Baseline glucose, increasing BMI predict progression to type 2 diabetes for children
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Key takeaways:
- Youths with higher initial HbA1c and 2-hour glucose levels have a greater risk for progression from prediabetes to type 2 diabetes.
- Boys are more than twice as likely to progress to type 2 diabetes as girls.
Higher initial glucose levels and increasing BMI over time could serve as predictors of progression from prediabetes to type 2 diabetes for children and adolescents, according to findings published in the Journal of the Endocrine Society.
In a retrospective analysis of data from a single pediatric clinic, 6.5% of children with prediabetes progressed to type 2 diabetes over a 7-year period. With most youths unlikely to progress to type 2 diabetes over a short-term period, providers can identify those who are most at risk for progression and intervene, according to Ashley H. Shoemaker MD, MSCI, associate professor of pediatrics in the Ian M. Burr division of endocrinology and diabetes at Vanderbilt University Medical Center.
“Certain laboratory tests may be helpful in predicting future type 2 diabetes risk,” Shoemaker told Healio. “We also found that continued weight gain was a major risk factor for diabetes progression. We suggest that treatment of obesity is an important intervention for patients with pediatric prediabetes.”
Shoemaker and colleagues performed a retrospective chart review of 552 children and adolescents aged 18 years and younger who attended Vanderbilt University Medical Center’s pediatric prediabetes clinic from May 17, 2015, to Aug. 30, 2022. Participants were classified as having impaired fasting glucose if they had a fasting glucose of 100 mg/dL to 125 mg/dL or a 2-hour glucose of 140 mg/dL to 199 mg/dL at their initial visit. At follow-up, youths were considered to have progressed to type 2 diabetes if they had a fasting plasma glucose of at least 126 mg/dL, a 2-hour plasma glucose of at least 200 mg/dL or an HbA1c of at least 6.5%. Blood pressure, weight, BMI and laboratory values were collected at each visit.
Risk factors for progression to type 2 diabetes
Of the participants, 6.5% progressed to type 2 diabetes by the end of the study. Those who progressed had a higher HbA1c (mean difference, 0.3 percentage points; 95% CI, 0.2-0.4; P < .001), fasting C-peptide (mean difference, 1.2 ng/mL; 95% CI, 0.5-1.9; P = .001) and 2-hour glucose (mean difference, 27 mg/dL; 95% CI, 17-36; P < .001) at their initial visit than youths who did not progress.
In a multivariable-adjusted model, boys had a higher risk for progression than girls (adjusted HR = 2.4; 95% CI, 1.2-4.7; P = .01). Risk for progression increased with every 0.1 percentage point increase in HbA1c (aHR = 1.3; 95% CI, 1.2-1.5; P < .001) and every 10 mg/dL increase in 2-hour glucose (aHR = 1.2; 95% CI, 1-1.3; P = .01) at the initial visit.
Type 2 diabetes diagnosis occurred a mean 28.8 months after the initial visit. Mean age at diagnosis was 14.9 years. Of those who progressed, 94% had a family history of type 2 diabetes, 92% had public insurance, 94% had acanthosis at baseline and 72% had impaired glucose tolerance at their initial visit. Increasing BMI was observed among 89% of children who progressed to type 2 diabetes.
Metformin may slow diabetes progression
At type 2 diabetes diagnosis, 28 youths received metformin, six required insulin and one received a GLP-1 receptor agonist. Mean HbA1c was 8.1%, with 53% of youths having an HbA1c of less than 7% at diagnosis.
Of the 36 children who progressed, 23 received metformin during their initial clinic visit, but only six were taking the medication as prescribed at the time of type 2 diabetes diagnosis. Those taking metformin as prescribed had a lower HbA1c and took 17 months longer to progress than those who missed doses or were not taking the medication at all.
“Further research is needed to evaluate the best medications for preventing youth-onset type 2 diabetes,” Shoemaker said. “For example, metformin showed some benefit in our study, but GLP-1 receptor agonists could be another option due to their added benefit of weight loss.”
For more information:
Ashley H. Shoemaker MD, MSCI, can be reached at ashley.h.shoemaker@vumc.org.
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