Glucoregulatory disorders in school refusal students

OBJECTIVES Our previous studies demonstrated autonomic nervous system disorders and cerebral blood hypoperfusion in school refusal students with underlying emotional distress due to fear or anxiety associated with school attendance. Because severe stress is known to affect glucoregulatory metabolism, this study used the oral glucose tolerance test (OGTT) to measure glucose metabolism in school refusal students. DESIGN A three‐hour OGTT was performed. In preparation for the test, students fasted overnight. After a fasting blood sample was drawn, students were given solutions containing a predetermined amount of glucose based on their body weight (1.75 g/kg to a maximum 75 g). After glucose ingestion, blood samples were drawn at 30, 60, 90, 120, 150, and 180 min to measure blood glucose (BG), immunoreactive insulin (IRI), pancreatic glucagon (IRG) and growth hormone (GH) levels. BG levels, IRI response, cumulative BG (ΣBG), cumulative IRI (ΣIRI), insulin/glucose ratio (ΔIRI/ΔBG), and insulinogenic index (ΣIRI/ΣBG) were then compared to previously reported normal control data. As an index of emotional difficulties, the self‐rating depressive scale (SDS) was carried out. PATIENTS Eighty‐one school refusal students (40 males and 41 females), 11–19 years of age (14.8 ± 2.1), were studied. Their school refusal periods ranged from one month to eight years. All students were within – 15 to + 20 %(‐0.04 ± 8.6) of ideal body weight. MEASUREMENTS BG levels were determined using a glucose oxidase reaction method. Serum hormones were measured by radioimmunoassay. RESULTS BG levels at all OGTT time intervals and ΣBG were significantly higher in school refusal students than the normal control data (ΣBG: 39.5 ± 4.4 vs 33.3 ± 3.4 mmol/l, P