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Published on: January 7, 2018
Association between impaired fasting glycaemia in pediatric obesity and type 2 diabetes in young adulthood
E Hagman1, P Danielsson1, L Brandt2
1Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Insights
Children with obesity are significantly more likely to develop type 2 diabetes mellitus (T2DM). Impaired fasting glucose (IFG) and elevated hemoglobin A1c (HbA1c) in obese children are key risk markers for T2DM development.
Area of Science:
- Endocrinology
- Pediatrics
- Metabolic Disorders
Background:
- Obesity in children is a growing concern with long-term health implications.
- Impaired fasting glucose (IFG) and elevated hemoglobin A1c (HbA1c) are known risk factors for type 2 diabetes mellitus (T2DM) in adults.
- The predictive value of these markers in obese children transitioning to adulthood requires further investigation.
Purpose of the Study:
- To assess the long-term risk of developing T2DM in individuals with a history of childhood obesity.
- To determine if IFG and elevated HbA1c levels in obese children serve as early risk markers for T2DM.
- To compare the predictive value of different IFG definitions (WHO vs. ADA) in this population.
Main Methods:
- A prospective cohort study involving 1620 subjects from the Swedish Childhood Obesity Treatment Registry (BORIS) and 8046 matched controls.
- IFG was defined using both American Diabetes Association (ADA) and World Health Organization (WHO) criteria.
- Elevated HbA1c was defined by ADA criteria. T2DM diagnosis was determined by medication use from a national registry.
Main Results:
- The childhood obesity cohort had a 24-fold increased likelihood of receiving T2DM medication in early adulthood compared to controls.
- WHO-defined IFG (≥6.1 mmol/l) was a significant predictor of future T2DM medication use (adjusted HR=3.73).
- Elevated HbA1c (≥39 mmol/l) also predicted T2DM medication use (adjusted HR=3.12), while the ADA-defined IFG interval (5.6-6.0 mmol/l) did not show significant predictive value beyond obesity itself.
Conclusions:
- WHO-defined IFG and elevated HbA1c are significant prediabetes indicators in obese Swedish children.
- The fasting glucose interval proposed by the ADA (5.6-6.0 mmol/l) is not a sufficient marker for prediabetes in this pediatric obese population.
- These findings highlight the importance of early identification and management of metabolic risks in obese children to prevent T2DM.
Objectives:
In adults, impaired fasting glycemia (IFG) increases the risk for type 2 diabetes mellitus (T2DM). This study aimed to investigate to which extent children with obesity develop T2DM during early adulthood, and to determine whether IFG and elevated hemoglobin A1c (HbA1c) in obese children are risk markers for early development of T2DM.
Methods:
In this prospective cohort study, 1620 subjects from the Swedish Childhood Obesity Treatment Registry - BORIS who were ⩾18 years at follow-up and 8046 individuals in a population-based comparison group, matched on gender age and living area, were included. IFG was defined according to both ADA (cut-off 5.6 mmol l(-1)) and WHO (6.1 mmol l(-1)). Elevated HbA1c was defined according to ADA (cut-off 39 mmol l(-1)). Main outcome was T2DM medication, as a proxy for T2DM. Data on medications were retrieved from a national registry.
Results:
The childhood obesity cohort were 24 times more likely to receive T2DM medications in early adulthood compared with the comparison group (95% confidence interval (CI): 12.52-46). WHO-defined IFG predicted future use of T2DM medication with an adjusted hazard ratio (HR) of 3.73 (95% CI: 1.87-7.45) compared with those who had fasting glucose levels <5.6 mmol l(-1). A fasting glucose level of 5.6-6.0 mmol l(-1), that is, the IFG-interval added by American Diabetes Association (ADA), did not increase the use of T2DM medication more than pediatric obesity itself, adjusted HR=1.72 (0.84-3.52). Elevated levels of HbA1c resulted in an adjusted HR=3.12 (1.50-6.52). More severe degree of obesity also increased the future T2DM risk.
Conclusion:
IFG according to WHO and elevated HbA1c (39-48 mmol l(-1)), but not the additional fasting glucose interval added by ADA (5.6-6.0 mmol l(-1)), can be considered as prediabetes in the obese pediatric population in Sweden.
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