Comparison of the Effect of Plasma Glucose Concentrations on Microvascular Disease Between Pima Indian Youths and Adults

Abstract

OBJECTIVE—To examine whether the current adult guidelines for diagnosis of diabetes are applicable to youth (age <20 years). RESEARCH DESIGN AND METHODS—We analyzed fasting plasma glucose (FPG) and 2-h plasma glucose (PG) in two groups of Pima Indians, youths aged 5–19 years and adults aged 20–34 years, in relation to the incidence of microvascular disease when subjects were reexamined at ages 25–39 (youths) and 40–54 (adults). Microvascular disease was defined as retinopathy or a urine protein-to-creatinine ratio ≥0.5 g. RESULTS—An increase in the incidence of microvascular disease occurred at nearly the same level of glycemia in both groups. For youths, this increase occurred at FPG ∼7.3 mmol/l and 2-h PG ∼10.0 mmol/l; for adults, this increase occurred at FPG ∼7.5 mmol/l and 2-h PG ∼10.3 mmol/l. Sensitivity of the adult diagnostic guidelines of FPG ≥7.0 mmol/l and 2-h PG ≥11.1 mmol/l for the detection of microvascular disease was much lower (with higher specificity) in youths than in adults. Receiver operating characteristics (ROC) curve areas were lower for FPG and 2-h PG for youths, suggesting that microvascular disease was less strongly predicted by baseline glucose. CONCLUSION—The current adult guidelines for diagnosis of diabetes are applicable to youth, as they identify a population at high risk of microvascular complications.

HbA1c and the Prediction of Type 2 Diabetes in Children and Adults

“…This recommendation included adult participants from the same study population we describe here, and we reported previously that HbA 1c and FPG measurements in adults were just as useful as 2hPG in predicting the risk of microvascular complications (16). Another study in this population found that a sharp rise in incidence of these complications occurred at the same level of glycemia in youth and adult cohorts; however, that study compared only FPG and 2hPG (17). …”

Childhood Predictors of Young-Onset Type 2 Diabetes

“…The participant was classified with type 2 diabetes if the fasting plasma glucose concentration was Ͼ7.0 mmol/l, the 2-h plasma glucose concentration was Ͼ11.1mmol/l, or there was an existing clinical diagnosis (as assessed by medical chart review). Standard anthropometric data were collected by trained observers with participants in lightweight clothing and no shoes as previously described in detail (10,12,16). No measures of puberty were available.…”

“…No measures of puberty were available. Metabolic variables were measured according to previously described methods (10,12,16). Statistical analysis.…”

“…Children exposed to diabetes in utero are at much greater risk of becoming obese (8,9) and developing type 2 diabetes (9 -11). Furthermore, individuals who develop type 2 diabetes in childhood and adolescence develop retinopathy and nephropathy at rates comparable with those of later-onset diabetes and by consequence have a substantial risk for microvascular complications at young ages (12). Thus, the prevention of young-onset type 2 diabetes presents a particularly important yet difficult challenge.…”

Targeting postprandial hyperglycemia

“…A prospective study of intensive insulin therapy in Japanese patients with type 2 diabetes mellitus showed significant reduction of progression of retinopathy, nephropathy, and neuropathy [62]. Several studies indicate that the risk of progression of microvascular disease is associated with both increased fasting and postprandial plasma glucose levels [63][64][65].…”