Strategy for early identification of prediabetes in lean populations: New insight from a prospective Chinese twin cohort of children and young adults

Guoying Wang; Sally Radovick; Xiping Xu; Houxun Xing; Genfu Tang; Tami R Bartell; Binyan Wang; Xiaobin Wang

doi:10.1016/j.diabres.2018.10.003

Strategy for early identification of prediabetes in lean populations: New insight from a prospective Chinese twin cohort of children and young adults

Diabetes Res Clin Pract. 2018 Dec:146:101-110. doi: 10.1016/j.diabres.2018.10.003. Epub 2018 Oct 9.

Authors

Guoying Wang¹, Sally Radovick², Xiping Xu³, Houxun Xing⁴, Genfu Tang⁴, Tami R Bartell⁵, Binyan Wang⁶, Xiaobin Wang⁷

Affiliations

¹ Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
² Department of Pediatrics, The Child Health Institute of NJ, Robert Wood Johnson Medical School, Rutgers University, NJ, USA.
³ Biomedical Research Institute, Anhui Medical University, Hefei, China; Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Laboratory for Food Quality and Safety, and Key Laboratory for Functional Dairy, College of Food Science & Nutritional Engineering, China Agricultural University, Beijing, China.
⁴ Biomedical Research Institute, Anhui Medical University, Hefei, China.
⁵ Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
⁶ Biomedical Research Institute, Anhui Medical University, Hefei, China. Electronic address: binyanwang163@163.com.
⁷ Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: xwang82@jhu.edu.

PMID: 30312713
DOI: 10.1016/j.diabres.2018.10.003

Abstract

Aims: To identify certain subgroups in young and lean populations, who may be at a high risk of developing prediabetes/diabetes, which is not captured by current BMI-based screening algorithms.

Methods: Incidence of prediabetes/diabetes was assessed using oral glucose tolerance tests among 1859 children and 1073 young adults from a prospective Chinese twin cohort.

Results: Over a 6-year follow-up, 507 (27.3%) children and 293 (27.3%) adults developed prediabetes/diabetes. Of the 800 incidents, 737(92.1%) and 644(80.5%) were lean at baseline and follow-up, respectively. Baseline fasting glucose in the top tertile of the normal range was associated with an increased risk of prediabetes/diabetes: odds ratio, 1.85 (95% CI 1.32-2.59) and 3.29 (95%CI 2.10-5.17) among normal weight and underweight children, respectively, and 2.74 (95% CI 1.78-4.23) and 3.08 (95% CI 1.69-5.58) among normal weight and overweight/obese adults, respectively, compared with the low tertile of fasting glucose.

Conclusions: We showed that majority incident cases of prediabetes/diabetes were not overweight/obese (at baseline), who would have been missed by traditional screening algorithm emphasizing overweight/obesity. Our findings revealed that an upper end of normal fasting glucose was a simple and robust predictor of future higher risk of prediabetes/diabetes in this young and lean population.

Keywords: Fasting plasma glucose; Incidence; Prediabetes.

MeSH terms

Adolescent
Adult
Asian People
Child
Cohort Studies
Female
Glucose Tolerance Test / methods*
Humans
Incidence
Male
Obesity / complications*
Prediabetic State / diagnosis*
Prediabetic State / epidemiology
Prospective Studies
Risk Assessment
Twins
Young Adult