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Submitted on April 14, 2008
Accepted on August 1, 2008
Divisions of Pediatric Endocrinology, Metabolism and Diabetes Mellitus and Weight Management and Wellness, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Center for Exercise and Health-Fitness Research, University of Pittsburgh, Pittsburgh, PA, USA
* To whom correspondence should be addressed. E-mail: ingrid.libman{at}chp.edu.
Objective: We examined the reproducibility of the OGTT in overweight children and evaluated distinguishing characteristics between those with concordant versus discordant results.
Design: Sixty overweight youth (8–17 years) completed two OGTTs (interval between tests 1 – 25 days). Insulin sensitivity was assessed by the surrogate measures of fasting glucose/insulin ratio, WBISI and HOMAIR, insulin secretion by the insulinogenic index with calculation of the glucose disposition index (GDI).
Results: Of the 10 subjects with IGT during the first OGTT only 3 (30%) had IGT during the second OGTT. The percent positive agreement between the first and second OGTT was low for both IFG and IGT (22.2% and 27.3% respectively). Fasting blood glucose had higher reproducibility compared to the 2 hour glucose. Youth with discordant OGTTs compared to those with concordant results were more insulin resistant (G/I 2.7 ± 1.4 vs 4.1 ± 1.8, p=0.006, WBISI of 1.3 ± 0.6 vs 2.2 ± 1.1, p=0.003 and HOMA IR10.6± 8.1 vs 5.7 ± 2.8, p=0.001), had a lower GDI (0.45 ± 0.58 vs 1.02 ± 1.0, p=0.03) and had higher LDL cholesterol (117.7 ± 36.6 vs 89.9 ± 20.1, p=0.0005) without differences in physical characteristics.
Conclusions: Our results show poor reproducibility of the OGTT in obese youth, in particular for the 2 hour plasma glucose. Obese youth who have discordant OGTT results are more insulin resistant with higher risk of developing T2DM, as evidenced by a lower GDI. The implications of this remain to be determined in clinical and research settings.
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