Abstract
BackgroundThe presence of impaired glucose tolerance (IGT) and metabolic syndrome (MetS) are two risk factors for Type 2 diabetes. The inter-relatedness of these factors among adolescents is unclear.MethodsWe evaluated the sensitivity and specificity of MetS for identifying IGT in an unselected group of adolescents undergoing oral glucose tolerance tests (OGTT) in the National Health and Nutrition Evaluation Survey 1999–2010. We characterized IGT as a 2-hour glucose ≥140 mg/dL and MetS using ATP-III-based criteria and a continuous sex- and race/ethnicity-specific MetS Z-score at cut-offs of +1.0 and +0.75 standard deviations (SD) above the mean.ResultsAmong 1513 adolescents, IGT was present in 4.8%, while ATP-III-MetS was present in 7.9%. MetS performed poorly in identifying adolescents with IGT with a sensitivity/specificity of 23.7%/92.9% for ATP-III-MetS, 23.6%/90.8% for the MetS Z-score at +1.0 SD and 35.8%/85.0 for the MetS Z-score at +0.75 SD. Sensitivity was higher (and specificity lower) but was still overall poor among overweight/obese adolescents: 44.7%/83.0% for ATP-III-MetS, 43.1%/77.1% for the MetS Z-score at +1.0 SD and 64.3%/64.3% for MetS Z-score at +0.75 SD.ConclusionThis lack of overlap between MetS and IGT may indicate that assessment of MetS is not likely to be a good indicator of which adolescents to screen using OGTT. These data further underscore the importance of other potential contributors to IGT, including Type 1 diabetes and genetic causes of poor beta-cell function. Practitioners should keep these potential causes of IGT in mind, even when evaluating obese adolescents with IGT.
Highlights
The persistent high prevalence of pediatric obesity has greatly increased risk of Type 2 diabetes mellitus (T2DM) in the current generation of children and adolescents, increasing the need for effective tools to predict those at highest risk [1,2]
These findings are in contrast to a study of early adolescent European children that showed a high reversion to normal glucose tolerance over a 1-year period [7]
That impaired glucose tolerance (IGT) does not distinguish between risk of T2DM and early, pre-clinical signs of Type 1 diabetes mellitus (T1DM), which results in elevated post-glucola blood glucose (BG) due to insufficient insulin secretion [10]
Summary
The persistent high prevalence of pediatric obesity has greatly increased risk of Type 2 diabetes mellitus (T2DM) in the current generation of children and adolescents, increasing the need for effective tools to predict those at highest risk [1,2]. T2DM over a follow-up period of 20 +/− 10 months, while none of the children with normal glucose tolerance progressed to T2DM over the same time frame [5,6]. While OGTT’s are labor- and time-intensive tests, the ADA recognizes them as one option in screening for T2DM risk [9]. It should be noted, that IGT does not distinguish between risk of T2DM and early, pre-clinical signs of Type 1 diabetes mellitus (T1DM), which results in elevated post-glucola BG due to insufficient insulin secretion [10]. The inter-relatedness of these factors among adolescents is unclear
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