/C-peptide. The rate of decline in -cell function was approximate to 20% per year. Conclusions After a median duration of 20 months of diabetes, youth with T2DM manifest a rapid decline in -cell function with no significant changes in peripheral or hepatic insulin sensitivity. Interventions to retard this deterioration in -cell function should be investigated.