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Clinical Manifestations of Insulin Resistance in Youth

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Insulin Resistance

Part of the book series: Contemporary Endocrinology ((COE))

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Abstract

The ongoing obesity epidemic places about a third of American youth at risk for developing obesity-related insulin resistance. This is manifested by reduced multiorgan effects of insulin, leading to elevated insulin concentrations and, in some cases, inappropriately elevated glucose and lipid concentrations. Many risk factors for insulin resistance—including genetics, epigenetics, obesity, diet, and lifestyle—are in common between adolescents and adults. However, adolescents have a unique risk factor in the physiologic insulin resistance of puberty, which along with obesity can pose a “double hit” to the beta-cell, causing increased burden for insulin secretion.

The diagnosis of insulin resistance-related health conditions is more difficult in pediatric patients, due to physiological growth and change that makes the establishment of standards difficult. Such conditions include nonalcoholic fatty liver disease, polycystic ovary syndrome, metabolic syndrome, prediabetes, type 2 diabetes, and lipodystrophies, each of which would obligate additional screening or treatment. Research on treatment options generally addresses holistic changes in diet and lifestyle, with or without the addition of insulin sensitizers. Though these interventions require diligence and can be difficult to maintain, even small successes can create improvements to measured insulin resistance.

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References

  1. Keller U, Gerber PP, Stauffacher W. Fatty acid-independent inhibition of hepatic ketone body production by insulin in humans. Am J Physiol. 1988;254(6 Pt 1):E694–9.

    CAS  PubMed  Google Scholar 

  2. Jefferson LS. Role of insulin in the regulation of protein synthesis. Diabetes. 1980;29(6):487–96.

    Article  CAS  PubMed  Google Scholar 

  3. Philippe J. Insulin regulation of the glucagon gene is mediated by an insulin-responsive DNA element. Proc Natl Acad Sci U S A. 1991;88(16):7224–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kahn BB. Glucose transport: pivotal step in insulin action. Diabetes. 1996;45(11):1644–54.

    Article  CAS  PubMed  Google Scholar 

  5. DeFronzo RA. The triumvirate: cell, muscle, liver: a collusion responsible for NIDDM. Diabetes. 1988;37(6):667–87.

    Article  CAS  PubMed  Google Scholar 

  6. Fielding BA, Frayn KN. Lipoprotein lipase and the disposition of dietary fatty acids. Br J Nutr. 1998;80(6):495–502.

    Article  CAS  PubMed  Google Scholar 

  7. Carnagarin R, Dharmarajan AM, Dass CR. Molecular aspects of glucose homeostasis in skeletal muscle–a focus on the molecular mechanisms of insulin resistance. Mol Cell Endocrinol. 2015;417:52–62.

    Article  CAS  PubMed  Google Scholar 

  8. Meshkani R, Adeli K. Hepatic insulin resistance, metabolic syndrome and cardiovascular disease. Clin Biochem. 2009;42(13–14):1331–46.

    Article  CAS  PubMed  Google Scholar 

  9. Hannon TS, Rao G, Arslanian SA. Childhood obesity and type 2 diabetes mellitus. Pediatrics. 2005;116(2):473–80.

    Article  PubMed  Google Scholar 

  10. Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet C, Marcovecchio ML, et al. Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab. 2010;95(12):5189–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Brown RJ, Yanovski JA. Estimation of insulin sensitivity in children: methods, measures and controversies. Pediatr Diabetes. 2014;15(3):151–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Hannon TS, Janosky J, Arslanian SA. Longitudinal study of physiologic insulin resistance and metabolic changes of puberty. Pediatr Res. 2006;60(6):759–63.

    Article  CAS  PubMed  Google Scholar 

  13. Moran A, Jacobs DR, Steinberger J, Hong CP, Prineas R, Luepker R, et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes. 1999;48(10):2039–44.

    Article  CAS  PubMed  Google Scholar 

  14. Caprio S, Plewe G, Diamond MP, Simonson DC, Boulware SD, Sherwin RS, et al. Increased insulin secretion in puberty: a compensatory response to reductions in insulin sensitivity. J Pediatr. 1989;114(6):963–7.

    Article  CAS  PubMed  Google Scholar 

  15. Lyssenko V, Jonsson A, Almgren P, Pulizzi N, Isomaa B, Tuomi T, et al. Clinical risk factors, DNA variants, and the development of type 2 diabetes. N Engl J Med. 2008;359(21):2220–32.

