RESUMO
BACKGROUND: Acanthosis nigricans (AN) is one of the signs suggestive of high insulin resistance (IR). IR is one of the mechanisms involved in pathogenesis of diabetes mellitus type-2 (DM Type-2). Thus, early detection of IR in children may allow us time to intervene well before the development of DM Type-2. In this study, 62% of children having AN had high IR. In children having both, AN and high body mass index (BMI), the incidence of IR was about 80%. This suggests that these easily detectable parameters alone can be useful in screening children at high risk of developing DM Type-2 in future. These simple criteria thus hold promise for use in high throughput screening programs for diabetes. CONTEXT: A pilot study conducted by the authors showed that children with AN have a high incidence of IR. The detection of IR in children may allow us time to intervene well before the development of DM Type-2. Detection of DM Type-2 by hyperglycemia may be too late to prevent the onset of microvascular changes. AIMS: This study aims to determine whether easily observable presence of AN can be used to screen for increased IR in children, and thereby to detect this important risk factor for DM Type-2. SETTINGS AND DESIGN: Cross-sectional, observational study. Two schools, one with children belonging to average economic background and the other, a residential school with children of affluent parents. Selection of children was done randomly. SUBJECTS AND METHODS: The study was conducted among 507 children in the age group of 10-18 years. Physical examination for the detection of AN, height and weight measurements, waist circumference, fasting plasma glucose, fasting plasma insulin, and lipid profile was done. Homeostatic model assessment of insulin resistance was calculated. STATISTICAL ANALYSIS USED: Data analysis was performed using descriptive statistics and inferential statistical methods. The association between categorical variables was done by Chi-square test. RESULTS: The presence of AN positively correlated with high IR, and when combined with increased BMI, the incidence rate of IR is 80%. CONCLUSIONS: AN can be used as a screening method to identify children at risk of DM Type-2-since those who have high IR have a high possibility of having DM Type-2 in future. Hence, early screening and simple, but effective interventional strategies can be instituted at this age, which may prevent or delay diabetes in the long run.
