Prediabetes in Children and Adolescents: What Does It Mean?

Orit Pinhas-Hamiel, MD; Phil Zeitler, MD, PhD

Disclosures

January 02, 2013

In This Article

Identified Risk Factors for Prediabetes

Obesity. The prevalence of prediabetes varies among different studies of obese children. IGT was detected in 25% of obese children aged 4-10 years and 21% of obese adolescents aged 11-18 years.[12] In a study of 736 overweight and obese children in Italy, 7.66% had IFG and only 3.18% had IGT.[13] Compared with normal-weight adolescents, obese adolescents had a 2.6-fold higher rate of prediabetes.[3]

Family history of diabetes. Family history is a strong risk factor for IFG. Among children and adolescents aged 7-15 years from Mexico, IFG (according to ADA criteria) was identified in 88% of those with a family history, compared with 1.9% of those without.[14] Furthermore, the presence of family history in a first-degree relative was associated with IFG, even in the absence of obesity. Similarly, among obese children from Germany,[15] a history of parental diabetes was associated with a 9.5-fold increased risk for prediabetes.

Sex. Theprevalence of prediabetes is 2.4-fold higher in boys.[3]

Age. Adolescents aged 12-15 years have been reported to have a significantly higher rate of prediabetes than those aged 16-19 years.[3] This may be related to the peak of pubertal insulin resistance that occurs during early adolescence.

Puberty. Among 437 overweight children and adolescents, puberty (Tanner stage 2 or higher) was associated with a 5.5-fold increased risk compared with the prepubertal period.[15]

Cardiometabolic risk factors. Adolescents with 2 or more cardiometabolic risk factors (hypertension, dyslipidemia, and hypertriglyceridemia) have a 2.7-fold higher rate of prediabetes than those with no cardiometabolic risk factors.[3] Similarly, adolescents with hyperinsulinemia have a 4-fold higher prevalence than those without cardiometabolic risk factors.

Ethnic origin. Data from the National Health and Nutrition Examination Survey among US adolescents revealed that non-Hispanic black youth have demonstrated lower rates of prediabetes than non-Hispanic white youth (prevalence ratio, 0.6; 95% confidence interval, 0.4-0.9).[3] Hispanic youth have significantly higher fasting glucose levels than black youth.[4]

Screening for prediabetes seems to be meaningful in patients who have a parental history of diabetes, are extremely obese, and have entered puberty; this is especially the case for patients of certain ethnic groups.

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