Insulin Resistance in Children: Consensus, Perspective, and Future Directions

May 4, 2011 | Artículos completos

Insulin Resistance in Children: Consensus, Perspective, and Future Directions

Claire Levy-Marchal, Silva Arslanian, Wayne Cutfield, Alan Sinaiko, Celine Druet, M. Loredana Marcovecchio, Francesco Chiarelli and on behalf of ESPE-LWPES-ISPAD-APPES-APEG-SLEP-JSPE, and the Insulin Resistance in Children Consensus Conference Group

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. Basedoncurrent screening criteriaandmethodology, there isnojustification 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.