Insulin Resistance in Adolescents with Type 2 Diabetes Is Associated with Impaired Exercise Capacity
Context: The incidence of pediatric type 2 diabetes (T2D) is rising, with unclear effects on the cardiovascular system. Cardiopulmonary fitness, a marker of morbidity and mortality, is abnormal in adults with T2D, yet the mechanisms are incompletely understood. Objective: We hypothesized that cardio...
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| creator | Nadeau, Kristen J. Zeitler, Phillip S. Bauer, Timothy A. Brown, Mark S. Dorosz, Jennifer L. Draznin, Boris Reusch, Jane E. B. Regensteiner, Judith G. |
| description | Context: The incidence of pediatric type 2 diabetes (T2D) is rising, with unclear effects on the cardiovascular system. Cardiopulmonary fitness, a marker of morbidity and mortality, is abnormal in adults with T2D, yet the mechanisms are incompletely understood.
Objective: We hypothesized that cardiopulmonary fitness would be reduced in youth with T2D in association with insulin resistance (IR) and cardiovascular dysfunction.
Design, Setting, and Participants: We conducted a cross-sectional study at an academic hospital that included 14 adolescents (age range, 12–19 yr) with T2D, 13 equally obese adolescents and 12 lean adolescents similar in age, pubertal stage, and activity level.
Main Outcome Measures: Cardiopulmonary fitness was measured by peak oxygen consumption (VO2peak) and oxygen uptake kinetics (VO2kinetics), IR by hyperinsulinemic clamp, cardiac function by echocardiography, vascular function by venous occlusion plethysmography, body composition by dual-energy x-ray absorptiometry, intramyocellular lipid by magnetic resonance spectroscopy, and inflammation by serum markers.
Results: Adolescents with T2D had significantly decreased VO2peak and insulin sensitivity, and increased soleus intramyocellular lipid, C-reactive protein, and IL-6 compared to obese or lean adolescents. Adolescents with T2D also had significantly prolonged VO2kinetics, decreased work rate, vascular reactivity, and adiponectin, and increased left ventricular mass and fatty acids compared to lean adolescents. In multivariate linear regression analysis, IR primarily, and fasting free fatty acids and forearm blood flow secondarily, were significant independent predictors of VO2peak.
Conclusions: Given the strong relationship between decreased cardiopulmonary fitness and increased mortality, these findings in children are especially concerning and represent early signs of impaired cardiac function.
Adolescents with type 2 diabetes have abnormal exercise function, vascular reactivity, and increased left ventricular mass. |
| doi_str_mv | 10.1210/jc.2008-2844 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2758737</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>67685292</sourcerecordid><originalsourceid>FETCH-LOGICAL-c456t-6b81b9d2851d0001310bdf78a541dc5732956ce3ee286df96870c603868ff2703</originalsourceid><addsrcrecordid>eNptkc2L1EAQxRtxccfVm2fJRU9m7e6kvy7CMLvqwIIgK3hrOt0Vt4dMErsS1_nv7TDD6oKnoqgf7z3qEfKK0UvGGX2_85ecUl1yXddPyIqZWpSKGfWUrCjlrDSKfz8nzxF3lLK6FtUzcs6M0DUzbEXCtse5i33xFTDi5HoPRd7WYegAPfQTFvdxuituDyMUvLiKroEJsNhisUYcfHQThCOy3Y8uprxd_4bkI0KxcaPzcTq8IGet6xBenuYF-fbx-nbzubz58mm7Wd-UvhZyKmWjWWMC14IFmsNWjDahVdqJmgUvVMWNkB4qAK5laI3UinpJKy1123JFqwvy4ag7zs0ewhI_uc6OKe5dOtjBRfv40sc7-2P4ZbkSWlUqC7w9CaTh5ww42X3MX-g618Mwo5VKasENz-C7I-jTgJigfTBh1C612J23Sy12qSXjr_8N9hc-9ZCBNyfAoXddm3IRER84zmklDV98qyMHfRh8ij2MCRDtbphTn1_7f_s_nQunEw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>67685292</pqid></control><display><type>article</type><title>Insulin Resistance in Adolescents with Type 2 Diabetes Is Associated with Impaired Exercise Capacity</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Nadeau, Kristen J. ; Zeitler, Phillip S. ; Bauer, Timothy A. ; Brown, Mark S. ; Dorosz, Jennifer L. ; Draznin, Boris ; Reusch, Jane E. B. ; Regensteiner, Judith G.</creator><creatorcontrib>Nadeau, Kristen J. ; Zeitler, Phillip S. ; Bauer, Timothy A. ; Brown, Mark S. ; Dorosz, Jennifer L. ; Draznin, Boris ; Reusch, Jane E. B. ; Regensteiner, Judith G.</creatorcontrib><description>Context: The incidence of pediatric type 2 diabetes (T2D) is rising, with unclear effects on the cardiovascular system. Cardiopulmonary fitness, a marker of morbidity and mortality, is abnormal in adults with T2D, yet the mechanisms are incompletely understood.
