Successful Strategy to Improve Glucose Tolerance in Thai Obese Youth
Nawaporn Numbenjapon MD*,**, Pairunyar Nakavachara MD*, Jeerunda Santiprabhob MD*, Pornpimol Kiattisakthavee MSc*, Renu Wongarn BA***, Supawadee Likitmaskul MD*
Affiliation : * Division of Endocrinology Diabetes and Metabolism, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Division of Endocrinology Diabetes and Metabolism, Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand *** Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Childhood obesity is an emerging national health problem in Thailand. Our previous study found that one third
of obese children and adolescents had impaired glucose tolerance (IGT) and 2.6 percent had already developed type 2
diabetes mellitus. An immediate strategy needs to be established in order to improve these metabolic problems.
Objective : To determine whether diet and exercise education for lifestyle modification with or without metformin therapy in our
diabetes clinic is enable to improve these metabolic problems.
Material and Method: Twenty-six Thai obese children and adolescents with IGT, who received at least 6 months of treatment
consisting of lifestyle modification alone or lifestyle modification and metformin (combined treatment) were enrolled into this
study. Each patient underwent the second 2-hour oral glucose tolerance test (OGTT). Plasma glucose, insulin levels, HbA1C
and lipid profiles were measured. The results were compared with historical pre-treatment data.
Results : Approximately 1 year after intervention, 19 out of 26 patients with IGT completed the second 2-hour OGTT. Sixteen
patients (84.2%) successfully reversed to be normal glucose tolerance whereas 3 patients (15.8%) remained IGT. Body mass
index (BMI), BMISDS, 2-hour plasma glucose, basal insulin level, 2-hour insulin level were significantly decreased after
treatment in normal OGTT group (Ps < 0.05). Treatment with lifestyle modification alone and combined treatment indiffer-
ently improved the abnormal glucose tolerance in our patient (83.3% vs. 84.6%).
Conclusion : Impaired glucose tolerance in obese youth is a reversible abnormality by lifestyle modification with or without
metformin.
Keywords : Obesity, Impaired glucose tolerance, Diabetes mellitus, Lifestyle modification, Metformin, Children, Adolescents
