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World J Diabetes. Apr 15, 2022; 13(4): 282-307
Published online Apr 15, 2022. doi: 10.4239/wjd.v13.i4.282
Insulin-resistance in paediatric age: Its magnitude and implications
Mohammed Al-Beltagi, Adel Salah Bediwy, Nermin Kamal Saeed
Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Egypt
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
Adel Salah Bediwy, Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
Adel Salah Bediwy, Department of Pulmonology, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama 12, Bahrain
Nermin Kamal Saeed, Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Busaiteen 15503, Bahrain
Author contributions: Al-Biltagi M, Bediwy AS, and Saeed NK collected the data and wrote and revised the manuscript.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, MBChB, MD, MSc, PhD, Chairman, Professor, Department of Pediatrics, Faculty of Medicine, Tanta University, Al Bahra Street, Tanta 31511, Egypt. mbelrem@hotmail.com
Received: February 18, 2022
Peer-review started: February 18, 2022
First decision: March 11, 2022
Revised: March 12, 2022
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: April 15, 2022
Processing time: 54 Days and 16.9 Hours
Abstract

Insulin resistance (IR) is insulin failure in normal plasma levels to adequately stimulate glucose uptake by the peripheral tissues. IR is becoming more common in children and adolescents than before. There is a strong association between obesity in children and adolescents, IR, and the metabolic syndrome components. IR shows marked variation among different races, crucial to understanding the possible cardiovascular risk, specifically in high-risk races or ethnic groups. Genetic causes of IR include insulin receptor mutations, mutations that stimulate autoantibody production against insulin receptors, or mutations that induce the formation of abnormal glucose transporter 4 molecules or plasma cell membrane glycoprotein-1 molecules; all induce abnormal energy pathways and end with the development of IR. The parallel increase of IR syndrome with the dramatic increase in the rate of obesity among children in the last few decades indicates the importance of environmental factors in increasing the rate of IR. Most patients with IR do not develop diabetes mellitus (DM) type-II. However, IR is a crucial risk factor to develop DM type-II in children. Diagnostic standards for IR in children are not yet established due to various causes. Direct measures of insulin sensitivity include the hyperinsulinemia euglycemic glucose clamp and the insulin-suppression test. Minimal model analysis of frequently sampled intravenous glucose tolerance test and oral glucose tolerance test provide an indirect estimate of metabolic insulin sensitivity/resistance. The main aim of the treatment of IR in children is to prevent the progression of compensated IR to decompensated IR, enhance insulin sensitivity, and treat possible complications. There are three main lines for treatment: Lifestyle and behavior modification, pharmacotherapy, and surgery. This review will discuss the magnitude, implications, diagnosis, and treatment of IR in children.

Keywords: Insulin resistance; Children; Diabetes mellitus; Obesity; Genetic; Acquired

Core Tip: Insulin resistance (IR) increases in children due to lifestyle changes and the pandemic of obesity. There is a strong association between obesity in children and adolescents and IR. There is a broad range of genetic and acquired causes of IR with a wide variability of its prevalence from one country to another. Many available tests can directly or indirectly estimate IR. To prevent future IR, we should target all the factors that could help the development of IR, especially obesity.