Insulin Resistance in Children: Consensus, Perspective, and Future Directions
Insulin Resistance in Children: Consensus, Perspective, and Future Directions
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DOI：
10.1210/jc.2010-1047
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发表时间：
2010-12-01
影响因子：
5.8
通讯作者：
Chiarelli, Francesco
中科院分区：
文献类型：
--
作者：
Levy-Marchal, Claire;Arslanian, Silva;Chiarelli, Francesco
目的：新的数据表明，胰岛素抵抗在儿童和青少年中很常见，与心脏代谢风险有关，因此需要在生命早期考虑。然而，如何定义胰岛素抵抗，如何测量胰岛素抵抗，胰岛素抵抗的危险因素是什么，以及是否有有效的策略来预防和治疗胰岛素抵抗仍然是一个混乱的问题。为了澄清这些观点，组织了一次共识会议。参与者：该共识得到了国际上所有主要儿科内分泌科学协会和37名参与者的支持。证据：一个独立的和系统的文献检索进行，以确定关键的文章有关的儿童insulin resistance.Consensus过程：会议分为五个主题和工作组：背景和定义;测量和筛选的方法;危险因素和后果;预防;和治疗。每个小组选择关键问题，搜索文献，并制定一份草案文件。在3-D会议，这些文件进行了辩论，并最终确定了每个小组，然后提交给他们的全面论坛进一步讨论和agreement.Conclusions：鉴于目前的儿童肥胖症的流行，胰岛素抵抗的儿童是一个重要的问题，面临的卫生保健专业人员。目前还没有明确的标准来定义儿童的胰岛素抵抗，而替代指标如空腹胰岛素是胰岛素敏感性的不良指标。根据目前的筛查标准和方法，没有理由对儿童进行胰岛素抵抗筛查。包括饮食和运动在内的生活方式干预可以改善胰岛素敏感性，而药物只能在选定的情况下使用。（临床内分泌代谢杂志95：5189-5198，2010）
Objective: Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points.Participants: The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants.Evidence: An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children.Consensus Process: The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement.Conclusions: Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases. (J Clin Endocrinol Metab 95: 5189-5198, 2010)