Insulin resistance in children with nephrotic syndrome with long-term glucocorticoid treatment and its intervention / 中华实用儿科临床杂志

ABSTRACT

Objective To investigate children with nephrotic syndrome (NS) receiving long-term glucocorticoid treatment while monitoring insulin resistance(IR) index,and analyze the influencing factors,and to observe the efficacy of metformin for preventing glucocorticoid-induced obesity and diabetes mellitus type 2.Methods A total of 32 cases including 20 boys and 12 girls with mean age of 7.6 years old(2 to 14 years old),were diagnosed as NS.All children undergoing long-term treatment of prednisone ＞ 1 mg/(kg · d) for at least 3 months.The height,body weight and body mass index(BMI) were monitored.The concentrations of serum insulin and C-peptide were determined by radioimmunoassay,the concentrations of serum HbA1 c were determined by high performance liquid chromatography,and the levels of fasting glucose,cholesterol and triglyceride were measured with an automatic measuring analyzer (American ABBO TT CCX-Ⅱ).The homeostasis model assessment-estimated insulin resistance(HOMA-IR) was calculated;When HOMA-IR ＞ 3.5,the patients were given metformin treatment for 12 weeks while supervising their height,weight,fasting blood glucose levels monthly.Results Out of 32 cases of NS with long-term use of prednisone,23 cases had HOMAIR ＞ 3.5 (72％).Thus,IR group included 23 patients,and non-IR (NIR) group had 9 patients.There were significant differences between 2 groups in BMI,age,prednisone dosage and the levels of triglyceride (TG) (all P ＜ 0.05).After 12 weeks of metformin treatment,the HOMA-IR (5.24 ± 1.82 vs 2.54 ± 1.09,P ＜ 0.01),HbA1 c levels [(6.36 ±0.82)％ vs(5.39 ±0.51)％,P ＜0.05],BMI[(27.42 ±6.12) kg/m2 vs(22.72 ±5.48) kg/m2,P ＜0.01],and TG levels[(2.03 ± 1.10) mmol/L vs(1.45 ±0.48) mmol/L,P＜0.05] were significantly reduced.Conclusions Older children with long-term use of glucocorticoid may easily lead to IR.Therefore,monitoring the HOMA-IR and early administration of mefformin is helpful for prevention and treatment of glucocorticoid-induced obesity and diabetes mellitus type 2.