Comparison of b-Cell function between overweight/Obese adults and adolescents across the spectrum of glycemia

OBJECTIVE Type 2 diabetes is a growing health problem among both adults and adolescents. To better understand the differences in the pathogenesis of diabetes between these groups we examined differences in b-cell function along the spectrum of glucose tolerance RESEARCH DESIGN AND METHODS We evaluated 89 adults and 50 adolescents with normal glucose tolerance (NGT) dysglycemia, or type 2 diabetes. Oral glucose tolerance test results were used for C-peptide and insulin/glucose minimal modeling. Model-derived and direct mea sures of insulin secretion and insulin sensitivity were compared across glycemic stages and between age-groups at each stage. RESULTS In adolescents with dysglycemia, there was marked insulin resistance (insulin sensi tivity index: adolescents, median [interquartile range] 1.8 [1.1–2.4] 3 10²⁴; adults 5.0 [2.3–9.9]; P = 0.01). The nature of b-cell dysfunction across stages of dysglycemia differed between the groups. We observed higher levels of secretion among adoles cents than adults (total insulin secretion: NGT, 143 [103–284] 3 10²⁹/min adolescen vs. 106 [71–127], P = 0.001); adults showed stepwise impairments in static insulin secretion (NGT, 7.5 [4.0–10.3] 3 10²⁹/min; dysglycemia, 5.0 [2.3–9.9]; type 2 di abetes, 0.7 [0.1–2.45]; P = 0.003), whereas adolescents showed diabetes-related impairment in dynamic secretion (NGT, 1,905 [1,630–3,913] 3 10²⁹; dysglycemia 2,703 [1,323–3,637]; type 2 diabetes, 1,189 [269–1,410]; P = 0.001). CONCLUSIONS Adults and adolescents differ in the underlying defects leading to dysglycemia, and in the nature of b-cell dysfunction across stages of dysglycemia. These results may suggest different approaches to diabetes prevention in youths versus adults.