    Article  CAS  PubMed  Google Scholar 

  16. Toperoff G, Aran D, Kark JD, Rosenberg M, Dubnikov T, Nissan B, et al. Genome-wide survey reveals predisposing diabetes type 2-related DNA methylation variations in human peripheral blood. Hum Mol Genet. 2012;21(2):371–83.

    Article  CAS  PubMed  Google Scholar 

  17. Chambers JC, Loh M, Lehne B, Drong A, Kriebel J, Motta V, Wahl S, Elliot HR, Rota F, Scott WR, Zhang W, Tan ST, Campanella G, Chadeau-Hyam M, Yengo L, Richmond RC, Adamowicz-Brice M, Afzal U, Bozaoglu K, Kooner JS. Epigenome-wide association of DNA methylation markers in peripheral blood from Indian Asians and Europeans with incident type 2 diabetes: a nested case-control study. Lancet Diabetes Endocrinol. 2015;3(7):526–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Wilson DM, Abrams SH, Aye T, Lee PD, Lenders C, Lustig RH, et al. Metformin extended release treatment of adolescent obesity: a 48-week randomized, double-blind, placebo-controlled trial with 48-week follow-up. Arch Pediatr Adolesc Med. 2010;164(2):116–23.

    PubMed  Google Scholar 

  19. Vaag A, Jensen CB, Poulsen P, Brons C, Pilgaard K, Grunnet L, et al. Metabolic aspects of insulin resistance in individuals born small for gestational age. Horm Res. 2006;65(Suppl 3):137–43.

    CAS  PubMed  Google Scholar 

  20. Holness MJ, Sugden MC. Epigenetic regulation of metabolism in children born small for gestational age. Curr Opin Clin Nutr Metab Care. 2006;9(4):482–8.

    Article  CAS  PubMed  Google Scholar 

  21. Weiss R, Kaufman FR. Metabolic complications of childhood obesity: identifying and mitigating the risk. Diabetes Care. 2008;31(Suppl 2):S310–6.

    Article  PubMed  Google Scholar 

  22. Arslanian SA, Saad R, Lewy V, Danadian K, Janosky J. Hyperinsulinemia in African-American children: decreased insulin clearance and increased insulin secretion and its relationship to insulin sensitivity. Diabetes. 2002;51(10):3014–9.

    Article  CAS  PubMed  Google Scholar 

  23. Bacha F, Gungor N, Lee S, Arslanian SA. Type 2 diabetes in youth: are there racial differences in beta-cell responsiveness relative to insulin sensitivity? Pediatr Diabetes. 2012;13(3):259–65.

    Article  CAS  PubMed  Google Scholar 

  24. Weiss R, Dziura JD, Burgert TS, Taksali SE, Tamborlane WV, Caprio S. Ethnic differences in beta cell adaptation to insulin resistance in obese children and adolescents. Diabetologia. 2006;49(3):571–9.

    Article  CAS  PubMed  Google Scholar 

  25. Hasson RE, Adam TC, Davis JN, Weigensberg MJ, Ventura EE, Lane CJ, et al. Ethnic differences in insulin action in obese African-American and Latino adolescents. J Clin Endocrinol Metab. 2010;95(8):4048–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. TODAY Study Group, Zeitler P, Hirst K, Pyle L, Linder B, Copeland K, et al. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012;366(24):2247–56.

    Article  PubMed Central  Google Scholar 

  27. Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA. 2014;311(17):1778–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. National Center for Health Statistics. Health, United States, 2015: with special feature on racial and ethnic health dsiparities. Hyattsville: National Center for Health Statistics; 2016.

    Google Scholar 

  30. Sjaarda L, Lee S, Tfayli H, Bacha F, Bertolet M, Arslanian S. Measuring beta-cell function relative to insulin sensitivity in youth: does the hyperglycemic clamp suffice? Diabetes Care. 2013;36(6):1607–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Wagner KA, Armah SM, Smith LG, Pike J, Tu W, Campbell WW, et al. Associations between diet behaviors and measures of glycemia, in clinical setting, in obese adolescents. Child Obes. 2016;12(5):341–7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Gilbert PA, Khokhar S. Changing dietary habits of ethnic groups in Europe and implications for health. Nutr Rev. 2008;66(4):203–15.

