Insulin resistance and metabolic syndrome in pediatric systemic lupus erythematosus patients: correlation with disease activity and serum leptin

ABSTRACT

To assess the occurrence of insulin resistance and metabolic syndrome and their correlation with disease activity and serum leptin in patients with pediatric SLE. This study included 30 non-diabetic pediatric SLE patients diagnosed according to ACR revised criteria for SLE and 10 age and sex matched controls. Patients were subjected to full history taking, thorough clinical examination and evaluation of disease activity using SLEDAI. Fasting serum insulin, glucose, leptin, high sensitivity C-reactive protein [HS-CRP] and lipid profile were measured. Insulin resistance [IR] was calculated with the homeostasis model assessment [HOMA-IR]. Patients were divided according to International Diabetes Federation [IDF] criteria for metabolic syndrome in children and adolescents into patients with and without metabolic syndrome who were compared regarding disease activity and serum leptin. Metabolic syndrome was detected in 9 patients [30%]. There was a non-significant difference regarding SLEDAI and HS-CRP between patients with and without metabolic syndrome. Serum leptin was non-significantly higher among patients with metabolic syndrome than in patients without. There were significantly higher fasting serum insulin and HOMA-IR in patients in comparison to controls. Stepwise multiple regression analysis of factors associated with HOMA-IR revealed that BMI, serum triglycerides and leptin level were the most sensitive independent predictors for IR. Pediatric SLE patients are susceptible to insulin resistance and metabolic syndrome regardless of disease activity. Management of metabolic syndrome in these young patients is beneficial to prevent its complications such as type II diabetes and cardiovascular disease