Glycemic Screening in Childhood May Predict Diabetes-Related Complications

New research indicates the importance of early glycemic screening in high-risk children in order to prevent future long-term complications from type 2 diabetes (T2D).

The data, presented at the 83rd American Diabetes Association Scientific Sessions (ADA 2023), suggest blood glucose levels collected at childhood examinations helped to predict future diabetes-related complications, including nephropathy and retinopathy.

“Evidence-based recommendations help drive diabetes prevention early on, and this study sheds light on how pediatric screenings are a critically important guideline,” Robert Gabbay, MD, PhD, chief scientific and medical officer, ADA, said in a statement. “Furthermore, the findings will help inform evidence-based recommendations to ensure better care for all people with diabetes, including vulnerable communities and those at high risk.”

Literature has shown the United States is experiencing a significant increase in obesity-induced youth-onset type 2 diabetes. Due to this rise, the ADA has recommended risk-based screening for prediabetes and/or diabetes in asymptomatic children with overweight or obesity by pediatric healthcare providers. But a lack of clinical evidence for the effectiveness of screening on long-term health outcomes related to metabolic dysfunction in childhood has slowed this recommendation.

The current study looked to understand the association between higher levels of glycemic during childhood with future microvascular complications in children who are American Indian. This population is twice as likely to be diagnosed with diabetes compared with children who are White. The investigative team used data from a longitudinal observational study with more than 4 decades of data (1965 - 2007) within an American Indian community in the southwestern United States.

Investigators analyzed glycated hemoglobin (HbA1c) and 2-hour post-load plasma glucose (2-hour PG) levels obtained during childhood (aged 5 - 19). Then, they analyzed the associations of these levels with future diabetes-related microvascular complications of nephropathy and retinopathy. Nephropathy was defined as albuminuria (albumin creatinine ratio [ACR], ≥30 mg/g) and severe albuminuria (ACR ≥300 mg/g); retinopathy was defined as ≥1 microaneurysm or hemorrhage, or proliferative retinopathy on direct ophthalmoscopy.

Upon analysis, the investigative team found higher levels of both glycated hemoglobin and 2-hour PG during childhood were significantly associated with an increased risk of retinopathy. In addition, the risk of albuminuria, including severe albuminuria, was observed to be elevated in children with T2D, based on baseline HbA1c, compared to those with prediabetes and normal glucose levels.

“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,” said Madhumita Sinha, MD, assistant clinical investigator and diabetes epidemiology and clinical research section head, National Institute of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases, said in a statement. “By screening with a simple blood test earlier, pediatric care providers can intervene sooner, potentially preventing adverse health outcomes down the line related to diabetes.”