Objective: We hypothesized that cardiopulmonary fitness would be reduced in youth with T2D in association with insulin resistance (IR) and cardiovascular dysfunction.
Design, Setting, and Participants: We conducted a cross-sectional study at an academic hospital that included 14 adolescents (age range, 12–19 yr) with T2D, 13 equally obese adolescents and 12 lean adolescents similar in age, pubertal stage, and activity level.
Main Outcome Measures: Cardiopulmonary fitness was measured by peak oxygen consumption (VO2peak) and oxygen uptake kinetics (VO2kinetics), IR by hyperinsulinemic clamp, cardiac function by echocardiography, vascular function by venous occlusion plethysmography, body composition by dual-energy x-ray absorptiometry, intramyocellular lipid by magnetic resonance spectroscopy, and inflammation by serum markers.
Results: Adolescents with T2D had significantly decreased VO2peak and insulin sensitivity, and increased soleus intramyocellular lipid, C-reactive protein, and IL-6 compared to obese or lean adolescents. Adolescents with T2D also had significantly prolonged VO2kinetics, decreased work rate, vascular reactivity, and adiponectin, and increased left ventricular mass and fatty acids compared to lean adolescents. In multivariate linear regression analysis, IR primarily, and fasting free fatty acids and forearm blood flow secondarily, were significant independent predictors of VO2peak.
Conclusions: Given the strong relationship between decreased cardiopulmonary fitness and increased mortality, these findings in children are especially concerning and represent early signs of impaired cardiac function.
Adolescents with type 2 diabetes have abnormal exercise function, vascular reactivity, and increased left ventricular mass.</description><identifier>ISSN: 0021-972X</identifier><identifier>EISSN: 1945-7197</identifier><identifier>DOI: 10.1210/jc.2008-2844</identifier><identifier>PMID: 19584191</identifier><identifier>CODEN: JCEMAZ</identifier><language>eng</language><publisher>Bethesda, MD: Endocrine Society</publisher><subject>Adiponectin - blood ; Adolescent ; Biological and medical sciences ; Biomarkers - blood ; Blood Flow Velocity ; Blood Pressure ; Body Composition ; Body Fat Distribution ; C-Reactive Protein - metabolism ; Case-Control Studies ; Child ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - metabolism ; Diabetes Mellitus, Type 2 - physiopathology ; Diabetes. Impaired glucose tolerance ; Echocardiography ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Exercise Test ; Exercise Tolerance ; Fatty Acids, Nonesterified - blood ; Feeding. Feeding behavior ; Female ; Fundamental and applied biological sciences. Psychology ; Heart Rate ; Humans ; Hypertrophy, Left Ventricular - metabolism ; Hypertrophy, Left Ventricular - physiopathology ; Inflammation - blood ; Insulin Resistance ; Interleukin-6 - blood ; Linear Models ; Lipids - blood ; Male ; Medical sciences ; Motor Activity ; Obesity - metabolism ; Obesity - physiopathology ; Original ; Oxygen Consumption ; Plethysmography ; Puberty ; Thinness ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vertebrates: endocrinology ; Young Adult</subject><ispartof>The journal of clinical endocrinology and metabolism, 2009-10, Vol.94 (10), p.3687-3695</ispartof><rights>2009 INIST-CNRS</rights><rights>Copyright © 2009 by The Endocrine Society 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-6b81b9d2851d0001310bdf78a541dc5732956ce3ee286df96870c603868ff2703</citedby><cites>FETCH-LOGICAL-c456t-6b81b9d2851d0001310bdf78a541dc5732956ce3ee286df96870c603868ff2703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22036922$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19584191$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nadeau, Kristen J.</creatorcontrib><creatorcontrib>Zeitler, Phillip S.</creatorcontrib><creatorcontrib>Bauer, Timothy A.</creatorcontrib><creatorcontrib>Brown, Mark S.</creatorcontrib><creatorcontrib>Dorosz, Jennifer L.</creatorcontrib><creatorcontrib>Draznin, Boris</creatorcontrib><creatorcontrib>Reusch, Jane E. B.</creatorcontrib><creatorcontrib>Regensteiner, Judith G.</creatorcontrib><title>Insulin Resistance in Adolescents with Type 2 Diabetes Is Associated with Impaired Exercise Capacity</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Context: The incidence of pediatric type 2 diabetes (T2D) is rising, with unclear effects on the cardiovascular system. Cardiopulmonary fitness, a marker of morbidity and mortality, is abnormal in adults with T2D, yet the mechanisms are incompletely understood.
