Progression from impaired glucose tolerance to type 2 diabetes in obese children and adolescents: a 3–6-year cohort study in southern Thailand

Somchit Jaruratanasirikul, Sudarat Thammaratchuchai, Maneerat Puwanant, Ladda Mo-suwan and Hutcha Sriplung



Childhood obesity is associated with abnormal glucose metabolism and type 2 diabetes mellitus (T2DM). This study evaluated the prevalence of abnormal glucose metabolism in asymptomatic obese children and adolescents, and determined the percentage of T2DM development after 3–6 years of follow-up.


During 2007–2013, 177 obese children and adolescents who had normal fasting plasma glucose (FPG<100 mg/dL) were given an oral glucose tolerance test (OGTT). The participants were classified into four groups: normal glucose tolerance (NGT), NGT-hyperinsulinemia (NGT-HI), impaired glucose tolerance (IGT), and diabetes mellitus (DM). Blood chemistries, including FPG, glycated hemoglobin, and lipid profiles, and liver function test were performed every 6–12 months or when the patient developed any symptom or sign indicative of diabetes.


Glucose metabolism alterations were detected in 81.4% of the participants: 63.8% with NGT-HI, 15.3% with IGT, and 2.3% with T2DM. The median levels of homeostasis model assessment-insulin resistance (HOMA-IR) in patients with IGT (8.63) were significantly greater than those in the patients with NGT (4.04) (p<0.01). During the follow-up, 22 patients (14.4%) developed T2DM significantly more from the IGT group (nine of 33 cases, 27.3%) than the NGT-HI group (12 of 108 cases, 11.1%) (p=0.022). The predicting parameters for T2DM conversion were weight status, body mass index (BMI), FBG, fasting insulin, alanine transaminase (ALT) levels, and HOMA-IR.


Glucose metabolism alteration was commonly found among obese adolescents. Factors associated with T2DM development were greater weight status and the severity of insulin resistance as shown by higher HOMA-IR levels.

  • 1.

    Gupta N, Goel K, Misra A. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev 2012;33:48–70.

  • 2.

    Viner RM, White B, Barrett T, Candy D, Gibson P, et al. Assessment of childhood obesity in secondary care: OSCA consensus statement. Arch Dis Child Educ Pract Ed 2012;97:98–105.

  • 3.

    Chavasit V, Kasemsup V, Tontisirin K. Thailand conquered under-nutrition very successfully but has not slowed obesity. Obes Rev 2013;14(Suppl 2):96–105.

  • 4.

    Winichagoon P. Thailand nutrition in transition: situation and challenges of maternal and child nutrition. Asia Pac J Clin Nutr 2013;22:6–15.

  • 5.

    Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet 2010;375:1737–48.

  • 6.

    Morandi A, Maffeis C. Predictors of metabolic risk in childhood obesity. Horm Res Paediatr 2014;82:3–11.

  • 7.

    Bartoli E, Fra GP, Carvavale Schianca GP. The oral glucose tolerance test (OGTT) revisited. Eur J Intern Med 2011;22:8–12.

  • 8.

    Brufani C, Ciampalini P, Grossi A, Fiori R, Fintini D, et al. Glucose tolerance status in 510 children and adolescents attending an obesity clinic in central Italy. Pediatr Diabetes 2010;11:47–54.

  • 9.

    Morrison KM, Xu L, Tarnopolsky M, Yusuf Z, Atkinson SA, et al. Screening for dysglycemia in overweight youth presenting for weight management. Diabetes Care 2012;35:711–6.

  • 10.

    Wabitsch M, Hauner H, Hertrampf M, Muche R, Hay B, et al. Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany. Int J Obes Relat Metab Disord 2004;28:307–13.

  • 11.

    Zhu H, Zhang X, Li M-Z, Xie J, Yang X-L. Prevalence of type 2 diabetes and pre-diabetes among overweight or obese children in Tianjin China. Diabet Med 2013;30:1457–65.

  • 12.

    Korwutthikulrangsri M, Mahachoklertwattana P, Chanprasertyothin S, Pongratanakul S, Poomthavorn P. Serum fibroblast growth factor 21 in overweight and obese Thai children and adolescents: its relation to glucose metabolism and its change after glucose loading. Clin Endocrinol 2015;83:820–7.

  • 13.

    Tirabanchasak S, Siripunthana S, Supornsilchai V, Wacharasindhu S, Sahakitrungruang T. Insulin dynamics and biochemical markers for predicting impaired glucose tolerance in obese Thai youth. J Pediatr Endocrinol Metab 2015;28:1039–45.

