Higher glycemia levels during childhood are tied to future microvascular complications

The study found that blood glucose from childhood examinations predicted future diabetes-related complications such as eye disease (retinopathy) and kidney disease (nephropathy). The findings, presented at the 2023 Scientific Sessions of the American Diabetes Association (ADA) in San Diego, CA, imply that higher glycemic levels during childhood are associated with an increased retinopathy and nephropathy risk.

There is a significant rise in obesity-induced youth-onset type 2 diabetes (T2D). As a result, the ADA has recommended risk-based screening for diabetes and/or prediabetes in asymptomatic children with obesity or overweight pediatric healthcare providers. However, there is currently a lack of clinical evidence for the utility of this screening concerning the long-term health outcomes related to metabolic dysfunction that begins in childhood.

To fill this knowledge gap, Laura Vazquez, from the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health in Phoenix, and colleagues sought to evaluate the association of higher levels of glycemia during childhood with future microvascular complications in American Indian children.

They used data from a longitudinal observational study of diabetes and its complications (from 1965 to 2007) to examine the association of HbA1c (glycated haemoglobin) and two-hour post-load plasma glucose (2-hr PG) obtained during childhood (ages 5-19) with future microvascular complications of retinopathy and nephropathy related to diabetes. The ability of childhood glycemic measures to predict future complications was compared using areas under the receiver operating characteristic curve (AUCs).

The authors reported the following findings:

• Higher 2-hr PG and HbA1c significantly increased the risk of retinopathy in children without type 2 diabetes at baseline (hazard ratios, 3.09 per 1 percent and 1.48 per 1 mmol/L, respectively).
• Compared to those with prediabetes and normal glucose levels, children with T2D based on baseline HbA1c had the highest incidence of severe albuminuria, albuminuria, and retinopathy.
• The incidence of these complications in those with prediabetes was always higher than in those with normoglycemia among children without T2D at baseline; no significant difference was seen in AUCs for HbA1c, 2-hr PG, or fasting PG, indicating a similar ability to predict future complications.

"These findings underscore the value of glycemic screening tests in high-risk children at a time when obesity and diabetes risk factors are disproportionately impacting at-risk communities," Madhumita Sinha, MD, FAAP, Assistant Clinical Investigator and Diabetes Epidemiology and Clinical Research Section Head, NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix Branch, said in a statement.

"By screening with a simple blood test earlier, pediatric care providers can intervene sooner, potentially preventing adverse health outcomes related to diabetes."

The authors add that there is a need for future studies to evaluate the implementation of measures such as lifestyle changes affecting long-term adverse health outcomes.

Reference:

Oral Presentations - Type 2 Diabetes in Youth: Glycemic Measures in Childhood as Predictors of Future Diabetes Related Microvascular Complications. Presented on Friday, June 23, 2023 at 5:30 PM PST