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Association between prediabetes diagnosis and body mass index trajectory of overweight and obese adolescents
Author(s) -
Vajravelu Mary Ellen,
Lee Joyce M.,
Shah Rachana,
Shults Justine,
Amaral Sandra,
Kelly Andrea
Publication year - 2020
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.13028
Subject(s) - prediabetes , medicine , body mass index , overweight , prospective cohort study , obesity , cohort , type 2 diabetes , demography , diabetes mellitus , endocrinology , sociology
Background Prediabetes awareness in adults has been associated with improved weight management. Whether youth with prediabetes diagnosis experience similar improvements is unknown. Objective To investigate the association between prediabetes identification and body mass index (BMI) trajectory in overweight and obese adolescents. Subjects Youth who were followed longitudinally in a large academic‐affiliated primary care network and who were overweight/obese while 10 to 18 years old. Methods Retrospective cohort study. Subjects were categorized as “screened” if at least 1 hemoglobin A1c (HbA1c) result was available. Time series analysis was used to determine the difference in difference (DID) in BMI Z‐score (BMI‐Z) slope before and after HbA1c between: (a) screened youth found to have prediabetes‐range HbA1c (5.7%‐6.4%, 39‐46 mmol/mol) versus normal HbA1c and (b) screened versus age‐matched unscreened obese youth. Results A total of 4184 (55.6% female) screened subjects (median follow‐up 9.7 years) were included. In which, 637 (15.2%) had prediabetes‐range HbA1c. Prediabetes was associated with a greater decrease in BMI‐Z slope than normal HbA1c (DID: −0.023/year [95% CI: −0.042 to −0.004]). When compared to age‐matched unscreened subjects (n = 2087), screened subjects (n = 2815) experienced a greater decrease in BMI‐Z slope after HbA1c than unscreened subjects at a matched age (DID: −0.031/y [95% CI ‐0.042 to −0.021]). Conclusions BMI‐Z trajectory improved more among youth with prediabetes‐range HbA1c but also stabilized in screened youth overall. Prospective studies are needed to identify provider‐ and patient‐level drivers of this observation.