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Objective: To assess the use of oral glucose tolerance testing (OGTT) to predi ct efficacy of insulin sensitization (metformin)-or suppression (octreotide) be cause insulin resistance and insulin hypersecretion may impact pharmacotherapeut ic efficacy in obese children. Study design: Forty-three and 24 obese children, with and without central nervous system (CNS) insult, underwent OGTT. Insulin s ensitivity was expressed as composite insulin sensitivity index (CISI), and secr etion as corrected insulin response (CIRgp). Those without CNS insult received metformin (weight-based dosing) for 6 to 16 months. Those with CNS insult receiv ed octreotide SQ 15 μg/kg/d for 6 months. Body mass index (BMI) and z-score responses were modeled using CIRgp and CISI. Results: Metformin: With CIRgp and CI SI = 1, BMI z-score in white children declined by 0.23 over the first 4 months (P < .001), and by 0.14 over the next year (P= .33). Each 2-fold increase in CI Rgp or CISI attenuated BMI z-score reduction, but with wide uncertainty (P= .24 ). Black children exhibited little response. Octreotide: With CIRgp and CISI = 1 , BMI z-score decreased by 0.23 in the first 4 months (P= .052). Efficacy was d ependent on an interaction between CIRgp and CISI (P= .051). Conclusions: Effica cy of metformin was predicted by pretreatment insulin resistance. Efficacy of oc treotide was predicted by insulin hypersecretion and sensitivity.
Objective: To assess the use of oral glucose tolerance testing (OGTT) to predi ct efficacy of insulin sensitization (metformin) -or suppression (octreotide) be cause insulin resistance and insulin hypersecretion may impact pharmacotherapeutic efficacy in obese children. Study design: Forty -three and 24 obese children, with and without central nervous system (CNS) insult, underwent OGTT. Insulin s ensitivity was expressed as composite insulin sensitivity index (CISI), and secr etion as corrected insulin response (CIRgp) Those with weight-based dosing for 6 to 16 months. Those with CNS insult receiv ed octreotide SQ 15 μg / kg / d for 6 months. Body mass index (BMI) and z-score responses were modeled using CIRgp and CISI. Results: Metformin: With CIRgp and CI SI = 1, BMI z-score in white children declined by 0.23 over the first 4 months (P <.001), and by 0.14 over the next year (P = .33). Each 2 -fold increase in CI Rgp or CISI attenuated BMI z-score reduc Octreotide: With CIRgp and CISI = 1, BMI z-score decreased by 0.23 in the first 4 months (P = .052). Efficacy was d Efficacy of octreotide was predicted by insulin hypersecretion and sensitivity.