Longitudinal follow up of dysglycemia in overweight and obese pediatric patients

Objective To examine factors related to progression of dysglycemia in overweight and obese youth in a large primary care setting. Research design and methods 10‐ to 18‐year‐old youth with body mass index ( BMI ) > 85 percentile and first‐time A1c 5.7%‐7.9% (39‐63 mmol/mol) were identified retrospectively through electronic medical records ( EMR ). Levels of dysglycemia were defined as low‐range prediabetes ( LRPD ; A1c 5.7%‐5.9% [39‐41 mmol/mol]), high‐range prediabetes ( HRPD ; A1c 6.0%‐6.4% [42‐46 mmol/mol]), or diabetes‐range (A1c 6.5%‐7.9% [48 mmol/mol]). Follow‐up A1c and BMI were extracted from the EMR . Follow up was truncated at the time of initiation of diabetes medication. Results Of 11 000 youth, 547 were identified with baseline dysglycemia (mean age 14.5 ± 2.2 years, 70% Hispanic, 23% non‐Hispanic Black, 7% other). Of these, 206 had LRPD , 282 HRPD , and 59 diabetes. Follow‐up A1c was available in 420 (77%), with median follow up of 12‐22 months depending on A1c category. At follow‐up testing, the percent with diabetes‐range A1c was 4% in youth with baseline LRPD , 8% in youth with baseline HRPD , and 33% in youth with baseline diabetes‐range A1c. There was a linear association between BMI increase and worsening A1c for LRPD ( P < .001) and HRPD ( P = .003). Conclusions Most adolescents with an initial prediabetes or diabetes‐range A1c did not have a diabetes‐range A1c on follow up. Moreover, prediabetes‐range A1c values do not all convey equal risk for the development of diabetes, with lower rates of progression for youth with initial A1c <6%. In youth with prediabetes‐range A1c, BMI stabilization was associated with improvement of glycemia.