Presence of Type 2 Diabetes Risk Factors in Children

Leslie K. Scott, PhD, PNP-BC, CDE

Disclosures

Pediatr Nurs. 2013;39(4):190-196. 

In This Article

Results

The clinic records of 971 students, grades 1 through 5, met inclusion criteria and were reviewed for the purpose of this study. The study group represented 74% of the population of the four schools included in the screening. Self-reported ethnicity and gender of the student records enrolled in this study consisted of 50.4% non-Hispanic Caucasians, 38.2% African Americans, and 15.8% "Other" (Hispanic and "other" students) and consisted of equal numbers of each gender (see Table 1). "Other" was self-described by the parent completing the health history form and included "bi-racial," Hispanic, and Asian ethnicities.

Almost 40% of the overall group of students had a BMI greater than the 85th percentile for age and gender. Nearly 17% were overweight (BMI 85th to 95th percentile for age and gender). Conversely, more than 23% of the students were obese (BMI greater than the 95th percentile for age and gender). Acanthosis nigricans was present in 26.9% of the students (see Table 2). Medical history forms in the clinic record indicated that 48% of the students identified a family history of diabetes. Data were then divided into two groups – students younger than 10 years of age (n = 602) and those 10 years of age or older (n = 369) – for the purpose of analyzing youth eligible for type 2 diabetes screening. There were no statistically significant differences between the groups related to gender, ethnicity, or presence of a family history of diabetes. However, students 10 years of age or older were more obese (28%, compared to 20.6% in younger group). Older students had lower rates of acanthosis nigricans, yet the severity was greater than that present in the younger group (see Table 3).

Chi-square analyses were used to evaluate relationships between BMI, ethnicity, age, gender, a positive family history of diabetes, and the presence of acanthosis nigricans. Data from all study participants, as well as each group according to student age, were analyzed. Among all three groups similar significant relationships emerged.

The presence of acanthosis nigricans was compared with ethnicity, age, gender, a positive family history of diabetes, and BMI percentiles. BMI was the best indicator for the presence of acanthosis nigricans. Students with a BMI greater than the 85th percentile for age and gender had higher rates of acanthosis nigricans when compared to students with a BMI less than the 85th percentile for age and gender (χ2 = 132.911; p = < 0.001). Odd ratio of 5.7 ± 0.158 (p = < 0.001) was calculated, indicating that overall, overweight and obese students were nearly six stutimes more likely to have acanthosis nigricans as compared to "normal weight" students. Obese students 10 years of age or older were greater than 10 times more likely to have acanthosis nigricans as compared with older students whose BMI was less than the 95th percentile for age and gender (χ2 = 86.237; p = < 0.001) (odds ratio 10.97 ± 0.284; p = < 0.001). These findings, although concerning, correlate with previous data used to determine the ADA/AAP type 2 diabetes screening guidelines. Although screening guidelines do not support the screening of younger children, it should be of concern that the presence of acanthosis nigricans was identified in students as young as 6 years of age.

An ethnic difference regarding the presence of acanthosis nigricans was found only in the older group among African-American students (χ2= 3.832; p = < 0.049). Among students 10 years of age or older, African-American students were almost twice as likely to have acanthosis nigricans (odds ratio 1.6 ± 0.25; p = 0.05) as compared to all other ethnic groups regardless of family history of diabetes, gender, or BMI. The lack of an ethnic relationship related to the presence of acanthosis nigricans may have resulted from the high number of non-Hispanic Caucasian students represented in the study.

The presence of a family history of diabetes and the presence of acanthosis nigricans were only affected by BMI. Regardless of age, gender, or ethnicity, students with a BMI less than the 85th percentile for age and gender were 2.3 times (p = < 0.001) less likely to have acanthosis nigricans and a family history of diabetes (χ2 = 51.86; p = < 0.001) when compared to students whose BMI is greater than the 95th percentile for age and gender. Older obese students were almost eight times more likely to have acanthosis nigricans and a family history of diabetes as compared to those whose BMI is less than the 95th percentile for age and gender. This finding supports the importance of screening for a family history of diabetes in older students who are obese with acanthosis nigricans.

Eligibility for Type 2 Diabetes Screening

Crosstabs were used to compare the various data to determine the number of students who qualify for further screening for type 2 diabetes. Of the students 10 years of age or older enrolled in the study, 39.3% were eligible for further screening for type 2 diabetes according to the ADA/AAP guidelines (see Figure 1) (ADA, 2000). Twenty-eight percent of the students were obese. Nearly 11% of the students screened were overweight with at least two risk factors associated with type 2 diabetes, thus meeting the criteria for further laboratory evaluation for type 2 diabetes (see Table 4). Almost 40% of the students younger than 10 years of age had risk factors associated with screening criteria. Younger African-American students were more likely to be obese (15.4%) compared to non-Hispanic Caucasian students (9%). Younger African-American students meeting screening criteria were also more likely to be overweight (8%) as compared to non-Hispanic Caucasian peers (1.2%) (see Table 5).

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