New research from the National Institutes of Health (NIH) found that blood glucose levels obtained at childhood examinations predicted future diabetes-related complications such as kidney disease (nephropathy) and eye disease (retinopathy). The findings were presented at the American Diabetes Association (ADA) 2023 Scientific Sessions in San Diego, CA and were simultaneously published in the Diabetes Care journal.
This data comes at a time when the United States is experiencing a significant rise in obesity induced youth-onset type 2 diabetes (T2D). As a result, ADA has recommended risk-based screening for prediabetes and/or diabetes in asymptomatic children with overweight or obesity by pediatric health care providers. However, there is currently a lack of clinical evidence for the usefulness of this screening with respect to the long term health outcomes related to metabolic dysfunction that begins in childhood. The study sought to evaluate the association of higher levels of glycemia during childhood with future microvascular complications in American Indian children—a population that is twice as likely to have diabetes than white individuals.
“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,” says Robert Gabbay, MD, PhD, chief scientific and medical officer for the ADA.
Data from a longitudinal observational study spanning more than four decades (1965-2007) within an American Indian community in the southwestern United States were utilized. The researchers examined associations of glycated hemoglobin (HbA1c) and 2-hour post-load plasma glucose (2-hr PG), obtained during childhood (ages 5-19), with future diabetes-related complications of nephropathy (albuminuria [albumin creatinine ratio (ACR) ≥ 30 mg/g], severe albuminuria [ACR ≥ 300 mg/g]), and retinopathy (at least one microaneurysm or hemorrhage or proliferative retinopathy on direct ophthalmoscopy).
Key findings revealed higher levels of glycated hemoglobin and 2-hr PG during childhood were significantly associated with increased risk of retinopathy. The risk of albuminuria, a symptom of kidney disease, including severe albuminuria, was also found to be elevated in children with T2D based on baseline HbA1c levels 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,” says Madhumita Sinha, MD, FAAP, assistant clinical investigator and diabetes epidemiology and clinical research section head, NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Phoenix Branch. “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.”
The authors note future studies are necessary to evaluate if the implementation of measures such as lifestyle changes impact long-term diabetes-related complications.