How to screen obese children at risk for type 2 diabetes mellitus?

Area of Science:

• Pediatric Endocrinology
• Metabolic Disorders
• Diabetes Screening

Background:

• Current screening for pediatric diabetes and its precursors (IGT, IR) relies on fasted plasma glucose (FPG).
• The added value of fasted plasma insulin (FPI) in conjunction with FPG for screening is not well-established.
• Obesity is a significant risk factor for developing insulin resistance and type 2 diabetes in children.

Purpose of the Study:

• To evaluate the additional diagnostic value of incorporating fasted plasma insulin (FPI) into the standard fasted plasma glucose (FPG) screening protocol for obese children.
• To compare the detection rates of diabetes, impaired glucose tolerance (IGT), and insulin resistance (IR) using FPG alone versus FPG combined with FPI.

Main Methods:

• Analysis of routinely collected oral glucose tolerance test (OGTT) data from 311 obese children (mean age 10.8 years).
• Diabetes and IGT diagnosed per American Diabetes Association criteria.
• Insulin resistance (IR) defined using homeostasis model assessment (HOMA)-IR ≥3.4.

Main Results:

• Screening with FPG and FPI identified 100% of diabetes cases compared to 80% with FPG alone.
• The FPG + FPI approach detected 64% of IGT cases, significantly higher than the 28% detected by FPG alone.
• All cases of insulin resistance (IR) were identified when using the combined FPG and FPI screening method, versus 0% with FPG alone.

Conclusions:

• Screening obese children for diabetes precursors using both FPG and FPI is more effective than using FPG alone.
• The combined FPG and FPI screening strategy identifies all diabetes cases and significantly increases the detection of IGT and IR.
• This enhanced screening approach offers comparable burden to FPG-only screening while improving the identification of at-risk pediatric populations.