Examining trends in prediabetes and its relationship with the metabolic syndrome in US adolescents, 1999–2014

Abstract

Introduction Prediabetes is a reversible state of glycemic abnormalities that is frequently associated with obesity and the metabolic syndrome (MetS). There has been controversy over determining the most effective methods of determining prediabetes status in adolescents. We sought to investigate temporal trends in prediabetes prevalence among U.S. adolescents using two definitions and evaluate relationships with obesity and a MetS-severity score. Methods We evaluated data from 5418 non-Hispanic-white, non-Hispanic-black, and Hispanic adolescents aged 12–19 participating in the National Health and Nutrition Examination Survey 1999–2014 with complete data regarding MetS and hemoglobin A1c (HbA1c). Prediabetes status was defined by American Diabetes Association (ADA) criteria: fasting glucose 100–125 mg/dL or HbA1c 5.7%–6.4%. MetS severity was assessed with a MetS-severity Z-score. Results Prevalence of prediabetes as defined by HbA1c abnormalities significantly increased from 1999–2014, while prevalence of prediabetes as defined by fasting glucose abnormalities showed no significant temporal trend. There were variations in these trends across different racial/ethnic groups. MetS Z-score was overall more strongly correlated with HbA1c, fasting insulin, and the homeostasis-model-of-insulin-resistance than was BMI Z-score. These correlations were true in each racial/ethnic group with the exception that in non-Hispanic-white adolescents, in whom the MetS Z-score was not significantly correlated to HbA1c measurements. Conclusion We found conflicting findings of temporal trends of U.S. adolescent prediabetes prevalence based on the ADA’s prediabetes criteria. The increasing prevalence of prediabetes by HbA1c assessment is concerning and raises the urgency for increased awareness and appropriate measures of prediabetes status among physicians and patients.

Prevalence of prediabetes and type 2 diabetes in children with obesity and increased transaminases in European German‐speaking countries. Analysis of the APV initiative

“…Even adolescents with merely moderately elevated alanine transaminase (ALT) values were shown to have deteriorations in lipid‐ and glucose metabolism (). Providing the only reliable available epidemiological data so far, a recent study demonstrated a prevalence of impaired glucose metabolism among children with histologically diagnosed NAFLD of around 30% (6.5% T2DM) in the United States (US) as compared to only 5% of children without NAFLD (less than 1% T2DM) (). Children with T2DM were shown to have greater risk of having non‐alcoholic steatohepatitis (NASH), and thus greater long‐term‐risk for an adverse hepatic outcome …”

Prediabetes: An emerging public health concern in adolescents

“…The prevalence of prediabetes has been investigated in various countries across the world, including Mexico (1.5%), UAE (5.4%) and China (0.28%) . The studies emerging from the United States and Canada focus on adolescents who have been diagnosed with diabetes or present findings that estimate the prevalence of prediabetes and/or undiagnosed diabetes . In the present study, community‐based screening was undertaken to determine the number of Canadian adolescents who were in the “at risk” or prediabetes and type 2 diabetes blood glucose range.…”

Impaired fasting glucose prevalence surge among Iranian adolescents in a decade: The Tehran Lipid and Glucose Study

“…Our findings indicate that central adiposity does not have any association with IFG, independent of general adiposity. Among US adolescents, however, Lee et al, found only a weak correlation between the temporal changes of BMI and prediabetes prevalence defined by HbA 1 C.They also emphasized the ethnic/racial differences in the correlations between BMI with prevalent IFG …”

“…Several cross‐sectional studies among adolescents have shown a wide range in the prevalence of IFG, from 3.5% among Chinese adolescents to 40.5% among Americans, depending on the population studied. However, limited studies have investigated the temporal changes of prediabetes in this age group . Recently, Lee et al, documented an increasing trend of prediabetes defined by hemoglobin A 1 C (HbA 1 C) but not with FPG criteria (ie, FPG: 100‐125 mg/dL) among US adolescents from 1999 to 2014.…”

“…However, limited studies have investigated the temporal changes of prediabetes in this age group . Recently, Lee et al, documented an increasing trend of prediabetes defined by hemoglobin A 1 C (HbA 1 C) but not with FPG criteria (ie, FPG: 100‐125 mg/dL) among US adolescents from 1999 to 2014. To the best of our knowledge, no studies have reported changes in the prevalence of prediabetes among adolescent populations from the Middle East, a region with high rates of obesity and physical inactivity …”