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J Clin Endocrinol Metab. 2015 Jan;100(1):244-50. doi: 10.1210/jc.2014-3184.

Insulin sensitivity and secretory response in adults born preterm: the Helsinki Study of Very Low Birth Weight Adults.

Author information

1
National Institute for Health and Welfare (E.K., P.H., K.W., N.K., J.G.E.), Diabetes Prevention Unit, 00271 Helsinki, Finland; Children's Hospital (E.K., S. S-K., P.H., K.W., N.K., A-L.J., S.A.), Helsinki University Central Hospital and University of Helsinki, 00029 HUS, Helsinki, Finland; Department of Obstetrics and Gynecology (E.K.), MRC Oulu, Oulu University Hospital and University of Oulu, 90029 OYS, Oulu, Finland; Department of Behavioral Sciences (J.L., K.R.), University of Helsinki, 00014 Helsinki, Finland; Folkhälsan Research Centre (J.L., J.G.E.,), 00014 Helsinki, Finland; Department of General Practice and Primary Health Care (J.G.E.), University of Helsinki, 00014 Helsinki, Finland; Unit of General Practice (J.G.E.), Helsinki University Central Hospital, 00029 HUS, Helsinki, Finland; and Vasa Central Hospital (J.G.E.), 65130 Vasa, Finland.

Abstract

CONTEXT:

Preterm birth is associated with an increased risk of type 2 diabetes in adult life. The mechanisms are poorly known.

OBJECTIVE:

We studied insulin sensitivity and secretion in adults born preterm at very low birth weight (VLBW; < 1500 g).

DESIGN:

Longitudinal Birth Cohort Study (Helsinki Study of Very Low Birth Weight Adults).

SETTING:

The study was conducted at Uusimaa, Finland.

PARTICIPANTS:

One hundred seven adults born at VLBW and 100 controls born at term not small for gestational age (SGA), group-matched for sex, age, and birth hospital. The mean age was 25.0 years.

MAIN OUTCOME MEASURES:

We performed a 14-sample intravenous glucose tolerance test and calculated insulin sensitivity (Si), insulin secretory response (AIR), and disposition index, by Minimal Model (Minmod Millennium®).

RESULTS:

Compared with controls, VLBW adults had lower Si (mean difference -11.9%, 95% CI -22.1 to -0.4%, adjusted for sex, age, and body mass index) and higher AIR (19.9%; 4.4-37.7%). The association with Si attenuated when further adjusted for height, parental diabetes, parental education, smoking, maternal smoking, hormonal contraception, and physical activity, but the association with AIR remained. Disposition index was similar. There was no difference between the 40 VLBW adults born SGA and the remaining VLBW adults.

CONCLUSIONS:

Adults born preterm at VLBW have lower insulin sensitivity than their term-born peers with a similar body size. In young adulthood, this remains compensated by higher insulin secretion. We suggest that this represents an early stage in the pathway leading to type 2 diabetes. Our results underline the importance of a healthy lifestyle and prompt vigilance in the screening of type 2 diabetes and impaired glucose tolerance in adults born preterm.

PMID:
25303493
DOI:
10.1210/jc.2014-3184
[Indexed for MEDLINE]

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