Adiponectin and leptin concentrations may aid in discriminating disease forms in children and adolescents with type 1 and type 2 diabetes

OBJECTIVE - The incidence of pediatric type 2 diabetes has recently seen an alarming increase. To improve our understanding of pediatric type 2 diabetes and identify markers that discriminate these subjects from those with type 1 diabetes, we performed a multivariant analysis associating serum adiponectin and leptin levels with anthropometrical parameters and disease state. RESEARCH DESIGN AND METHODS - Samples from children and adolescents with type 1 diabetes (n = 41) and type 2 diabetes (n = 17) and from nondiabetic individuals of similar age from the general population (n = 43) were investigated. An analysis included the parameters of matching for BM1 and Tanner stage. Receiver-operator characteristic (ROC) curves were established to assess these analytes' association with disease. RESULTS - Contrary to studies of adult type 1 diabetes, adiponectin levels in our pediatric type 1 diabetic subjects (10.2 μg/ml [95% CI 8.6-11.7]) did not differ from those of healthy control subjects (10.6 μg/ml [9.2-12.0]; P = NS). Children with type 2 diabetes (5.5 μg/ml [4.8-6.2]) had significantly lower adiponectin levels than both of those groups. Conversely, type 2 diabetic subjects showed marked elevations in serum leptin concentrations (24.3 ng/ml [17.1-31.5]) compared with healthy control subjects (2.7 ng/ml [1.3-4.1]; P < 0.001) and type 1 diabetic subjects (5.1 ng/ml [3.5-6.71; P < 0.001). Importantly, each of the properties ascribed to pediatric type 2 diabetes was present when the comparison was restricted to healthy children or type 1 diabetic patients whose BMI was >85th percentile or who had Tanner stage 4 and 5. The evaluation of adiponectin-to-leptin ratios revealed a striking difference between children with type 1 diabetes (6.3 [3.8-8.8]) and type 2 diabetes (0.3 [0.2-0.5]; P < 0.001). CONCLUSIONS - In pediatric diabetes, where diagnosis of disease is often difficult, these studies suggest that the adiponectin-to-leptin ratio may provide additional help in the discrimination between type 1 and type 2 diabetes.