INS and obesity due to melanocortin 4 receptor deficiency: The analysis of 909 children and adolescents with overweight/obesity and 99 healthy controls showed a significantly lower SPISE index in those with impaired glucose tolerance, a positive correlation with insulin sensitivity indices and a negative relationship with age, blood pressure, HOMA-IR, basal and + 120th glucose levels during OGTT, suggesting that SPISE is associated with metabolic impairment and can be considered a predictor of future glucose abnormalities (36).