Association of β-cell function and insulin resistance with pediatric type 2 diabetes among Chinese children

Zhen-Ran Xu; Hong-Wei Du; Lan-Wei Cui; Rong-Xiu Zheng; Gui-Mei Li; Hai-Yan Wei; Fei-Yu Lu; Li-Li Chen; Chu-Shan Wu; Shu-Xin Zhang; Shu-Le Zhang; Fang Liu; Miao-Ying Zhang; Zhou Pei; Cheng-Jun Sun; Jing Wu; Fei-Hong Luo

doi:10.4239/wjd.v12.i8.1292

Association of β-cell function and insulin resistance with pediatric type 2 diabetes among Chinese children

World J Diabetes. 2021 Aug 15;12(8):1292-1303. doi: 10.4239/wjd.v12.i8.1292.

Authors

Zhen-Ran Xu¹, Hong-Wei Du², Lan-Wei Cui³, Rong-Xiu Zheng⁴, Gui-Mei Li⁵, Hai-Yan Wei⁶, Fei-Yu Lu², Li-Li Chen³, Chu-Shan Wu⁴, Shu-Xin Zhang⁴, Shu-Le Zhang⁵, Fang Liu⁶, Miao-Ying Zhang¹, Zhou Pei¹, Cheng-Jun Sun¹, Jing Wu¹, Fei-Hong Luo⁷

Affiliations

¹ Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China.
² Department of Pediatric Endocrinology and Inherited Metabolic Diseases, The First Bethune Hospital of Jilin University, Changchun 130021, Jilin Province, China.
³ Department of Pediatrics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China.
⁴ Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin 300052, China.
⁵ Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China.
⁶ Department of Endocrinology, Henan Children's Hospital, Zhengzhou 450052, Henan Province, China.
⁷ Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China. luofh@fudan.edu.cn.

Abstract

Background: In addition to insulin resistance, impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus (T2DM). Scarce clinical data exist for pediatric T2DM.

Aim: To investigate the association of β-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study.

Methods: This multicenter cross-sectional study included 161 newly diagnosed T2DM children and adolescents between January 2017 and October 2019. Children with normal glycemic levels (n = 1935) were included as healthy control subjects. The homeostasis models (HOMAs) were used to assess the β-cell function (HOMA2-%B) and insulin resistance (HOMA2-IR) levels. The HOMA index was standardized by sex and age. We performed logistic regression analysis to obtain odds ratios (ORs) for T2DM risk using the standardized HOMA index, adjusted for confounding factors including sex, Tanner stage, T2DM family history, body mass index z-score, and lipid profile.

Results: The male-female ratio of newly diagnosed T2DM patients was 1.37:1 (OR = 2.20, P = 0.011), and the mean ages of onset for boys and girls were 12.5 ± 1.9 years and 12.3 ± 1.7 years, respectively. The prevalence of related comorbidities including obesity, elevated blood pressure, and dyslipidemia was 58.2%, 53.2%, and 80.0%, respectively. The T2DM group had lower HOMA2-%B levels (P < 0.001) and higher HOMA2-IR levels (P < 0.001) than the control group. Both the decrease in HOMA2-%B z-score (OR = 8.40, 95%CI: 6.40-11.02, P < 0.001) and the increase in HOMA2-IR z-score (OR = 1.79, 95%CI: 1.60-2.02, P < 0.001) were associated with a higher risk of T2DM, and the decrease in HOMA2-%B z-score always had higher ORs than the increase in HOMA2-IR z-score after adjusting for confounding factors.

Conclusion: Besides insulin resistance, β-cell function impairment is also strongly associated with Chinese pediatric T2DM. Gender difference in susceptibility and high comorbidities warrant specific T2DM screening and prevention strategies in Chinese children.

Keywords: Adolescent; Diabetes mellitus; Homeostasis models; Insulin resistance; Type 2; β-cell dysfunction.