    Article  PubMed  Google Scholar 

  33. Kaufman-Shriqui V, Fraser D, Friger M, Bilenko N, Vardi H, Abu-Saad K, et al. Factors associated with childhood overweight and obesity among acculturated and new immigrants. Ethn Dis. 2013;23(3):329–35.

    PubMed  Google Scholar 

  34. Goel MS, McCarthy EP, Phillips RS, Wee CC. Obesity among US immigrant subgroups by duration of residence. JAMA. 2004;292(23):2860–7.

    Article  CAS  PubMed  Google Scholar 

  35. Gualdi-Russo E, Zaccagni L, Manzon VS, Masotti S, Rinaldo N, Khyatti M. Obesity and physical activity in children of immigrants. Eur J Pub Health. 2014;24(Suppl 1):40–6.

    Article  Google Scholar 

  36. Delavari M, Sonderlund AL, Swinburn B, Mellor D, Renzaho A. Acculturation and obesity among migrant populations in high income countries–a systematic review. BMC Public Health. 2013;13:458.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Bergouignan A, Latouche C, Heywood S, Grace MS, Reddy-Luthmoodoo M, Natoli AK, et al. Frequent interruptions of sedentary time modulates contraction- and insulin-stimulated glucose uptake pathways in muscle: ancillary analysis from randomized clinical trials. Sci Rep. 2016;6:32044.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. McGarrah RW, Slentz CA, Kraus WE. The effect of vigorous-versus moderate-intensity aerobic exercise on insulin action. Curr Cardiol Rep. 2016;18(12):117.

    Article  PubMed  Google Scholar 

  39. Nestler JE, Powers LP, Matt DW, Steingold KA, Plymate SR, Rittmaster RS, et al. A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab. 1991;72(1):83–9.

    Article  CAS  PubMed  Google Scholar 

  40. Engmann L, Jin S, Sun F, Legro RS, Polotsky AJ, Hansen KR, et al. Racial and ethnic differences in the polycystic ovary syndrome (PCOS) metabolic phenotype. Am J Obstet Gynecol. 2017;216(5):493.e1–493.e13.

    Article  Google Scholar 

  41. Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003–2012. JAMA. 2015;313(19):1973–4.

    Article  CAS  PubMed  Google Scholar 

  42. Lee AM, Gurka MJ, DeBoer MD. Trends in metabolic syndrome severity and lifestyle factors among adolescents. Pediatrics. 2016;137(3):e20153177.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents. Lancet. 2007;369(9579):2059–61.

    Article  PubMed  Google Scholar 

  44. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004;350(23):2362–74.

    Article  CAS  PubMed  Google Scholar 

  45. Li C, Ford ES, Zhao G, Mokdad AH. Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among U.S. adolescents: National Health and Nutrition Examination Survey 2005–2006. Diabetes Care. 2009;32(2):342–7.

    Article  PubMed  PubMed Central  Google Scholar 

  46. American Diabetes Association. Statistics about diabetes. Available from: http://www.diabetes.org/diabetes-basics/statistics/.

  47. Centers for Disease Control and Prevention. National Diabetes Statistics Report: estimates of diabetes and its burden in the United States. Atlanta: U.S. Department of Health and Human Services; 2014.

    Google Scholar 

  48. Hamman RF, Bell RA, Dabelea D, D’Agostino RB Jr, Dolan L, Imperatore G, et al. The SEARCH for Diabetes in Youth study: rationale, findings, and future directions. Diabetes Care. 2014;37(12):3336–44.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Witchel SF, Oberfield S, Rosenfield RL, Codner E, Bonny A, Ibanez L, et al. The diagnosis of polycystic ovary syndrome during adolescence. Horm Res Paediatr. 2015;83(6):376–89.

    Article  CAS  Google Scholar 

  50. Carreau AM, Baillargeon JP. PCOS in adolescence and type 2 diabetes. Curr Diab Rep. 2015;15(1):564.

    Article  PubMed  CAS  Google Scholar 

  51. Williams RM, Ong KK, Dunger DB. Polycystic ovarian syndrome during puberty and adolescence. Mol Cell Endocrinol. 2013;373(1–2):61–7.

    Article  CAS  PubMed  Google Scholar 

  52. Lewy VD, Danadian K, Witchel SF, Arslanian S. Early metabolic abnormalities in adolescent girls with polycystic ovarian syndrome. J Pediatr. 2001;138(1):38–44.

