Prevalence of Pre-Diabetes and Its Association With Clustering of Cardiometabolic Risk Factors and Hyperinsulinemia Among U.S. Adolescents

Abstract

OBJECTIVE—Impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are considered to constitute “pre-diabetes.” We estimated the prevalence of IFG, IGT, and pre-diabetes among U.S. adolescents using data from a nationally representative sample. RESEARCH DESIGN AND METHODS—We analyzed data from participants aged 12–19 years in the National Health and Nutrition Examination Survey 2005–2006. We used fasting plasma glucose and 2-h glucose during an oral glucose tolerance test to assess the prevalence of IFG, IGT, and pre-diabetes and used the log-binomial model to estimate the prevalence ratios (PRs) and 95% CIs. RESULTS—The unadjusted prevalences of IFG, IGT, and pre-diabetes were 13.1, 3.4, and 16.1%, respectively. Boys had a 2.4-fold higher prevalence of pre-diabetes than girls (95% CI 1.3–4.3). Non-Hispanic blacks had a lower rate than non-Hispanic whites (PR 0.6, 95% CI 0.4–0.9). Adolescents aged 16–19 years had a lower rate than those aged 12–15 years (0.6, 0.4–0.9). Overweight adolescents had a 2.6-fold higher rate than those with normal weight (1.3–5.1). Adolescents with two or more cardiometabolic risk factors had a 2.7-fold higher rate than those with none (1.5–4.8). Adolescents with hyperinsulinemia had a fourfold higher prevalence (2.2–7.4) than those without. Neither overweight nor number of cardiometabolic risk factors was significantly associated with pre-diabetes after adjustment for hyperinsulinemia. CONCLUSIONS—Pre-diabetes was highly prevalent among adolescents. Hyperinsulinemia was independently associated with pre-diabetes and may account for the association of overweight and clustering of cardiometabolic risk factors with pre-diabetes.

Cardiovascular risk factors, diet and lifestyle among European, South Asian and Chinese adolescents in Canada

“…The present study found no significant differences in FBG among ethnic groups (4.9 mmol/L on average) or the occurrence of impaired FBG, which was lower than the 13% reported among adolescents in NHANES (25). However, recent data from our SHARE study has shown that FBG levels can be higher among South Asian adults compared with European and Chinese Canadian adults (5.5 mmol/L, 5.2 mmol/L and 5.2 mmol/L, respectively) (9,10).…”

Pathophysiological role of enhanced bone marrow adipogenesis in diabetic complications

“…[99][100][101] A hyperinsulinemic state is frequently observed in the development of type 2 diabetes as pancreatic production of insulin surges in an attempt to counteract the ever-increasing resistance of peripheral tissues. 102,103 Hyperinsulinemia may be capable of inducing the adipogenesis of cells within the marrow stem cell niche through a signaling cascade involving PKB and mTOR, culminating with activation of C/EBPa and PPARg. 104 Conversely, hypoinsulinemia, a hallmark of type 1 diabetes and an eventual occurrence following b-cell failure in type 2 diabetics, may also indirectly lead to enhanced adipogenesis.…”

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“…Evidenced in the national study of 8th grade schoolchildren aged 13-15 years found that 40.2% of them were either overweight or obese (Ministry of Education, 2010). Obesity in the adolescence increases the risk of developing diabetes (Li C, Ford et al, 2009), leading to other health complications, including hypercholesterolemia and hypertension (Brophy, Cooksey et al 2009) and metabolic syndrome, where visceral obesity and insulin resistance are considered as main characteristics that determine a negative cardiovascular profile (Faloia, Michetti et al 2012).…”