Office-Based Childhood Measures May Help Predict Future Type 2 Diabetes

From Medscape Medical News
Laurie Barclay, MD

January 6, 2010 — Office-based childhood measures may help predict future long-term risk for type 2 diabetes mellitus (T2DM), according to the results of a study reported in the January 2010 issue of Archives of Pediatric & Adolescent Medicine.

"In the past 25 years, the prevalences of obesity and...T2DM have increased concomitantly, and the age at onset of T2DM has dropped precipitously, especially in black females," write John A. Morrison, PhD, from Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio, and colleagues. "Models to identify children at increased and very low risk for young-adult T2DM could provide diagnostic and therapeutic insights into etiologic relationships of hyperinsulinemia, insulin resistance, and obesity with the development of T2DM and could provide targeted avenues for prevention."

The goal of the study was to assess whether pediatric office measures (waist circumference, body mass index [BMI], systolic and diastolic blood pressure, and parental diabetes) and laboratory measures (glucose, triglyceride, high-density lipoprotein cholesterol, and insulin levels) could help predict T2DM risk at ages 19 and 39 years.

At urban and suburban schools, 1067 girls enrolled in the National Growth and Health Study at age 10 years and 822 schoolchildren aged 6 to 18 years at entry in the Princeton Follow-up Study had follow-up evaluations at 9 and 26 years. The primary endpoint was development of T2DM.

In the Princeton Follow-up Study, predictors of T2DM at age 39 years were childhood systolic blood pressure and BMI in the top fifth percentile and black race (area under the receiver-operator curve [AUC], 0.698). When childhood glucose levels of 100 mg/dL or more and high-density lipoprotein cholesterol in the bottom fifth percentile and triglyceride concentration in the top fifth percentile were added as explanatory variables, AUC increased to 0.717 and 0.709, respectively. The likelihood of T2DM at age 39 years was 2% if childhood BMI, systolic blood pressure, and diastolic blood pressure were all lower than the 75th percentile, and this decreased further to 1% if the parents had no diabetes.

Systolic blood pressure in the top fifth percentile and parental diabetes predicted T2DM at age 19 years among children enrolled in the National Growth and Heath Study (AUC, 0.699). When insulin in the top fifth percentile was added, AUC was increased to 0.764, with insulin being a significant variable. The likelihood of T2DM at age 19 years was 0.2% if childhood BMI, systolic blood pressure, and diastolic blood pressure were all lower than the 75th percentile; 0.2% if the parents also did not have diabetes; and 0.3% if childhood insulin level was also below the 75th percentile.

"Office-based childhood measures predict the presence and absence of future T2DM 9 and 26 years after baseline," the study authors write. "Childhood insulin measurement improves prediction, facilitating approaches to primary prevention of T2DM."

Limitations of this study include childhood insulin measured only in the National Growth and Health Study and not in the Princeton Follow-up Study, length of follow-up 22 to 30 years in the Princeton Follow-up Study vs 9 years in the National Growth and Health Study, inability to differentiate type 1 from T2DM in insulin users at follow-up, and lack of certain laboratory tests.

"Our data have practical clinical value in assessment of preteen-aged and teenaged children, since children with SBP [systolic blood pressure], triglyceride, BMI, and insulin in the top fifth percentile, a glucose concentration of at least 100 mg/dL, and a parent with diabetes could be targeted for primary prevention of T2DM through diet, exercise, and possibly insulin-sensitizing drug intervention, with special focus on overweight children with a positive family history of DM," the study authors conclude.

The National Institutes of Health, the American Heart Association, the Taft Research Fund, and the Lipoprotein Research Fund of the Jewish Hospital of Cincinnati helped support this study. The study authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2010;164:53-60. Abstract