Prediabetes in Children and Adolescents: What Does It Mean?

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

January 02, 2013

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.