Degree of Obesity and Glucose Allostasis Are Major Effectors of Glucose Tolerance Dynamics in Obese Youth

• Published in: Diabetes care Vol. 30; no. 7; pp. 1845 - 1850
• Main Authors: Weiss, Ram, Cali, Anna M, Dziura, James, Burgert, Tania S, Tamborlane, William V, Caprio, Sonia
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.07.2007
• Subjects: Adolescent; Allostasis; Allostasis - physiology; Biological and medical sciences; blood glucose; Blood Glucose - metabolism; body mass index; Changes; Child; Children & youth; complications; Cross-Sectional Studies; Diabetes; diagnosis; Disease control; Endocrinopathies; etiology; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Glucose; Glucose Intolerance; Glucose Intolerance - diagnosis; Glucose Intolerance - etiology; glucose tolerance; Glucose Tolerance Test; Glucose tolerance tests; Health aspects; Humans; Insulin; insulin resistance; Insulin-Secreting Cells; Insulin-Secreting Cells - physiology; Longitudinal Studies; Male; Medical sciences; Metabolism; Obesity; Obesity - complications; Overweight persons; Physical examinations; physiology; Plasma; Puberty; Risk factors; Teenagers; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Youth; United States; Human; Obesity; Nutrition; Nutrition disorder; Tolerance; Metabolic diseases; Glucose; Effector; Allostasis; Dynamics; Adolescent; Behavior; Endocrinology; Nutritional status
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc07-0325

OBJECTIVE:-- One of the signals for the β-cell to maintain an adequate response to worsening insulin sensitivity is elevated ambient glycemia, namely the concept of "glucose allostasis." We examined whether glucose allostasis can be demonstrated using oral glucose tolerance tests (OGTTs) and the effects of the dynamics of β-cell demand on longitudinal changes of glucose tolerance in obese youth. RESEARCH DESIGN AND METHODS-- A cross-sectional analysis of 784 OGTTs of obese youth was used to demonstrate the concept of allostasis, and a longitudinal assessment of 181 subjects was used to examine the effects of changes in β-cell demand and the degree of obesity on glucose tolerance. RESULTS:-- Glucose allostasis can be demonstrated using indexes derived from an OGTT. Increasing β-cell demand and the degree of obesity at baseline were independently related to elevations in ambient glycemia over time. Baseline BMI Z score was a significant contributor to elevated glucose levels on the second OGTT, while the change in degree of obesity during follow-up was not. CONCLUSIONS:-- Increasing β-cell demand related to worsening insulin sensitivity and the degree of obesity per se have independent roles in the development of elevated glucose levels over time. This implicates that peripheral insulin sensitization and/or β-cell enhancement alongside a significant reduction in obesity may be needed to prevent the development of altered glucose metabolism in obese youth.