Study: Children and Adolescents with Metabolic Syndrome at Higher Risk of Type 2 Diabetes

Children and adolescents with the metabolic syndrome are at increased risk for developing Type 2 Diabetes and subclinical atherosclerosis in adulthood, according to study by Costan Magnussen (University of Turku, Finland) and team. However, the study also revealed that screening for high body mass index (BMI) alone in this age group is a simpler and equally accurate predictor of later cardiometabolic outcomes compared with the metabolic syndrome as a whole.

Study:

The researchers used data from the Bogalusa Heart Study and Cardiovascular Risk in Young Finns Study to assess whether the metabolic syndrome and its associated components in childhood and adolescence predict Type 2 Diabetes and high carotid intima-media thickness (IMT) in later life. In all 1781 children aged 9-18 years were recruited during 1984-1988. They were then followed up between 2001 and 2007 when aged 24-41 years.

Result:

Children who had the metabolic syndrome had a 2-3 times higher risk for developing Type 2 Diabetes or having increased carotid IMT (at or above 90th percentile for population) than those without the metabolic syndrome. However, they also stated that use of pediatric BMI alone to predict adult Type 2 Diabetes or high carotid IMT was the most significant component of the pediatric metabolic syndrome for predicting adult outcomes.

Comments from the researchers:

"Our findings have direct clinical relevance because they suggest that in the clinical setting, efforts to identify youth with heightened future risk of meaningful outcomes can be minimally achieved with the use of BMI only.”

"However, clinicians who use high BMI to identify youth at increased future risk need to keep in mind that a large proportion of contemporary youth will be classified as at risk and that our analyses are unable to discount that youth metabolic syndrome may be useful in identifying and possibly treating other cardiometabolic disorders."

Study: Children with Type 2 Diabetes have more rapid disease progression than adults

Children with Type 2 Diabetes Mellitus (T2DM) have more rapid disease progression than adults, revealed a study by Dr. Lorraine E. Levitt Katz and colleagues at The Children's Hospital of Philadelphia and the University of Pennsylvania. It has been observed that two years after diagnosis, children and adolescents with Type 2 Diabetes need increasing doses of insulin due to a rapid decline in beta cell function.

Method 

As a part of the study, the researchers observed 59 children (mean age - 14) with Type 2 Diabetes Mellitus for four years. Most of the children were African-American and thirteen of them had Diabetic Ketoacidosis (DKA) at diagnosis. The children received only metformin (up to 1000mg twice daily) for oral medication and insulin therapy was started for hemoglobin (Hb)A1c levels of 8.5% or higher. At baseline, 84% of the children needed insulin, with higher doses required in the group with Diabetic Ketoacidosis. Baseline HbA1c was 13.0% in the Diabetic Ketoacidosis group and 9.8% in the kids without DKA.

Dr. Levitt Katz and her associates found that “within the first 6 months, the HbA1c levels in both groups reached the lowest point and gradually rose after 1 year. Over 4 years, the HbA1c levels had risen with differences in the nonacidotic and Diabetic Ketoacidosis groups.” Gradually, insulin requirements began to rise after two years, and by four years all of the subjects needed higher insulin doses. The highest median dose was in the Diabetic Ketoacidosis group.

Result 

The insulin reserve over time in childhood Type 2 Diabetes Mellitus has been unknown but the researchers suspected there would be “a more rapid decline in glycemic control than has been published for adults and that this decline would be more severe for those presenting with Diabetic Ketoacidosis.” The researchers concluded that “Type 2 Diabetes in youth progresses more rapidly to insulin deficiency than in adults.”