Baseline HbA1c over 6% greatly increases type 2 diabetes risk for adolescents with obesity
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Key takeaways:
- The risk for developing type 2 diabetes increases with higher baseline HbA1c for adolescents with overweight or obesity.
- A large increase in type 2 diabetes risk was observed with a baseline HbA1c more than 6%.
The risk for developing type 2 diabetes is substantially higher for adolescents with overweight or obesity and an HbA1c of at least 6.1% compared with those with an HbA1c of 5.5% or less, according to study data.
“Our study is one of the first large population studies to report the incidence and risk of type 2 diabetes by incremental level of HbA1c in a racially and ethnically diverse group of adolescents with overweight and obesity,” Francis M. Hoe, MD, a pediatric endocrinologist with Kaiser Permanente in Northern California, told Healio. “In our study, HbA1c was a very strong predictor for developing type 2 diabetes. Absolute risk for developing type 2 diabetes was low, especially for those with an HbA1c of less than 5.9%.”
Hoe and colleagues conducted a retrospective cohort study using electronic health record data from Kaiser Permanente Northern California from 2010 to 2019. The study included adolescents aged 10 to 17 years without diabetes at baseline who had at least one HbA1c recorded from 2010 to 2018 and a BMI in the 85th percentile or higher for age and sex according to CDC growth chart reference data. Participants were defined as having developed type 2 diabetes during follow-up if they were diagnosed by a health care provider or had an HbA1c, fasting glucose, random glucose or 2-hour glucose level in the diabetes range as defined by American Diabetes Association glycemic thresholds. Adolescents were classified as having type 2 diabetes unless they had at least one positive diabetes autoantibody indicating type 1 diabetes, were diagnosed with maturity-onset diabetes of the young or were diagnosed with a secondary form of diabetes.
The findings were published in JAMA Network Open.
Diabetes risk rises with baseline HbA1c
There were 74,552 adolescents with overweight or obesity and a baseline HbA1c of less than 6.5% included in the study (mean age, 13.4 years; 50.6% female; 43.6% Hispanic; 21.6% white; 17.6% Asian/Pacific Islander; 11.1% Black). Participants were followed for a median of 3.5 years. Of the study group, 0.9% developed incident diabetes during follow-up. Of those diagnosed with diabetes, 89.7% were classified as having type 2 diabetes.
The 5-year cumulative incidence of type 2 diabetes was 1%. Incidence rates climbed with baseline HbA1c, reaching 11% for those with a baseline HbA1c of 6.1% to 6.2% and 28.5% for adolescents with a baseline HbA1c of 6.3% to 6.4%. Cumulative incidence of type 2 diabetes was 0.3% with a baseline HbA1c of less than 5.5%, 0.5% with a baseline HbA1c of 5.5% to 5.6%, 1.1% with a baseline HbA1c of 5.7% to 5.8%, and 3.8% with a baseline HbA1c of 5.9% to 6%.
Risk higher for girls, older adolescents
In multivariable analysis, adolescents with a baseline HbA1c of 6.3% to 6.4% had a nearly 72-fold increased risk for developing type 2 diabetes than those with a baseline HbA1c of less than 5.5% (adjusted HR = 71.9; 95% CI, 51.1-101.1). Those with moderate obesity (aHR = 2; 95% CI, 1.4-2.7) or severe obesity (aHR = 5.2; 95% CI, 3.9-7.1) had a higher risk for type 2 diabetes than those with overweight. Girls were more likely to develop type 2 diabetes than boys (aHR = 1.5; 95% CI, 1.3-1.8). Participants aged 15 to 17 years had a higher risk for type 2 diabetes than those aged 10 to 11 years (aHR = 1.7; 95% CI, 1.4-2.1). Asian and Pacific Islander adolescents had a higher risk for developing type 2 diabetes than white adolescents (aHR = 1.7; 95% CI, 1.3-2.2).
Hoe said the findings reveal which adolescents would benefit most from closer monitoring based on their initial HbA1c levels.
“Those with a HbA1c in the higher end of the prediabetes range (6.1% to 6.2% and 6.3% to 6.4%) had a 23-fold and 72-fold greater risk for developing type 2 diabetes, compared to those with HbA1c of less 5.5%,” Hoe said. “These adolescents are at greatest risk and will benefit most from intervention and follow-up diabetes monitoring. Adolescents with prediabetes but at an HbA1c in the low end of the prediabetes range (5.7% to 5.8%) have a low risk of developing diabetes. Although this group will still likely benefit from lifestyle intervention, they could perhaps be considered for follow-up diabetes monitoring less frequently than once per year, as currently recommended by the ADA.”
In future studies, Hoe said the researchers plan to examine the effects of weight and BMI change over time and look at how that may change type 2 diabetes risk.
For more information:
Francis M. Hoe, MD, can be reached at francis.m.hoe@kp.org.
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