“To study risk factors for the development of insulin resistance in type 1 diabetes mellitus, carbohydrate tolerance disorders, and obesity in children and adolescents”
(research supervisor – Doctor of Medical Sciences O.A. Budreiko, 2008−2010)
The research work carrying-out made it possible to establish according to the data of standard diagnostic tests that insulin resistance in children and adolescents with obesity was revealed fourfold more frequent than the carbohydrate metabolism disorders.
Research object: insulin resistance in children and adolescents with type 1 and 2 diabetes mellitus (DM), some other carbohydrate metabolism disorders, and obesity.
Objective: to improve prognosis of IR at type 1 DM as well as in disorders of carbohydrate tolerance and obesity.
Methods: clinical, biochemical, immunological, radioimmune, instrumental, and statistical.
Theoretical and practical results: it has been established that in children and adolescents with obesity insulin resistance (IR) is revealed four times more often than disorders of carbohydrate metabolism according to standard diagnostic tests data. Prevalence of IR increases significantly during puberty, especially in boys and with a considerable degree of obesity. It has been determined that some signs of a reduced insulin sensitivity are also found in patients with type 1 DM, which can be explained by an increasing need in exogenous insulin. It has been shown that the most important components of IR formation in childhood obesity and adolescents are dislipidemia, disorders in melatonin, leptin and IFR-1 production, cytokine disbalance, and presence of antibodies to B-cells antigens (IA2). It has also been established that the most significant risk factors of IR development in childhood obesity are: low body weight at birth, the process of puberty, neuroendocrine obesity, and dislipidemia. In type 1 DM excessive body weight is less significant, and the risk factors of lowered sensitivity to insulin may include the puberty process, insufficient compensation of carbohydrate metabolism, , dislipidemia, rise in production of counter-insular hormones (STH and cortisol), and cytokine imbalance (an increased level of TNF-a). It has also been revealed that most children and adolescents with obesity (74.1%) have microcirculatory disturbances of various stages, while some 20% of the patients have moderate disorders of spastic-atonic nature. An important position in formation of microcirculatory disorders in obesity belongs to hyperglycemia (on an empty stomach), insulin resistance, and hyperinsulinemia, against the background of which there are most often revealed microcirculatory disorders of the second stage of severity as well as sympathicotonic prevalence in vegetative regulation.
Novelty: prevalence of IR was first revealed in children and adolescents with obesity and its presence was proved in patients with type 1 DM. Common risk factors were singled out for IR formation in children and adolescents with obesity and carbohydrate metabolism disorders (period of puberty, dyslipidemia) as well as their differences, namely absence of correlation with an excessive body weight in patients with type I DM, as distinct from children and adolescents with obesity , where IR development was connected with its type and degree. The role of dislipidemia, cytokine disbalance, production of some counter-insular hormones and melatonin has been proved to contribute to IR formation in children and adolescents with obesity and carbohydrate metabolism disorders. There were established relationships of microcirculatory disturbances at obesity with sympathicotonia, as well as with IR and some other carbohydrate metabolism disorders in children and adolescents with the disease.
Effectiveness: optimization of diagnostics will make it possible to predict IR development in type 1 DM, some disorders of carbohydrate metabolism and obesity.
Fields of application: endocrinology and pediatrics.
