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Prediabetes in Adolescents: Prevalence, Management and Diabetes Prevention Strategies
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Prediabetes in Adolescents: Prevalence, Management and Diabetes Prevention Strategies
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Journal Article
Prediabetes in Adolescents: Prevalence, Management and Diabetes Prevention Strategies
2021
Overview
The ongoing obesity epidemic in children and adolescents has greatly increased the prevalence of related comorbidities. Prediabetes is defined based on levels of fasting glucose, oral glucose tolerance tests or hemoglobin A1c, that are intermediate between normal levels and thresholds that define type 2 diabetes mellitus (T2DM). As such, prediabetes represents a sign of early pathophysiology preceding T2DM development. Recent analyses of data from US adolescents estimate prediabetes to be present in 4-23% of adolescents, depending on criteria used, with other studies finding an 8% risk of progression from prediabetes to T2DM over a 3-year period. These data support the importance of intervention to avoid long-term sequelae, focusing on reducing degree of obesity and insulin resistance. Lifestyle modification, with increases in physical activity and dietary improvements, remains the first-line approach. Other interventions are based on additional long-term risks and range from metformin treatment for more moderate cases of prediabetes to bariatric surgery for adolescents with severe obesity and comorbidities. As data accumulate regarding sequelae of T2DM in adolescents, there remains a critical need for prevention of obesity and T2DM throughout childhood, and prediabetes should be a trigger for improving this risk profle. Keywords: prediabetes, pediatrics, obesity, type 2 diabetes mellitus, insulin resistance Plain Language Summary Prediabetes represents blood sugar elevations that are above normal but not yet at thresholds that define type 2 diabetes. Prediabetes can be a precursor to later type 2 diabetes and represents an opportunity to improve lifestyle habits (and sometimes treat with medicines) to avoid ever getting type 2 diabetes.
