CLINICAL STUDY Lack of physiological suppression of circulating IGFBP-1 in puberty in patients with insulin-dependent diabetes mellitus

Objective: To evaluate the interaction between serum free insulin, insulin-like binding protein (IGFBP)-1 and leptin concentrations during puberty in insulin-dependent diabetes mellitus (IDDM). Design: Adolescent patients with IDDM (n 101; age.9 years, duration.2 years) from the Out-patient Clinic of the Department of Pediatrics at Oulu University Hospital, and non-diabetic controls, were recruited to the study. Free insulin, IGFBP-1, leptin and insulin antibody concentrations were measured from a fasting serum sample. Results: Free insulin concentrations were lower in the patients than in the controls (4:3^2:3 mU=l com-pared with 6:5^3:1 mU=l; P, 0:001), and there was an inverse correlation between free insulin and fasting blood glucose in the boys with diabetes (r 20:53; P, 0:001), whereas a positive correlation was observed between free insulin and leptin concentrations in the girls with diabetes (r 0:30; P 0:020). The IGFBP-1 concentrations were greater in the patients than in the controls (16:5^10:6mg=l compared with 4:0^3:3; P, 0:001), and they correlated significantly with blood glucose (r 0:63; P, 0:001) and free insulin (r 20:35; P, 0:001). No significant difference was observed in the leptin concentrations between the patients and controls overall, despite greater total body fat in the girls with diabetes compared with the control girls. Conclusions: Adolescents with IDDM are characterised by morning hypoinsulinaemia and high circulat-ing IGFBP-1 concentrations, which may contribute to insulin resistance and impaired metabolic control during puberty. The mechanism behind the increased total body fat in the postpubertal female patients remains to be determined. European Journal of Endocrinology 147 235–24