Preemies seen prone to 'pre-diabetes'

Children who were born prematurely, regardless of their actual birth weight, have a reduction in insulin sensitivity - a pre-diabetic condition that can lead to full-blown diabetes.

The finding is similar to that seen in children and adults who were born at term but who had a low birth weight.

"There is increasing evidence that this latter group has a marked increased risk of insulin resistance-related diseases," Dr. Paul L. Hofman from the University of Auckland in New Zealand told AMN Health.

Disorders associated with insulin resistance, or reduced insulin sensitivity, include type 2 diabetes, high blood pressure, heart disease, stroke, and adult-onset obesity

"Therefore it is likely that if this reduced insulin sensitivity tracks with age, then prematurely born infants will also be at risk of these adult diseases," Hofman added.

Hofman and his co-investigators measured insulin sensitivity - that is, how efficiently insulin processes glucose - in 72 healthy children 4 to 10 years of age.

Of the 50 who were born before 32 weeks, 38 had a birth weight appropriate for gestational age and 12 were small for gestational age. Of the 22 children born at term, 13 were small for gestational age.

Children born prematurely at any birth weight had an approximately 30 percent reduction in insulin sensitivity compared with children of normal birth weight born at term, the team reports in Thursday's issue of The New England Journal of Medicine.

At age 4 to 10 years, children born prematurely had a "compensatory increase in acute insulin release" - that is they produced more insulin at meal times to overcome the insulin resistance.

While the reason why prematurity leads to reduced insulin sensitivity is not known, this study supports the idea that "what happens in fetal life and early childhood appears to permanently modify your risks of later adult diseases," Hofman said.

"However, with ongoing exercise, avoidance of obesity and of lifestyles that cause insulin resistance, these later problems can be avoided," he emphasized. "By identifying these risks in children it leaves a large window where interventions can be put in place to prevent these complications."

SOURCE: New England Journal of Medicine, November 18, 2004.