Objective: We hypothesized that cardiopulmonary fitness would be reduced in youth with T2D in association with insulin resistance (IR) and cardiovascular dysfunction.
Design, Setting, and Participants: We conducted a cross-sectional study at an academic hospital that included 14 adolescents (age range, 12–19 yr) with T2D, 13 equally obese adolescents and 12 lean adolescents similar in age, pubertal stage, and activity level.
Main Outcome Measures: Cardiopulmonary fitness was measured by peak oxygen consumption (VO2peak) and oxygen uptake kinetics (VO2kinetics), IR by hyperinsulinemic clamp, cardiac function by echocardiography, vascular function by venous occlusion plethysmography, body composition by dual-energy x-ray absorptiometry, intramyocellular lipid by magnetic resonance spectroscopy, and inflammation by serum markers.
Results: Adolescents with T2D had significantly decreased VO2peak and insulin sensitivity, and increased soleus intramyocellular lipid, C-reactive protein, and IL-6 compared to obese or lean adolescents. Adolescents with T2D also had significantly prolonged VO2kinetics, decreased work rate, vascular reactivity, and adiponectin, and increased left ventricular mass and fatty acids compared to lean adolescents. In multivariate linear regression analysis, IR primarily, and fasting free fatty acids and forearm blood flow secondarily, were significant independent predictors of VO2peak.
Conclusions: Given the strong relationship between decreased cardiopulmonary fitness and increased mortality, these findings in children are especially concerning and represent early signs of impaired cardiac function.
Adolescents with type 2 diabetes have abnormal exercise function, vascular reactivity, and increased left ventricular mass.</description><subject>Adiponectin - blood</subject><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Blood Flow Velocity</subject><subject>Blood Pressure</subject><subject>Body Composition</subject><subject>Body Fat Distribution</subject><subject>C-Reactive Protein - metabolism</subject><subject>Case-Control Studies</subject><subject>Child</subject><subject>Cross-Sectional Studies</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - metabolism</subject><subject>Diabetes Mellitus, Type 2 - physiopathology</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Echocardiography</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Exercise Test</subject><subject>Exercise Tolerance</subject><subject>Fatty Acids, Nonesterified - blood</subject><subject>Feeding. Feeding behavior</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Hypertrophy, Left Ventricular - metabolism</subject><subject>Hypertrophy, Left Ventricular - physiopathology</subject><subject>Inflammation - blood</subject><subject>Insulin Resistance</subject><subject>Interleukin-6 - blood</subject><subject>Linear Models</subject><subject>Lipids - blood</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Motor Activity</subject><subject>Obesity - metabolism</subject><subject>Obesity - physiopathology</subject><subject>Original</subject><subject>Oxygen Consumption</subject><subject>Plethysmography</subject><subject>Puberty</subject><subject>Thinness</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>Vertebrates: endocrinology</subject><subject>Young Adult</subject><issn>0021-972X</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkc2L1EAQxRtxccfVm2fJRU9m7e6kvy7CMLvqwIIgK3hrOt0Vt4dMErsS1_nv7TDD6oKnoqgf7z3qEfKK0UvGGX2_85ecUl1yXddPyIqZWpSKGfWUrCjlrDSKfz8nzxF3lLK6FtUzcs6M0DUzbEXCtse5i33xFTDi5HoPRd7WYegAPfQTFvdxuituDyMUvLiKroEJsNhisUYcfHQThCOy3Y8uprxd_4bkI0KxcaPzcTq8IGet6xBenuYF-fbx-nbzubz58mm7Wd-UvhZyKmWjWWMC14IFmsNWjDahVdqJmgUvVMWNkB4qAK5laI3UinpJKy1123JFqwvy4ag7zs0ewhI_uc6OKe5dOtjBRfv40sc7-2P4ZbkSWlUqC7w9CaTh5ww42X3MX-g618Mwo5VKasENz-C7I-jTgJigfTBh1C612J23Sy12qSXjr_8N9hc-9ZCBNyfAoXddm3IRER84zmklDV98qyMHfRh8ij2MCRDtbphTn1_7f_s_nQunEw</recordid><startdate>20091001</startdate><enddate>20091001</enddate><creator>Nadeau, Kristen J.