Endocrinol Metab.  2020 Dec;35(4):847-857. 10.3803/EnM.2020.771.

Cross-Sectional and Longitudinal Examination of Insulin Sensitivity and Secretion across Puberty among Non-Hispanic Black and White Children

• Marwitz SE
• Gaines MV
• Brady SM
• Mi SJ
• Broadney MM
• Yanovski SZ
• Hubbard VS
• Yanovski JA

• KMID: 2511012
• DOI: http://doi.org/10.3803/EnM.2020.771

Abstract

Background
Few studies using criterion measures of insulin sensitivity (SI) and insulin secretory capacity (ISC) have been conducted across puberty to adulthood. We examined how SI and ISC change from pre-puberty through adulthood.
Methods
Hyperglycemic clamp studies were performed in a convenience sample of non-Hispanic Black (NHB) and White children evaluated at age 6 to 12 years and at approximately 5-year intervals into adulthood (maximum age 27 years). SI and ISC (first-phase and steady-state insulin secretion) were determined cross-sectionally in 133 unique participants across puberty and in adulthood. Additionally, longitudinal changes in SI and ISC were compared at two timepoints among three groups defined by changes in pubertal development: pre-pubertal at baseline and late-pubertal at follow-up (n=27), early-pubertal at baseline and late-pubertal at follow-up (n=27), and late-pubertal at baseline and adult at follow-up (n=24).
Results
Cross-sectionally, SI was highest in pre-puberty and early puberty and lowest in mid-puberty (analysis of covariance [ANCOVA] P=0.001). Longitudinally, SI decreased from pre-puberty to late puberty (P<0.001), then increased somewhat from late puberty to adulthood. Cross-sectionally, first-phase and steady-state ISC increased during puberty and decreased in adulthood (ANCOVA P<0.02). Longitudinally, steady-state and first-phase ISC increased from pre-puberty to late puberty (P<0.007), and steady-state ISC decreased from late puberty to adulthood. The NHB group had lower SI (P=0.003) and greater first-phase and steady-state ISC (P≤0.001), independent of pubertal development.
Conclusion
This study confirms that SI decreases and ISC increases transiently during puberty and shows that these changes largely resolve in adulthood.

Keyword

Glucose clamp techniques; Insulin resistance; Puberty; Insulin secretion; Child; Adolescent

Figure

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  Fig. 1 Cross-sectional results of hyperglycemic clamp studies: (A) first phase insulin secretion (analysis of covariance [ANCOVA] P=0.02); (B) steady state insulin secretion (ANCOVA P<0.001); (C) insulin sensitivity (ANCOVA P<0.004) by pubertal development. All means were adjusted for fat percentage, method of body composition assessment, sex, and race. Roman numerals in group description refer to pubertal development. Girls with Tanner breast stage 1 and boys with testes ≤3 mL were considered pre-pubertal and classified as pubertal group I. Girls with Tanner breast stage 2 and boys with testes >3 to <10 mL were considered to be in early puberty and classified as pubertal group II. Girls with Tanner breast stage 3 and boys with testes ≥10 to <15 mL were considered to be in mid-puberty and classified as pubertal group III. Girls with Tanner breast stage 4 and boys with testes ≥15 to <25 mL were considered to be in late puberty and classified as pubertal group IV. Girls with Tanner breast stage 5 and boys with testes ≥25 mL were considered end-pubertal and classified as pubertal group V. Adult participants (age >18 years) had all achieved pubertal group IV or V when last examined. a,b,cGroups with different superscripted letters are significantly different in post hoc tests (P<0.05).

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  Fig. 2 Comparisons of longitudinal changes in hyperglycemic clamp results. (A) Change in first phase insulin secretion, (B) change in steady state insulin secretion, (C) change in insulin sensitivity. There were significant differences between groups identified by progression of pubertal development for change in steady state insulin secretion (analysis of covariance [ANCOVA] P=0.047) and insulin sensitivity (ANCOVA P<0.001), but not for change in first phase insulin secretion (ANCOVA P=0.689). All means were adjusted for baseline fat percentage, method of body composition assessment, change in fat percentage, sex, and race. Values for PΔ are tests comparing changes from baseline to follow-up within each pubertal group. Roman numerals in group description refer to pubertal development groups at baseline and follow-up. Girls with Tanner breast stage 1 and boys with testes ≤3 mL were considered pre-pubertal and classified as pubertal group I. Girls with Tanner breast stage 2 and boys with testes >3 to <10 mL were considered to be in early puberty and classified as pubertal group II. Girls with Tanner breast stage 3 and boys with testes ≥10 to <15 mL were considered to be in mid-puberty and classified as pubertal group III. Girls with Tanner breast stage 4 and boys with testes ≥15 to <25 mL were considered to be in late puberty and classified as pubertal group IV. Girls with Tanner breast stage 5 and boys with testes ≥25 mL were considered end-pubertal and classified as pubertal group V. Adult participants (age >18 years) had all achieved pubertal groups IV or V when last examined. Group 1 was pre-pubertal (pubertal group I) at baseline and late-pubertal (pubertal groups IV or V) at follow-up, group 2 was early-pubertal (pubertal groups II or III) at baseline and late-pubertal (pubertal groups IV or V) at follow-up, and group 3 was late-pubertal (pubertal groups IV or V) at baseline and studied again at follow-up as adults 4 to 10 years later.

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