Background: The American Diabetes Association recommends risk-based screening for dysglycaemia (prediabetes and type 2 diabetes) in youth with overweight/obesity plus ≥1 risk factor. However, evidence for these recommendations is lacking.Objectives: Examine the association between the number of risk factors and the prevalence of dysglycaemia in youth with overweight/obesity at initial presentation.Methods: In a paediatric obesity registry, youth (>10 and <20 years old, body mass index ≥85th percentile) were categorized into four groups according to number of risk factors (1, 2, 3 and ≥4). Based on oral glucose tolerance test, participants were classified into normal glucose tolerance or dysglycaemia.Results: Of 635 youth, 31.5% had prediabetes and 6.1% had type 2 diabetes. The prevalence of dysglycaemia was 23.1% with 1 risk factor and increased to 44.9% with ≥4 risk factors (p = 0.025). Dyslipidaemia, family history of type 2 diabetes and maternal history of gestational diabetes were significantly associated with dysglycaemia.Fasting and 2-h insulin, 2-h glucose increased (all p < 0.0001) and ALT increased (p = 0.001) with increasing risk factors. Insulin sensitivity and β-cell function deteriorated significantly with increasing risk factors.
Conclusion:Screening for dysglycaemia in youth with obesity and any additional risk factor is warranted to target early management.impaired glucose tolerance, prediabetes, risk factors, youth-type 2 diabetes
| INTRODUCTIONParallel to the increasing rates of childhood obesity, the incidence 1 and the prevalence 2 of youth-type 2 diabetes (T2D) is escalating worldwide, particularly in non-white racial/ethnic populations. The highest rate of youth-T2D exists in the United States, with an incidence that increased from 9 to 12.5 cases per 100 000 between 2002 and 2012. 1,3 While the trends in Europe and Asia are similar, the overall incidence remains lower. [4][5][6] Scientific information suggests that youth-T2D is an aggressive disease with early and rapidly progressing complications. [7][8][9] Youth with T2D have higher complications and mortality compared to peers with type 1 diabetes. 10,11 These youth also have a higher risk of early death than adults with T2D when matched for diabetes duration. 12 The treatment options for T2D in Adolescents and Youth (TODAY) showed >50% glycaemic failure rates on metformin, the only Abbreviations: ADA, American Diabetes Association; BMI, body mass index; GDM, gestational diabetes mellitus; HAPO FUS, Hyperglycaemia and Adverse Pregnancy Outcome Follow-up Study; HDL, high density lipoprotein; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; ΔI 30 /ΔG 30 , insulinogenic index; 1/I F , inverse of fasting insulin; LDL, low density lipoprotein; oDI, oral disposition index; OGTT, oral glucose tolerance test; PCOS, polycystic ovary syndrome; SEM, standard error of the mean; SGA, small for gestational age; TC, total cholesterol; TG, triglycerides; TODAY, treatment options for type 2 diabetes in adolescents and youth; T2D, type 2...
