Utility of Childhood Glucose Homeostasis Variables in Predicting Adult Diabetes and Related Cardiometabolic Risk Factors: The Bogalusa Heart Study: Response to d'Annunzio, Russo, and Lorini

We thank d'Annunzio, Russo, and Lorini (1) for their interest in our article (2) related to carbohydrate-insulin variables in youth and later adult pre-diabetes and diabetes. As they noted, normal values of homeostasis model assessment of insulin resistance (HOMA-IR) are increased with sexual maturation. This is consistent with our previous findings in Bogalusa, Louisiana, with children. Svec et al. (3) reported earlier that there was a positive trend of postglucose insulin response with increasing Tanner stages.

The study cohort from our population emphasized the usefulness and the need to develop common cut-off values of childhood glucose homeostasis variables for predicting adult pre-diabetes and type 2 diabetes. Whether the risk of developing type 2 diabetes is best determined by fasting plasma glucose (FPG), insulin, or HOMA-IR remains unclear. The FPG level has been proven to have high reproducibility, small variability, and favorable application to clinical settings (4). In a multivariate analysis of repeated measurements (generalized equation estimation method) adjusted for traditional risk factors, we demonstrated that childhood FPG, more so than insulin, is a critical and independent predictor of adult pre-diabetes and type 2 diabetes 21 years later (5).

Earlier Bergman (6) questioned the adequacies of absolute threshold levels for diagnosing pre-diabetes. Indeed, the current cut-off value of FPG (100 mg/dl), revised by the American Diabetes Association (ADA), is applied without distinction of age-group even in youth. Moreover, the ADA asserted that risk for diabetes related to FPG is continuous. However, our other findings indicated a threshold of 85 mg/dl in children, above which the risk of adult diabetes began to increase (7).

In view of the prevalence of type 2 diabetes in epidemic proportions, there is an urgent need to address the issue of establishing an appropriate FPG cut-off point in children for predicting diabetes status later in life.