Insulin Resistance, Depression, and the Progression to Type-2 Diabetes in Youth
Issue Date
2014-05-31Author
Platt, Adrienne Milligan
Publisher
University of Kansas
Format
96 pages
Type
Dissertation
Degree Level
Ph.D.
Discipline
Nursing
Rights
This item is protected by copyright and unless otherwise specified the copyright of this thesis/dissertation is held by the author.
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ABSTRACT Childhood obesity has become epidemic in the United States. Coinciding with this rapid increase in obesity is the development of type-2 diabetes in youth. Little is known about the progression of insulin resistance to type-2 diabetes or association of depressive symptoms and impaired glucose metabolism in at-risk obese youth. A retrospective chart review and a secondary data analysis was done using a descriptive correlational design exploring the incidence of insulin resistance, hyperinsulinemia, impaired fasting glucose, impaired glucose tolerance, and progression to type-2 diabetes in a cohort of 78 high-risk obese youth age 11 to 17 years presenting to a pediatric endocrinology clinic from 2007 to 2009. Association between self-reported depressive symptom scores using the Center for Epidemiological Studies Depression Scale for Children (CES-DC) and measures above were also explored. Of the 78 participants enrolled in the original study, 44 (56.4%) underwent oral glucose tolerance testing, and 4 (9.1%) were diagnosed with impaired glucose tolerance. None had a confirmed diagnosis of type-2 diabetes over the 6 year study period. Two hour oral glucose tolerance results significantly correlated with the initial HbA1c (r=.470, p=.007), the sum of insulin levels (r=.518, p=.001), and HOMA-IR (r=.429, p=.007). The insulin total correlated with HOMA-IR (r=.553, p=.001). The incidence of self-reported depressive symptoms was high in 35 (49 %) participants (n=71). None of the measures of impaired glucose metabolism correlated with depression scores. These results indicate that even with a small sample of obese youth, 78 % met criteria for insulin resistance. The HbA1c correlated with 2-hour glucose tolerance test results. Glucose tolerance testing is used clinically for confirmatory diagnosis of impaired glucose tolerance and type-2 diabetes which support the use of HbA1c for screening youth. Despite lack of association between depressive symptoms and impaired glucose metabolism, 49% reported symptoms of depression with 11% moderate or severe. It would be prudent to screen all obese youth for depressive symptoms as this may impact their ability to implement lifestyle changes. Future research is needed with a larger prospective sample of high-risk obese youth to identify those more likely to develop type-2 diabetes and benefit from lifestyle interventions.
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