Prediabetes in children and adolescents in Israel: a large-scale retrospective cohort study

To determine the prevalence of impaired fasting glucose (IFG) and increased glycated hemoglobin A1c (HbA1c) among Israeli children and adolescents without diabetes. A retrospective cohort study of children aged 5-18 years from three central Israeli districts from 2010 to 2020 was conducted. Data retrieved from the electronic patient medical files included age, sex, sector, socioeconomic status (SES), body mass index (BMI), fasting plasma glucose, and HbA1c levels. IFG was defined as fasting glucose 100-125 mg/dL; increased HbA1c as 5.7-6.4%. Of the 19,654 participants (54% male), rates of obesity were higher in the 10-14-year-old group (44.1%). Prevalence of IFG and/or elevated HbA1c was highest among morbidly obese individuals across all ages. Notably, low SES was associated with increased odds for IFG in children aged 5-9 years, and increased odds for prediabetic parameters among adolescents (10-18y). Children from the Arab sector had consistently higher adjusted odds of prediabetes compared to other groups.

Significant disparities exist in prediabetes risk among Israeli youth, influenced by sex, age, obesity, sector, and SES. Findings support the use of targeted, age- and sector-specific strategies for early identification and prevention, including glucose screening and efforts to address social determinants of health in pediatric care.

• Prediabetes among children and adolescents has become increasingly common, yet population-based data from diverse settings are limited.

• This study demonstrated higher prediabetes risk among children from the Arab sector and from low socioeconomic status. • These findings support early, equitable screening and culturally tailored prevention strategies to reduce future type 2 diabetes risk.