    Article  CAS  PubMed  Google Scholar 

  53. Tfayli H, Arslanian S. Menstrual health and the metabolic syndrome in adolescents. Ann N Y Acad Sci. 2008;1135:85–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Glueck CJ, Aregawi D, Winiarska M, Agloria M, Luo G, Sieve L, et al. Metformin-diet ameliorates coronary heart disease risk factors and facilitates resumption of regular menses in adolescents with polycystic ovary syndrome. J Pediatr Endocrinol Metab. 2006;19(6):831–42.

    Article  CAS  PubMed  Google Scholar 

  55. Arslanian SA, Lewy V, Danadian K, Saad R. Metformin therapy in obese adolescents with polycystic ovary syndrome and impaired glucose tolerance: amelioration of exaggerated adrenal response to adrenocorticotropin with reduction of insulinemia/insulin resistance. J Clin Endocrinol Metab. 2002;87(4):1555–9.

    Article  CAS  PubMed  Google Scholar 

  56. Vos MB, Abrams SH, Barlow SE, Caprio S, Daniels SR, Kohli R, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children. J Pediatr Gastroenterol Nutr. 2017;64(2):319–34.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Newton KP, Hou J, Crimmins NA, Lavine JE, Barlow SE, Xanthakos SA, et al. Prevalence of prediabetes and type 2 diabetes in children with nonalcoholic fatty liver disease. JAMA Pediatr. 2016;170(10):e161971.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Kim G, Giannini C, Pierpont B, Feldstein AE, Santoro N, Kursawe R, et al. Longitudinal effects of MRI-measured hepatic steatosis on biomarkers of glucose homeostasis and hepatic apoptosis in obese youth. Diabetes Care. 2013;36(1):130–6.

    Article  CAS  PubMed  Google Scholar 

  59. Cali AM, De Oliveira AM, Kim H, Chen S, Reyes-Mugica M, Escalera S, et al. Glucose dysregulation and hepatic steatosis in obese adolescents: is there a link? Hepatology. 2009;49(6):1896–903.

    Article  CAS  PubMed  Google Scholar 

  60. Nolis T. Exploring the pathophysiology behind the more common genetic and acquired lipodystrophies. J Hum Genet. 2014;59(1):16–23.

    Article  CAS  PubMed  Google Scholar 

  61. Abate N. Adipocyte maturation arrest: a determinant of systemic insulin resistance to glucose disposal. J Clin Endocrinol Metab. 2012;97(3):760–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Gupta N, Asi N, Farah W, Almasri J, Moreno Barrionuevo P, Alsawas M, et al. Clinical features and management of non-HIV related lipodystrophy in children: a systematic review. J Clin Endocrinol Metab. 2016;102(2):363–74. https://doi.org/10.1210/jc.2016-2271.

    Article  PubMed Central  Google Scholar 

  63. Garg A. Gender differences in the prevalence of metabolic complications in familial partial lipodystrophy (Dunnigan variety). J Clin Endocrinol Metab. 2000;85(5):1776–82.

    CAS  PubMed  Google Scholar 

  64. Hussain I, Garg A. Lipodystrophy syndromes. Endocrinol Metab Clin N Am. 2016;45(4):783–97.

    Article  Google Scholar 

  65. Gambineri A, Semple RK, Forlani G, Genghini S, Grassi I, Hyden CS, et al. Monogenic polycystic ovary syndrome due to a mutation in the lamin A/C gene is sensitive to thiazolidinediones but not to metformin. Eur J Endocrinol. 2008;159(3):347–53.

    Article  CAS  PubMed  Google Scholar 

  66. Altshuler D, Hirschhorn JN, Klannemark M, Lindgren CM, Vohl MC, Nemesh J, et al. The common PPARgamma Pro12Ala polymorphism is associated with decreased risk of type 2 diabetes. Nat Genet. 2000;26(1):76–80.

    Article  CAS  PubMed  Google Scholar 

  67. Hudon SE, Coffinier C, Michaelis S, Fong LG, Young SG, Hrycyna CA. HIV-protease inhibitors block the enzymatic activity of purified Ste24p. Biochem Biophys Res Commun. 2008;374(2):365–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Diker-Cohen T, Cochran E, Gorden P, Brown RJ. Partial and generalized lipodystrophy: comparison of baseline characteristics and response to metreleptin. J Clin Endocrinol Metab. 2015;100(5):1802–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Reinehr T, Lass N, Toschke C, Rothermel J, Lanzinger S, Holl RW. Which amount of BMI-SDS reduction is necessary to improve cardiovascular risk factors in overweight children? J Clin Endocrinol Metab. 2016;101(8):3171–9.

