Risk Factors of Youth Type 2 Diabetes (Y-T2DM) and Prevalence of Dysglycemia (DG)

Abstract

The incidence of Y-T2DM is increasing parallel with the childhood obesity epidemic. The ADA consensus recommends screening for Y-T2DM or prediabetes in asymptomatic overweight youth who have any two additional risk factors (RFs): family history of T2DM in 1st or 2nd degree relatives, minority race/ethnicity, insulin resistance [acanthosis nigricans, polycystic ovary syndrome, hypertension, dyslipidemia, and small for gestational age], and maternal GDM during the child’s gestation. However, the evidence for these recommendations is minimal, if not nonexistent. In an established pediatric obesity registry, OGTT data of 618 youth ˃10 years old, BMI ≥ 85th%, were analyzed to evaluate the prevalence of DG based on the frequency of RFs. Participants were divided into 4 groups according to the number of RFs. Participants were 70% females, 70% Caucasians, 31% with prediabetes, and 5.1% with Y-T2DM. With increasing RFs, the prevalence of normal glucose tolerance (NGT) declined, DG increased, fasting glucose concentration did not change, but fasting insulin concentration increased significantly (Table: mean ± SE). Participants with 1 RF had ∼25% prevalence of DG. The odds for DG with 2, 3 and ≥ 4RFs were 1.6, 1.7, and 2.5 respectively compared to 1 RF (P=0.01). In conclusion, the prevalence of prediabetes and T2DM in overweight/obese youth is high ∼25% in the presence of only 1 RF, and escalates with increasing number of RFs. Obesity + 1 RF (n=45)Obesity + 2 RF (n=165)Obesity + 3 RF (n=223)Obesity + ≥4RF (n=185)P-ANOVAAge (years)13.7 ± 0.314.0 ± 0.214.3 ± 0.114.4 ± 0.2NSGlycemic status (NGT/Dysglycemia), n (%)34 (75.6 %) / 11 (24.4 %)1(65.5 %) / 57 (34.5 %)143 (64.1 %) / 80 (35.9 %)103 (55.7 %) / 82 (44.3 %)0.009BMI percentile97.6 ± 0.498.0 ± 0.398.4 ± 0.298.6 ± 0.2NSFasting glucose (mg/dl)92.4 ± 1.293.9 ± 0.994.0 ± 0.994.9 ± 1.2NSFasting insulin (μu/ml)25.6 ± 2.331.0 ± 1.934.7 ± 1.642.5 ± 2.7< 0.0001OGTT 2-hr. Glucose (mg/dl)117.6 ± 4.7125.9 ± 3.0129.4 ± 2.7138.4 ± 3.30.001OGTT 2-hr. Insulin (μU/ml)121.5 ± 17.6160.7 ± 11.2169.9 ± 10.8217.0 ± 14.3< 0.0001 Disclosure M. Saleh: None. J. Kim: None. C. March: None. S. Yousuf: None. S.A. Arslanian: None.