Glycemic Screening in Childhood May Predict Diabetes-Related Complications, According to New Data

New research shows that higher levels of glycemia in childhood are associated with future microvascular complications, such as nephropathy and retinopathy. These findings highlight the importance of early glycemic screening in high-risk children to predict long-term health outcomes.¹

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Researchers presented the data at the 83rd Scientific Sessions of the American Diabetes Association® (ADA) in San Diego, CA. The study abstract was simultaneously published in the Diabetes Care journal.

“The United States Preventive Services Task Force recently questioned the benefits of risk-based screening for prediabetes/T2D in asymptomatic children with overweight/obesity due to lack of long-term health outcomes data,”¹ wrote investigators. The current analysis used longitudinal data from an observational study (1965 to 2007) of children from a Native American community, a population twice as likely to have diabetes than white individuals, according to the US Centers for Disease Control and Prevention.²

Researchers examined the associations of HbA1c and 2-hour post-load plasma glucose (2-hr PG), obtained during childhood (ages 5-18), with future albuminuria (albumin creatinine ratio [ACR] ≥30 mg/g), severe albuminuria (ACR ≥300 mg/g), and retinopathy. For the purpose of the study, retinopathy was defined as at least 1 microaneurysm or hemorrhage, or proliferative retinopathy on direct ophthalmoscopy.¹

Investigators used area under the ROC curve (AUC) to compare “the performance of childhood glycemic measures in predicting these complications.”¹

FINDINGS

Results showed that in children without T2D at baseline, higher HbA1c (hazard ratio [HR] 3.09 per 1%, 95% CI 1.17-8.22) and 2-hr PG (HR 1.48 per 1 mmol/L, 95% CI 1.31-1.67) significantly increased the risk of retinopathy. Children with T2D (based on baseline HbA1c levels) had the highest incidence of albuminuria, severe albuminuria, and retinopathy compared to those with prediabetes and normal HbA1c levels.¹

In addition, investigators noted that AUCs for HbA1c, 2-hr PG, or fasting plasma glucose were not significantly different.

“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 study coauthor Madhumita Sinha, MD, of the National Institute of Health, in an ADA 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.”³

“Evidence-based recommendations help drive diabetes prevention early on, and this study sheds light on how pediatric screenings are a critically important guideline. 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,” said Robert Gabbay, MD, PhD, chief scientific and medical officer for the ADA, in an agency press release.³ Gabbay was not involved in the study.

1. Vazquez L, Vazquez Arreola E, Hanson RL, Sinha M. 131-OR: Glycemic measures in childhood as predictors of future diabetes-related microvascular complications. Diabetes. 2023; 72(Supplement_1):131–OR. doi:10.2337/db23-131-OR.

2. US Centers for Disease Control and Prevention. Native Americans with Diabetes. https://www.cdc.gov/vitalsigns/aian-diabetes/index.html. Updated November, 15, 2018. Accessed June 29, 2023.

3. Childhood diabetes screening shown to predict future diabetes-related complications. American Diabetes Association. June 23, 2023. Accessed June 29, 2023.