Insulin Resistance in Adolescents with Type 2 Diabetes Is Associated with Impaired Exercise Capacity
Insulin Resistance in Adolescents with Type 2 Diabetes Is Associated with Impaired Exercise Capacity
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DOI：
10.1210/jc.2008-2844
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发表时间：
2009-10-01
影响因子：
5.8
通讯作者：
Regensteiner, Judith G.
中科院分区：
文献类型：
--
作者：
Nadeau, Kristen J.;Zeitler, Phillip S.;Regensteiner, Judith G.
背景：儿童2型糖尿病（T2 D）的发病率正在上升，对心血管系统的影响尚不清楚。心血管健康，发病率和死亡率的标志，是异常的成年人与T2 D，但其机制是不完全understood.Objective：我们假设，心肺健康将减少青年与T2 D与胰岛素抵抗（IR）和心血管功能障碍。设计，设置和参与者：我们在一家学术医院进行了一项横断面研究，其中包括14名青少年。（年龄范围，12-19岁）患有T2 D的13名同等肥胖的青少年和12名年龄、青春期阶段和活动水平相似的瘦型青少年。通过峰值氧耗量（VO（2）峰值）和氧摄取动力学（VO（2）动力学）测量心脏适应性，通过高胰岛素钳夹测量IR，通过超声心动图测量心脏功能，通过静脉闭塞体积描记术测量血管功能，通过双能X线吸收法测量身体成分，结果：与肥胖或偏瘦青少年相比，T2 D青少年VO（2）峰值和胰岛素敏感性显著降低，比目鱼肌肌内脂质、C反应蛋白和IL-6升高。与瘦型青少年相比，T2 D青少年的VO（2）动力学显著延长，做功率、血管反应性和脂联素降低，左心室质量和脂肪酸增加。在多元线性回归分析中，IR为主，空腹游离脂肪酸和前臂血流量其次，是显着的独立预测VO（2）peak.Conclusions：鉴于心肺功能下降和死亡率增加之间的密切关系，这些发现在儿童特别关注，并代表早期迹象受损的心脏功能。（临床内分泌代谢杂志94：3687-3695，2009）
Context: The incidence of pediatric type 2 diabetes (T2D) is rising, with unclear effects on the cardiovascular system. Cardiopulmonary fitness, a marker of morbidity and mortality, is abnormal in adults with T2D, yet the mechanisms are incompletely understood.Objective: We hypothesized that cardiopulmonary fitness would be reduced in youth with T2D in association with insulin resistance (IR) and cardiovascular dysfunction.Design, Setting, and Participants: We conducted a cross-sectional study at an academic hospital that included 14 adolescents (age range, 12-19 yr) with T2D, 13 equally obese adolescents and 12 lean adolescents similar in age, pubertal stage, and activity level.Main Outcome Measures: Cardiopulmonary fitness was measured by peak oxygen consumption (VO(2)peak) and oxygen uptake kinetics (VO(2)kinetics), IR by hyperinsulinemic clamp, cardiac function by echocardiography, vascular function by venous occlusion plethysmography, body composition by dual-energy x-ray absorptiometry, intramyocellular lipid by magnetic resonance spectroscopy, and inflammation by serum markers.Results: Adolescents with T2D had significantly decreased VO(2)peak and insulin sensitivity, and increased soleus intramyocellular lipid, C-reactive protein, and IL-6 compared to obese or lean adolescents. Adolescents with T2D also had significantly prolonged VO(2)kinetics, decreased work rate, vascular reactivity, and adiponectin, and increased left ventricular mass and fatty acids compared to lean adolescents. In multivariate linear regression analysis, IR primarily, and fasting free fatty acids and forearm blood flow secondarily, were significant independent predictors of VO(2)peak.Conclusions: Given the strong relationship between decreased cardiopulmonary fitness and increased mortality, these findings in children are especially concerning and represent early signs of impaired cardiac function. (J Clin Endocrinol Metab 94: 3687-3695, 2009)