Parental history of diabetes raises risk for poor outcomes in pediatric type 2 diabetes
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Children with type 2 diabetes with a parental — particularly, maternal — history of diabetes have elevated risks for adverse outcomes and early onset of complications, according to a speaker.
“In participants with youth-onset type 2 diabetes that were followed over 10 years, we saw that a maternal history of diabetes was associated with accelerated loss of glycemic control, impaired beta-cell function and an increased incidence of renal hyperfiltration and unfavorable vascular indices,” Rachana Shah, MD, MSTR, pediatric endocrinologist and assistant professor of pediatrics at Children’s Hospital of Philadelphia, said during a presentation at the American Diabetes Association Scientific Sessions. “Both maternal and parental diabetes were associated with baseline HbA1c and oral disposition index.”
Shah and colleagues analyzed data from the TODAY study, a multicenter randomized trial of youths aged 10 to 17 years with recent-onset type 2 diabetes. Earlier TODAY analysis revealed parental diabetes during pregnancy was associated with earlier type 2 diabetes onset in children as well as a higher HbA1c and impaired beta-cell function at diagnosis. Shah and colleagues conducted further analysis of the effect of parental diabetes on disease progression or complications in youths with type 2 diabetes. Researchers collected data from physical exams and lab tests, as well as DXA and oral glucose tolerance test results at select TODAY study visits. Information on diabetes diagnosis of biological parents was also included in the analysis.
Worse metabolic parameters with parental diabetes
Of the study cohort, 158 youths did not have a parent with diabetes, 177 had a mother with diabetes, 72 had a father with diabetes and 79 had two parents with diabetes. There was no significant difference in age, sex and race or ethnicity between the four groups, but a higher percentage of participants with both parents with diabetes, vs. the other three groups, had a household income of $25,000 or less. Youths who had both parents with diabetes or only a mother with diabetes had higher birth weight compared with those with no parental history of diabetes or only a father with diabetes.
Mean HbA1c was lower among youths with no parental diabetes history (5.8%) compared with those who had two parents with diabetes (6.2%) or those who had only a mother with diabetes (6.1%; P < .0001). Mean C-peptide index was higher among those with no parental diabetes history (0.115 ng/mL per mg/dL) compared with those who had both parents with diabetes (0.063 ng/mL per mg/dL) or only a mother with diabetes (0.066 ng/mL per mg/dL; P < .0001). A history of maternal diabetes before or during pregnancy was associated with higher HbA1c, higher insulin sensitivity and lower C-peptide index vs. no diabetes. Parental diabetes was also associated with higher HbA1c, higher insulin sensitivity and lower C-peptide index compared with no history of diabetes.
“Overall, maternal diabetes was related to worsened glycemic features at diagnosis,” Shah said during a presentation.
More complications with diabetes history
Children with type 2 diabetes who had two parents with diabetes or only a mother with diabetes had higher incidences of loss of glycemic control compared with those who had only a father with diabetes or no parent with diabetes. A similar trend was seen with incidences of renal hyperfiltration.
Youths with no parental history of diabetes had lower 5-year change in heart rate variability, measured as the standard deviation of NN intervals (mean change, –0.33 milliseconds), compared those with two parents with diabetes (mean change, –12.2 milliseconds), only a mother with diabetes (mean change, –16.2 milliseconds) and only a father with diabetes (mean change, –16 milliseconds; P for all = .006). No associations were found with retinopathy and arterial stiffness.
“We know that parental diabetes is associated with adverse diabetes characteristics and accelerated onset of complications in youth with type 2 diabetes,” Shah said. “Further studies on the mechanisms of prenatal exposures are needed with the ultimate goal of preventing adverse impacts.”
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Isganaitis EM, et al. 19-OR. Presented at: American Diabetes Association Scientific Sessions; June 25-29, 2021 (virtual meeting).
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