</creator><creator>Zeitler, Phillip S.</creator><creator>Bauer, Timothy A.</creator><creator>Brown, Mark S.</creator><creator>Dorosz, Jennifer L.</creator><creator>Draznin, Boris</creator><creator>Reusch, Jane E. B.</creator><creator>Regensteiner, Judith G.</creator><general>Endocrine Society</general><general>The Endocrine Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20091001</creationdate><title>Insulin Resistance in Adolescents with Type 2 Diabetes Is Associated with Impaired Exercise Capacity</title><author>Nadeau, Kristen J. ; Zeitler, Phillip S. ; Bauer, Timothy A. ; Brown, Mark S. ; Dorosz, Jennifer L. ; Draznin, Boris ; Reusch, Jane E. B. ; Regensteiner, Judith G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-6b81b9d2851d0001310bdf78a541dc5732956ce3ee286df96870c603868ff2703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adiponectin - blood</topic><topic>Adolescent</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Blood Flow Velocity</topic><topic>Blood Pressure</topic><topic>Body Composition</topic><topic>Body Fat Distribution</topic><topic>C-Reactive Protein - metabolism</topic><topic>Case-Control Studies</topic><topic>Child</topic><topic>Cross-Sectional Studies</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - metabolism</topic><topic>Diabetes Mellitus, Type 2 - physiopathology</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Echocardiography</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Exercise Test</topic><topic>Exercise Tolerance</topic><topic>Fatty Acids, Nonesterified - blood</topic><topic>Feeding. Feeding behavior</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Hypertrophy, Left Ventricular - metabolism</topic><topic>Hypertrophy, Left Ventricular - physiopathology</topic><topic>Inflammation - blood</topic><topic>Insulin Resistance</topic><topic>Interleukin-6 - blood</topic><topic>Linear Models</topic><topic>Lipids - blood</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Motor Activity</topic><topic>Obesity - metabolism</topic><topic>Obesity - physiopathology</topic><topic>Original</topic><topic>Oxygen Consumption</topic><topic>Plethysmography</topic><topic>Puberty</topic><topic>Thinness</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>Vertebrates: endocrinology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nadeau, Kristen J.</creatorcontrib><creatorcontrib>Zeitler, Phillip S.</creatorcontrib><creatorcontrib>Bauer, Timothy A.</creatorcontrib><creatorcontrib>Brown, Mark S.</creatorcontrib><creatorcontrib>Dorosz, Jennifer L.</creatorcontrib><creatorcontrib>Draznin, Boris</creatorcontrib><creatorcontrib>Reusch, Jane E. B.</creatorcontrib><creatorcontrib>Regensteiner, Judith G.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The journal of clinical endocrinology and metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nadeau, Kristen J.</au><au>Zeitler, Phillip S.</au><au>Bauer, Timothy A.</au><au>Brown, Mark S.</au><au>Dorosz, Jennifer L.</au><au>Draznin, Boris</au><au>Reusch, Jane E. B.</au><au>Regensteiner, Judith G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Insulin Resistance in Adolescents with Type 2 Diabetes Is Associated with Impaired Exercise Capacity</atitle><jtitle>The journal of clinical endocrinology and metabolism</jtitle><addtitle>J Clin Endocrinol Metab</addtitle><date>2009-10-01</date><risdate>2009</risdate><volume>94</volume><issue>10</issue><spage>3687</spage><epage>3695</epage><pages>3687-3695</pages><issn>0021-972X</issn><eissn>1945-7197</eissn><coden>JCEMAZ</coden><abstract>Context: The incidence of pediatric type 2 diabetes (T2D) is rising, with unclear effects on the cardiovascular system. Cardiopulmonary fitness, a marker of morbidity and mortality, is abnormal in adults with T2D, yet the mechanisms are incompletely understood.