    Article  CAS  PubMed  Google Scholar 

  70. Garnett SP, Gow M, Ho M, Baur LA, Noakes M, Woodhead HJ, et al. Improved insulin sensitivity and body composition, irrespective of macronutrient intake, after a 12 month intervention in adolescents with pre-diabetes; RESIST a randomised control trial. BMC Pediatr. 2014;14:289.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  71. Marson EC, Delevatti RS, Prado AK, Netto N, Kruel LF. Effects of aerobic, resistance, and combined exercise training on insulin resistance markers in overweight or obese children and adolescents: a systematic review and meta-analysis. Prev Med. 2016;93:211–8.

    Article  PubMed  Google Scholar 

  72. Lee S, Deldin AR, White D, Kim Y, Libman I, Rivera-Vega M, et al. Aerobic exercise but not resistance exercise reduces intrahepatic lipid content and visceral fat and improves insulin sensitivity in obese adolescent girls: a randomized controlled trial. Am J Physiol Endocrinol Metab. 2013;305(10):E1222–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Lee S, Kim Y. Effects of exercise alone on insulin sensitivity and glucose tolerance in obese youth. Diabetes Metab J. 2013;37(4):225–32.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Loprinzi PD, Tudor-Locke C. Weight-activity associations with cardiometabolic risk factors among U.S. youth. Physiol Behav. 2015;149:165–8.

    Article  CAS  PubMed  Google Scholar 

  75. Ekelund U, Luan J, Sherar LB, Esliger DW, Griew P, Cooper A, et al. Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA. 2012;307(7):704–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Duvivier BM, Schaper NC, Hesselink MK, van Kan L, Stienen N, Winkens B, et al. Breaking sitting with light activities vs structured exercise: a randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes. Diabetologia. 2016;60(3):490–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  77. Dunstan DW, Kingwell BA, Larsen R, Healy GN, Cerin E, Hamilton MT, et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care. 2012;35(5):976–83.

    Article  PubMed  PubMed Central  Google Scholar 

  78. TODAY Study Group. Effects of metformin, metformin plus rosiglitazone, and metformin plus lifestyle on insulin sensitivity and beta-cell function in TODAY. Diabetes Care. 2013;36(6):1749–57.

    Article  PubMed Central  CAS  Google Scholar 

  79. Savoye M, Caprio S, Dziura J, Camp A, Germain G, Summers C, et al. Reversal of early abnormalities in glucose metabolism in obese youth: results of an intensive lifestyle randomized controlled trial. Diabetes Care. 2014;37(2):317–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Kendall D, Vail A, Amin R, Barrett T, Dimitri P, Ivison F, et al. Metformin in obese children and adolescents: the MOCA trial. J Clin Endocrinol Metab. 2013;98(1):322–9.

    Article  CAS  PubMed  Google Scholar 

  81. Burgert TS, Duran EJ, Goldberg-Gell R, Dziura J, Yeckel CW, Katz S, et al. Short-term metabolic and cardiovascular effects of metformin in markedly obese adolescents with normal glucose tolerance. Pediatr Diabetes. 2008;9(6):567–76.

    Article  CAS  PubMed  Google Scholar 

  82. Yanovski JA, Krakoff J, Salaita CG, McDuffie JR, Kozlosky M, Sebring NG, et al. Effects of metformin on body weight and body composition in obese insulin-resistant children: a randomized clinical trial. Diabetes. 2011;60(2):477–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Clarson CL, Mahmud FH, Baker JE, Clark HE, McKay WM, Schauteet VD, et al. Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improve insulin resistance. Endocrine. 2009;36(1):141–6.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Endocrinology, University of Nebraska Medical Center, Children’s Hospital and Medical Center, Omaha, NE, USA

    Melinda E. Chen

  2. Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Indianapolis, IN, USA

    Tamara S. Hannon

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  1. Section of Pediatric Endocrinology, Children’s Hospital Colorado, Aurora, CO, USA

    Philip S. Zeitler

  2. Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA

    Kristen J. Nadeau

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Chen, M.E., Hannon, T.S. (2020). Clinical Manifestations of Insulin Resistance in Youth. In: Zeitler, P., Nadeau, K. (eds) Insulin Resistance. Contemporary Endocrinology. Humana, Cham. https://doi.org/10.1007/978-3-030-25057-7_1

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