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Fasting Insulin Levels in Children May Predict Adult Diabetes

Elevated fasting insulin levels in children aged 3 to 6 years may help predict which children will develop type 2 diabetes as adults…

Although researchers did not find the same association for older children and adolescents, they did find an association between body mass index (BMI) in peripubertal years and type 2 diabetes (T2DM) in adulthood.

The researchers wrote, “Taken together, these data suggest that caution is warranted in interpreting elevated fasting insulin levels in older childhood and adolescence as an indicator of risk for the development of later T2DM.”

Matthew A. Sabin, MD, PhD, from the Centre for Hormone Research, Murdoch Children’s Research Institute, Victoria, Australia, analyzed data on 2478 children enrolled in a population-based follow-up study on cardiovascular risk factors. The children were 3 to 18 years old in 1980 and were followed through 2001, 2007, or 2011 for potential diabetes.
The mean follow-up time ranged from 21 to 31 years, and a total of 84 individuals developed type 2 diabetes.

The researchers found a significant association between fasting insulin levels at age 3 to 6 years and diabetes as adults, even after adjusting for covariates age, sex, duration of follow-up, BMI, and parental history They also found a significant association between BMI in children aged 9 to 18 years and adult diabetes, even after adjustment but not an association with fasting insulin levels in that age bracket.

The lack of association between peripubertal insulin levels and adult diabetes may be related to a general increase in insulin levels for the age group, which may “mask pathologic increases in insulin levels that would otherwise indicate pancreatic strain,” the researchers write.

The prevalence of overweight or obesity for this population was 1.5% at age 3 to 6 years and 4.3% at age 9 to 18 years, which is low compared with current rates.

The researchers wrote: “The high prevalence of childhood obesity, alongside its recognized links with insulin resistance and T2DM, has led to increased awareness that fasting insulin levels may be a useful indicator of long-term risk for T2DM, even among nonobese youth.”

Practice Pearls:

  • Significant association between fasting insulin levels at age 3 to 6 years and diabetes as adults
  • Researchers did not find the same association for older children and adolescents
  • Children aged three to six with elevated fasting insulin levels could be at risk of developing type 2 diabetes as adults.

Pediatrics. Published online December 22, 2014. Abstract