Objective: We hypothesized that cardiopulmonary fitness would be reduced in youth with T2D in association with insulin resistance (IR) and cardiovascular dysfunction.
Design, Setting, and Participants: We conducted a cross-sectional study at an academic hospital that included 14 adolescents (age range, 12–19 yr) with T2D, 13 equally obese adolescents and 12 lean adolescents similar in age, pubertal stage, and activity level.
Main Outcome Measures: Cardiopulmonary fitness was measured by peak oxygen consumption (VO2peak) and oxygen uptake kinetics (VO2kinetics), IR by hyperinsulinemic clamp, cardiac function by echocardiography, vascular function by venous occlusion plethysmography, body composition by dual-energy x-ray absorptiometry, intramyocellular lipid by magnetic resonance spectroscopy, and inflammation by serum markers.
Results: Adolescents with T2D had significantly decreased VO2peak and insulin sensitivity, and increased soleus intramyocellular lipid, C-reactive protein, and IL-6 compared to obese or lean adolescents. Adolescents with T2D also had significantly prolonged VO2kinetics, decreased work rate, vascular reactivity, and adiponectin, and increased left ventricular mass and fatty acids compared to lean adolescents. In multivariate linear regression analysis, IR primarily, and fasting free fatty acids and forearm blood flow secondarily, were significant independent predictors of VO2peak.
Conclusions: Given the strong relationship between decreased cardiopulmonary fitness and increased mortality, these findings in children are especially concerning and represent early signs of impaired cardiac function.
Adolescents with type 2 diabetes have abnormal exercise function, vascular reactivity, and increased left ventricular mass.</abstract><cop>Bethesda, MD</cop><pub>Endocrine Society</pub><pmid>19584191</pmid><doi>10.1210/jc.2008-2844</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The journal of clinical endocrinology and metabolism, 2009-10, Vol.94 (10), p.3687-3695 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adiponectin - blood Adolescent Biological and medical sciences Biomarkers - blood Blood Flow Velocity Blood Pressure Body Composition Body Fat Distribution C-Reactive Protein - metabolism Case-Control Studies Child Cross-Sectional Studies Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - metabolism Diabetes Mellitus, Type 2 - physiopathology Diabetes. Impaired glucose tolerance Echocardiography Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Exercise Test Exercise Tolerance Fatty Acids, Nonesterified - blood Feeding. Feeding behavior Female Fundamental and applied biological sciences. Psychology Heart Rate Humans Hypertrophy, Left Ventricular - metabolism Hypertrophy, Left Ventricular - physiopathology Inflammation - blood Insulin Resistance Interleukin-6 - blood Linear Models Lipids - blood Male Medical sciences Motor Activity Obesity - metabolism Obesity - physiopathology Original Oxygen Consumption Plethysmography Puberty Thinness Vertebrates: anatomy and physiology, studies on body, several organs or systems Vertebrates: endocrinology Young Adult |
| title | Insulin Resistance in Adolescents with Type 2 Diabetes Is Associated with Impaired Exercise Capacity |
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