  • 14.

    World Health Organization. Growth reference data for 5–19 years 2007 WHO reference. Available at: http://www./who/int/growthref/en/. Accessed: 14 September 2015.

  • 15.

    Department of Health, Ministry of Public Health. Reference for weight, height and nutritional indices in Thai children aged 1 day to 19 years. Bangkok, Thailand: Department of Health, Ministry of Public Health, 2000.

  • 16.

    Craig ME, Hattersley A, Donaghue K. ISPAD clinical practice consensus guideline 2006–2007. Definition, epidemiology and classification. Pediatr Diabetes 2006;7:343–51.

  • 17.

    Ten S, MacLaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab 2004;89:2526–39.

  • 18.

    Matsuda M, DeFranco RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999;22:1462–70.

  • 19.

    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–9.

  • 20.

    Keskin M, Kurtoglu S, Kendirci M, Atabek E, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005;115:e500–3.

  • 21.

    Albareda M, Rodriguez-Espinosa J, Murugo M, de Leiva A, Corcoy R. Assessment of insulin sensitivity and beta-cell function from measurement in the fasting state and during an oral glucose tolerance test. Diabetologia 2000;43:1507–11.

  • 22.

    Likitmaskul S, Kiattisathavee P, Chaichanwatanakul K, Punnakanta L, Angsusingha K, et al. Increasing prevalence of type 2 diabetes mellitus in Thai children and adolescents associated with increasing prevalence of obesity. J Pediatr Endocrinol Metab 2003;16:71–7.

  • 23.

    Panamonta O, Thamsiri N, Panamonta M. Prevalence of type II diabetes and metabolic syndrome among overweight school children in Khon Kaen, Thailand. J Med Assoc Thai 2010;93:56–60.

  • 24.

    Lee JM, Herman WH, Okumura MJ, Gurney JG, Davis MM. Prevalence and determinants of insulin resistance among U.S. adolescents. Diabetes Care 2006;29:2427–32.

  • 25.

    Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet C, et al. Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab 2010;95:5189–98.

  • 26.

    Cho YH, Craig ME, Donaghue KC. Puberty as an accelerator for diabetes complications. Pediatr Diabetes 2014;15:18–26.

  • 27.

    Roemmich JN, Clark PA, Lusk M, Friel A, Weltman A, et al. Pubertal alterations in growth and body composition. VI. Pubertal insulin resistance: relation to adiposity, body fat, distribution and hormone release. Int J Obes Relat Metab Disord 2002;26:701–9.

  • 28.

    Cree-Green M, Triolo TM, Nadeau KJ. Etiology of insulin resistance in youth with type 2 diabetes. Curr Diab Rep 2013;13:81–8.

  • 29.

    Weiss R, Taksali SE, Tamborlane WV, Burgert TS, Savoye M, et al. Predictors of changes in glucose tolerance status in obese youth. Diabetes Care 2005;28:902–5.

  • 30.

    Kleber M, deSousa G, Papcke S, Wabitsch M, Reinehr T. Impaired glucose tolerance in obese white children and adolescents: three to five year follow-up in untreated patients. Exp Clin Endocrinol Diabetes 2011;119:172–6.

  • 31.

    Kleber M, Lass N, Papcke S, Wabitsch M, Reinehr T. One-year follow-up of untreated obese white children and adolescents with impaired glucose tolerance: high conversion rate to normal glucose tolerance. Diabet Med 2010;27:516–21.

  • 32.

    Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 2008;93: s9–30.

  • 33.

    Maffeis C, Pinelli L, Brambilla P, Banzato C, Valzolgher L, et al. Fasting plasma glucose (FPG) and the risk of impaired glucose tolerance in obese children and adolescents. Obesity 2010;18:1437–42.

  • 34.

    Grandone A, Amato A, Luongo C, Santoro N, Perrone L, et al. High-normal fasting glucose levels are associated with increased prevalence of impaired glucose tolerance in obese children. J Endocrinol Invest 2008;31:1098–102.

Purchase article
Get instant unlimited access to the article.
Price including VAT
Log in
Already have access? Please log in.

Journal + Issues

The Journal of Pediatric Endocrinology and Metabolism (JPEM) is the only international journal dedicated exclusively to endocrinology in the neonatal, pediatric and adolescent age groups, and publishes the results of clinical investigations in pediatric endocrinology and basic research. JPEM publishes Review Articles, Original Research, Case Reports, Short Communications and Letters to the Editor.