Insulin dynamics predict body mass index and z-score response to insulin suppression or sensitization pharmacotherapy in obese children

Robert H. Lustig, Michele L. Mietus-Snyder, Peter Bacchetti, Ann A. Lazar, Pedro A. Velasquez-Mieyer, Michael Christensen

Research output: Contribution to journalArticle

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Abstract

Objective: To assess the use of oral glucose tolerance testing (OGTT) to predict efficacy of insulin sensitization (metformin) or suppression (octreotide) because insulin resistance and insulin hypersecretion may impact pharmacotherapeutic efficacy in obese children. Study design: Forty-three and 24 obese children, with and without central nervous system (CNS) insult, underwent OGTT. Insulin sensitivity was expressed as composite insulin sensitivity index (CISI), and secretion as corrected insulin response (CIRgp). Those without CNS insult received metformin (weight-based dosing) for 6 to 16 months. Those with CNS insult received octreotide SQ 15 μg/kg/d for 6 months. Body mass index (BMI) and z-score responses were modeled using CIRgp and CISI. Results: Metformin: With CIRgp and CISI = 1, BMI z-score in white children declined by 0.23 over the first 4 months (P < .001), and by 0.14 over the next year (P = .33). Each 2-fold increase in CIRgp or CISI attenuated BMI z-score reduction, but with wide uncertainty (P = .24). Black children exhibited little response. Octreotide: With CIRgp and CISI = 1, BMI z-score decreased by 0.23 in the first 4 months (P = .052). Efficacy was dependent on an interaction between CIRgp and CISI (P = .051). Conclusions: Efficacy of metformin was predicted by pretreatment insulin resistance. Efficacy of octreotide was predicted by insulin hypersecretion and sensitivity.

Original languageEnglish (US)
Pages (from-to)23-29
Number of pages7
JournalJournal of Pediatrics
Volume148
Issue number1
DOIs
StatePublished - Jan 1 2006

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Insulin Resistance
Body Mass Index
Insulin
Drug Therapy
Octreotide
Metformin
Central Nervous System
Glucose Tolerance Test
Uncertainty
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Insulin dynamics predict body mass index and z-score response to insulin suppression or sensitization pharmacotherapy in obese children. / Lustig, Robert H.; Mietus-Snyder, Michele L.; Bacchetti, Peter; Lazar, Ann A.; Velasquez-Mieyer, Pedro A.; Christensen, Michael.

In: Journal of Pediatrics, Vol. 148, No. 1, 01.01.2006, p. 23-29.

Research output: Contribution to journalArticle

Lustig, Robert H. ; Mietus-Snyder, Michele L. ; Bacchetti, Peter ; Lazar, Ann A. ; Velasquez-Mieyer, Pedro A. ; Christensen, Michael. / Insulin dynamics predict body mass index and z-score response to insulin suppression or sensitization pharmacotherapy in obese children. In: Journal of Pediatrics. 2006 ; Vol. 148, No. 1. pp. 23-29.
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