Love–Osborne KA, et al. – In this assessment, the physicians examined the factors associated with the progression of dysglycemia in overweight and obese youth. They observed that most adolescents with an initial prediabetes or diabetes–range A1c did not have a diabetes–range A1c on follow up. Moreover, prediabetes–range A1c values did not all convey equal risk for the development of diabetes, as lower rates of progression were observed in youth with initial A1c <6%. Significant improvement was noticed in glycemia with body mass index (BMI) stabilization in youth with prediabetes–range A1c.

Methods

• With the aid of electronic medical records (EMR), 10– to 18–year–old youth with body mass index (BMI) > 85 percentile and first–time A1c 5.7%–7.9% (39–63 mmol/mol) were identified.
• Levels of dysglycemia were defined as low–range prediabetes (LRPD; A1c 5.7%–5.9% [39–41 mmol/mol]), high–range prediabetes (HRPD; A1c 6.0%–6.4% [42–46 mmol/mol]), or diabetes–range (A1c 6.5%–7.9% [48 mmol/mol]).
• From the EMR, follow–up A1c and BMI were extracted.
• At the time of initiation of diabetes medication, follow up was truncated.

Results

• Out of 11 000 youth, 547 were identified with baseline dysglycemia (mean age 14.5 ± 2.2 years, 70% Hispanic, 23% non–Hispanic Black, 7% other).
• Of these, 206 had LRPD, 282 HRPD, and 59 diabetes.
• Follow–up A1c was available in 420 (77%), with median follow up of 12–22 months depending on A1c category.
• At follow–up testing, the percent with diabetes–range A1c was 4% in youth with baseline LRPD, 8% in youth with baseline HRPD, and 33% in youth with baseline diabetes–range A1c.
• A linear association was observed between BMI increase and worsening A1c for LRPD (P < .001) and HRPD (P = .003).