Risk Factors of Youth Type 2 Diabetes (Y-T2DM) and Prevalence of Dysglycemia (DG)

The incidence of Y-T2DM is increasing parallel with the childhood obesity epidemic. The ADA consensus recommends screening for Y-T2DM or prediabetes in asymptomatic overweight youth who have any two additional risk factors (RFs): family history of T2DM in 1^st or 2^nd degree relatives, minority race/ethnicity, insulin resistance [acanthosis nigricans, polycystic ovary syndrome, hypertension, dyslipidemia, and small for gestational age], and maternal GDM during the child’s gestation. However, the evidence for these recommendations is minimal, if not nonexistent. In an established pediatric obesity registry, OGTT data of 618 youth ˃10 years old, BMI ≥ 85^th%, were analyzed to evaluate the prevalence of DG based on the frequency of RFs. Participants were divided into 4 groups according to the number of RFs. Participants were 70% females, 70% Caucasians, 31% with prediabetes, and 5.1% with Y-T2DM. With increasing RFs, the prevalence of normal glucose tolerance (NGT) declined, DG increased, fasting glucose concentration did not change, but fasting insulin concentration increased significantly (Table: mean ± SE). Participants with 1 RF had ∼25% prevalence of DG. The odds for DG with 2, 3 and ≥ 4RFs were 1.6, 1.7, and 2.5 respectively compared to 1 RF (P=0.01).

In conclusion, the prevalence of prediabetes and T2DM in overweight/obese youth is high ∼25% in the presence of only 1 RF, and escalates with increasing number of RFs.