Youth prediabetes and type 2 diabetes: Risk factors and prevalence of dysglycaemia

Abstract

Background: The American Diabetes Association recommends risk-based screening for dysglycaemia (prediabetes and type 2 diabetes) in youth with overweight/obesity plus ≥1 risk factor. However, evidence for these recommendations is lacking.Objectives: Examine the association between the number of risk factors and the prevalence of dysglycaemia in youth with overweight/obesity at initial presentation.Methods: In a paediatric obesity registry, youth (>10 and <20 years old, body mass index ≥85th percentile) were categorized into four groups according to number of risk factors (1, 2, 3 and ≥4). Based on oral glucose tolerance test, participants were classified into normal glucose tolerance or dysglycaemia.Results: Of 635 youth, 31.5% had prediabetes and 6.1% had type 2 diabetes. The prevalence of dysglycaemia was 23.1% with 1 risk factor and increased to 44.9% with ≥4 risk factors (p = 0.025). Dyslipidaemia, family history of type 2 diabetes and maternal history of gestational diabetes were significantly associated with dysglycaemia.Fasting and 2-h insulin, 2-h glucose increased (all p < 0.0001) and ALT increased (p = 0.001) with increasing risk factors. Insulin sensitivity and β-cell function deteriorated significantly with increasing risk factors. Conclusion:Screening for dysglycaemia in youth with obesity and any additional risk factor is warranted to target early management.impaired glucose tolerance, prediabetes, risk factors, youth-type 2 diabetes | INTRODUCTIONParallel to the increasing rates of childhood obesity, the incidence 1 and the prevalence 2 of youth-type 2 diabetes (T2D) is escalating worldwide, particularly in non-white racial/ethnic populations. The highest rate of youth-T2D exists in the United States, with an incidence that increased from 9 to 12.5 cases per 100 000 between 2002 and 2012. 1,3 While the trends in Europe and Asia are similar, the overall incidence remains lower. [4][5][6] Scientific information suggests that youth-T2D is an aggressive disease with early and rapidly progressing complications. [7][8][9] Youth with T2D have higher complications and mortality compared to peers with type 1 diabetes. 10,11 These youth also have a higher risk of early death than adults with T2D when matched for diabetes duration. 12 The treatment options for T2D in Adolescents and Youth (TODAY) showed >50% glycaemic failure rates on metformin, the only Abbreviations: ADA, American Diabetes Association; BMI, body mass index; GDM, gestational diabetes mellitus; HAPO FUS, Hyperglycaemia and Adverse Pregnancy Outcome Follow-up Study; HDL, high density lipoprotein; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; ΔI 30 /ΔG 30 , insulinogenic index; 1/I F , inverse of fasting insulin; LDL, low density lipoprotein; oDI, oral disposition index; OGTT, oral glucose tolerance test; PCOS, polycystic ovary syndrome; SEM, standard error of the mean; SGA, small for gestational age; TC, total cholesterol; TG, triglycerides; TODAY, treatment options for type 2 diabetes in adolescents and youth; T2D, type 2...

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“…Today, prediabetes is on the rise along with diabetes [ 20 ]. Controlling blood sugar has reduced mortality and increased life expectancy, but there are still many patients who suffer from long-term complications of the disease, so, preventing pre-diabetes to diabetes is more important to prevent chronic complications [ 21 ].…”

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“…5 Indeed, the prevalence of dysglycemia, escalated from ~23% in youth with overweight and one risk factor to up to ~45% in youth with ≥4 risk factors. 6 In line with current guidelines for screening, 5 most of the studies have investigated prevalence of dysglycemia in children older than 10 years old. Analysis of data from the National Health and Nutrition Examination Survey from 1999 through 2012 demonstrated that prevalence of IFG and prediabetic HbA1c increased with worsening of obesity from overweight to class III obesity in adolescents older than 12 years old.…”

“…In 2018 the American Diabetes Association (ADA) made the recommendation to screen for prediabetes all youth with overweight at 10 years of age or above with one or more of risk factors among nonwhite race, family history of type 2 diabetes (T2D) in first or second degree relatives, maternal gestational diabetes, or signs of insulin resistance, specifically acanthosis nigricans, hypertension, dyslipidemia, polycystic ovarian syndrome or small‐for‐gestational age birth weight 5 . Indeed, the prevalence of dysglycemia, escalated from ~23% in youth with overweight and one risk factor to up to ~45% in youth with ≥4 risk factors 6 …”

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“…Several factors may be involved in the anticipation of T2D onset, although the dramatic increase in childhood and adolescent obesity worldwide plays a key role in this process [5]. Similarly, the condition of prediabetes in youth has risen steeply worldwide in parallel with rising rates of obesity [6]. In the National Health and Nutrition Examination Survey cohort database, 13.1% of United States adolescents had impaired fasting glycemia, and 3.4% had impaired glucose tolerance after oral glucose load.…”