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Weight stabilization in adolescents with prediabetes halts transition to diabetes
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Adolescents in the higher ranges of prediabetes require more immediate follow-up due to a quicker transition to diabetes, but recent study results showed that the more attainable goal of not gaining weight helped halt the progression to diabetes and may be a more important endpoint for physicians.
“Weight stabilization helped prevent progression, which we’ve known in adults for a long time, but we haven’t really had a lot of data in kids,” Kathy Love-Osborne, MD, of Denver Health and Hospitals, told Endocrine Today. “For providers, it helps to remind ourselves that we have to make sure the goals we set for our patients are realistic. If you get them to stop gaining, if that’s enough to prevent the progression to diabetes, that’s a much more attainable goal for patients than telling them they need to lose 50 lb.”
The researchers looked at 518 obese adolescents (mean age, 14.6 ± 2.2 years; mean BMI, 35 ± 6.1 kg/m2; 71% Hispanic, 22% black) identified as having prediabetes; one group had an HbA1c level of 5.7% to 5.9%, another included those at 6% to 6.4%, and the last was >6.5%.
Of those in the lowest HbA1c group, only 2% progressed from prediabetes to having an HbA1c within diabetes range, whereas 9% of those in the middle HbA1c group made the same progression. Love-Osborne said only 31% of those patients with HbA1c >6.5% stayed above that threshold through follow-up.
Weight stabilization was associated with non-progression in both the 5.7% to 5.9% group (P<.001) and the 6% to 6.4% group (P<.02), according to Love-Osborne.
Given the differences in progression, she said her practice has changed its protocol for follow-up.
“For the low range prediabetes (5.7-5.9), we actually recommend the primary care provider mostly focusing on stopping weight gain and rechecking HbA1c in a year,” Love-Osborne said, noting that BMI should still be monitored. “The higher range kids (6-6.4), there’s a much higher rate of progression. We recommend those kids are followed up more quickly in 3 to 6 months. ... We basically are trying to use this data to make this easier on providers of how aggressive do you need to be with these kids.” — by Katrina Altersitz
For more information:
Love-Osborne K. Platform presentation #3545.6. Presented at: Pediatric Academic Societies and Asian Society for Pediatric Research joint meeting; May 3-6, 2014; Vancouver, British Columbia.
Disclosure: Love-Osborne reports no relevant financial disclosures.