The United States Preventive Services Task Force recently questioned the benefits of risk-based screening for prediabetes/T2D in asymptomatic children with overweight/obesity due to lack of long-term health outcomes data. We examined associations of HbA1c and 2-hour post-load plasma glucose (2-hr PG), obtained during childhood (5 - <18 years) in a longitudinal study in an American Indian community (1965-2007), with future albuminuria [albumin creatinine ratio (ACR) ≥ 30 mg/g], severe albuminuria (ACR ≥ 300 mg/g), and retinopathy (at least one microaneurysm or hemorrhage or proliferative retinopathy on direct ophthalmoscopy). We compared the performance of childhood glycemic measures in predicting these complications using area under the ROC curve (AUC). In children without T2D at baseline, higher HbA1c (HR=3.09 per 1%, 95% CI: 1.17-8.22) and 2-hr PG (HR= 1.48 per 1 mmol/L, 95% CI: 1.31-1.67) significantly increased retinopathy risk. Children with T2D based on baseline HbA1c had the highest incidence of albuminuria, severe albuminuria, and retinopathy compared to those with prediabetes and normal HbA1c levels. AUCs for HbA1c, 2-hr PG, or FPG were not significantly different (Figure). Higher levels of glycemia in childhood associated with future microvascular complications demonstrating the utility of screening tests performed in high-risk children in predicting long-term health outcomes.
L.Vazquez: None. E.Vazquez arreola: None. R.L.Hanson: None. M.Sinha: None.
National Institute of Diabetes and Digestive and Kidney Diseases