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Prediabetes in Adolescence Dramatically Increases Cardiovascular Risk

Jul 28, 2018
 

The risk of diabetes and prediabetes in adolescence: getting diabetes in our later years increases risk for CVD, but getting diabetes or prediabetes as a youth increases risk for CVD and death dramatically.

We know that having diabetes that is not properly managed increases the risk for CVD.  We also know that the longer a person has diabetes that is not managed, the greater the risk for CVD.  Getting diabetes in your 50-60’s increases risks for CVD, but getting diabetes in the adolescent years almost guarantees the diagnosis of CVD and death at a much earlier age.

 

This study included 2005–2014 NHANES data on 2,843 adolescents without diabetes to assess CVD risk factors among those with prediabetes or normal glucose. The prevalence of prediabetes in this group was 17.4%. In adjusted analyses, compared with normal glucose, prediabetes was associated with obesity, low HDL-cholesterol, high triglycerides, and elevated liver transaminase.

Adolescents with type 2 diabetes are more likely to have cardiovascular disease (CVD) risk factors, but there are few data available among adolescents with prediabetes. This study characterized CVD risk factors among adolescents with prediabetes in the USA and compared levels of those risk factors with adolescents with normal glucose.

The 2005-2014 National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey, included 2,843 adolescents ages 12-19 years after excluding those with diabetes. Prediabetes was based on an HbA1c, a fasting plasma glucose or a 2-h plasma glucose. Cardiometabolic risk factors were determined in adolescents using age-appropriate cut-off points. Than calculated odds ratios (OR) and 95% confidence intervals (CI) of these outcomes associated with having prediabetes were compared with normal glucose levels.

From the results, the weighted prevalence of prediabetes was 17.4%. After adjustment, prediabetes vs. normal glucose was associated with obesity, low HDL-cholesterol, high triglycerides, and elevated liver transaminase, but not with hypertension, elevated total cholesterol, elevated LDL-cholesterol, or albuminuria

From the results, it was concluded that U.S. adolescents with prediabetes are more likely to have obesity, low HDL-cholesterol, high triglycerides, and elevated liver transaminase than adolescents with normal glucose. Addressing prediabetes in youth is important for the prevention of type 2 diabetes and long-term comorbidity.

In an earlier study, they analyzed the prevalence of IFG, IGT, and prediabetes, and used the log-binomial model to estimate the prevalence ratios (PRs) and 95% CIs. And analyzed data from participants ages 12–19 years in the National Health and Nutrition Examination Survey 2005–2006.  To assess prediabetes, they used fasting plasma glucose and 2-h glucose during an oral glucose tolerance test.

The results showed that the unadjusted prevalence of IFG, IGT, and prediabetes were 13.1, 3.4, and 16.1%, respectively. Boys had a 2.4-fold higher prevalence of prediabetes than girls (95% CI 1.3–4.3). Non-Hispanic blacks had a lower rate than non-Hispanic whites (PR 0.6, 95% CI 0.4–0.9). Adolescents ages 16–19 years had a lower rate than those ages 12–15 years (0.6, 0.4–0.9). Overweight adolescents had a 2.6-fold higher rate than those with normal weight (1.3–5.1). Adolescents with two or more cardiometabolic risk factors had a 2.7-fold higher rate than those with none (1.5–4.8). Adolescents with hyperinsulinemia had a fourfold higher prevalence (2.2–7.4) than those without. Neither excess weight nor number of cardiometabolic risk factors was significantly associated with prediabetes after adjustment for hyperinsulinemia.

Previous studies of IGT among children and adolescents have been largely limited to those with obesity, a family history of diabetes, or multiple cardiometabolic risk factors. The prevalence estimates of IGT varied from 4% to 21% in previous studies. Although IGT prevalence estimates among adolescents with excess weight is helpful in understanding the absolute health risk associated with IGT in this special population, the relative health burden of IGT among adolescents with excess weight compared with adolescents of normal weight has not been established. In a few school-based studies, the prevalence of IGT is estimated to range from 0.3% to 2.3%, and the prevalence of IFG is estimated to vary from 6.7 to 40.5.

It was concluded that prediabetes was highly prevalent among adolescents. Hyperinsulinemia was independently associated with prediabetes and may account for the association of excess weight and clustering of cardiometabolic risk factors with prediabetes. Individuals with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are at increased risk for diabetes and cardiovascular-related death.

Practice Pearls:

  • These findings highlight the importance of addressing prediabetes in adolescence to possibly prevent or delay development of type 2 diabetes and complications.
  • Because adolescents with prediabetes usually have no apparent clinical symptoms, efforts may be needed to identify them early.
  • Start early to intervene against the root causes of insulin resistance such as excess weight, physical inactivity, and unhealthy diet in pediatric primary care and through public health services.

Diabetes  May 31, 2018