USA: Study on Type 2 Diabetes Prevention in Children

A recent study published in the Journal of the Endocrine Society has revealed metformin therapy and weight stabilization to be important interventions for preventing type 2 diabetes in children. In addition, A1c plus nonfasting glucose may be a feasible way to identify high-risk pediatric patients in a clinical setting.

The researchers revealed that over a 7-year study period, 6.5% of patients with prediabetes developed type 2 diabetes (T2D). They suggested that initial visit laboratory values and weight trajectory may help risk stratification, whereas fasting plasma glucose is less helpful.

There has been an increase in the prevalence of pediatric type 2 diabetes, yet there is no clarity on what definition of pediatric prediabetes predicts progression to T2D. There is a need for strategies to identify better at-risk individuals who could benefit from early intervention.

Ashley H Shoemaker, Vanderbilt University Medical Center, Nashville, TN, USA, and colleagues conducted a chart review of patients evaluated in the VUMC Prediabetes Clinic over 7 years to determine risk factors for progression to type 2 diabetes.

Inclusion criteria include ≥1 glucose from oral glucose tolerance test and haemoglobin A1c (HbA1C). Exclusion criteria included type 2 diabetes, T2D on the initial visit, or maturity-onset diabetes of the young. A total of 552 patients were included.

Study Findings

• 6.5% progressed to type 2 diabetes.
• At initial visit, T2D progressors had a higher body mass index (38.6 ± 6.5 versus 34.2 ± 8.4 kg/m²), HbA1C (6.0 ± 0.3%, versus 5.7± 0.3), 2-hour glucose (141 ± 28 versus 114 ± 29 mg/dL), and C-peptide (4.8 versus 3.6 ng/mL).
• Fasting glucose was not significantly different.
• In a multivariable model, male sex (hazard ratio [HR], 2.4), initial visit HbA1C (HR, 1.3 per 0.1% increase), and 2-hour glucose level (HR, 1.2 per 10 mg/dL increase) were all predictive of T2D progression.
• Patients who progressed to T2D had an increase in body mass index of 4.2 kg/m², and children consistently taking metformin took longer to progress (43 ± 21 versus 26 ± 16 months).

"Over the 7 years of our study, only 6.5% of pediatric patients with prediabetes developed T2D, highlighting the importance of identifying which patients would most benefit from antidiabetes and antiobesity medications or intensive lifestyle interventions," the researchers wrote.

"Preventing further worsening of obesity is an important intervention for prevention of type 2 diabetes in children and metformin may have a role in the management of pediatric prediabetes," they concluded.

Limitations

Limitations were that additional patients who developed type 2 diabetes may have lost to follow-up since the authors did not contact patients to confirm their disease status. Also, the authors were unable to establish racial differences in the T2D progression because of missing data.

Reference

Belsky, N., Tamaroff, J., & Shoemaker, A. H. (2023). Risk Factors for Progression to Type 2 Diabetes in a Pediatric Prediabetes Clinic Population. Journal of the Endocrine Society, 7(11). https://doi.org/10.1210/jendso/bvad118