Academic journal article Childhood Obesity

Addressing Prediabetes in Childhood Obesity Treatment Programs: Support from Research and Current Practice

Academic journal article Childhood Obesity

Addressing Prediabetes in Childhood Obesity Treatment Programs: Support from Research and Current Practice

Article excerpt

[Author Affiliation]

Matthew A. Haemer. 1 Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO.

H. Mollie Grow. 2 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.

Cristina Fernandez. 3 Department of Pediatrics, Creighton University School of Medicine, Omaha, NE.

Gloria J. Lukasiewicz. 4 Children's Hospital Association, Alexandria, VA.

Erinn T. Rhodes. 5 Division of Endocrinology, Boston Children's Hospital, Boston, MA.

Laura A. Shaffer. 6 Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY.

Brooke Sweeney. 7 Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY.

Susan J. Woolford. 8 Department of Pediatrics, University of Michigan, Ann Arbor, MI.

Elizabeth Estrada. 9 Division of Endocrinology, Connecticut Children's Medical Center, Hartford, CT.

Address correspondence to: Matthew A. Haemer, MD, MPH, Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, 12631 E 17th Avenue, F561, Aurora, CO 80045, E-mail: Matthew.Haemer@ucdenver.edu

Introduction

The increased prevalence of obesity, particularly severe obesity, in all pediatric age groups, has been accompanied by an increase in type 2 diabetes mellitus (T2DM), prediabetes, and insulin resistance (IR).1-4 Along with other comorbidities of obesity, including hypertension, dyslipidemia, fatty liver disease, musculoskeletal disorders, and cardiovascular disease, T2DM and its complications represent a significant cause of long-term disability within the US population and a challenge to the resources of the US healthcare system.5-7 Still, little evidence exists in pediatric populations for effective prevention and treatment of T2DM.2,6,8 Currently, it is estimated that one third of US youth are overweight or obese, and up to 15% of adolescents may have prediabetes and/or diabetes.1 Adolescents and young adults with T2DM are expected to lose 15 years from their life expectancy and may experience severe, chronic complications by their forties.7,9-11 Most diagnostic tools and therapeutic interventions currently in use for pediatric T2DM are based on information extrapolated from adult literature. However, the pathophysiology and response to treatment varies between children and adults. The TODAY study, the first long-term study of children with T2DM, and others have reported faster progression of T2DM and beta-cell failure in children, compared to adults, and poor treatment results.12-15

Data collected from 2001 through 2005 as part of the SEARCH study,16 a large, multi-center study of physician-diagnosed diabetes among youth 0-19 years of age, provide estimates of prevalence and incidence rates of T2DM by age and ethnicity. The prevalence of T2DM in 2001 was lowest among non-Hispanic white youths 10-19 years of age at 0.18 in 1000, with an incidence of 3.7 per 100,000 person-years during the 4-year study.17 Prevalence and incidence rates were higher among African American (1.06 in 1000; 19.0 per 100,000 person-years), Hispanic (0.46, 11.6), and Asian/Pacific Island youth (0.52, 12.1) than non-Hispanic white youth, with the highest rates among Navajo youth (1.45; 27.7).18-21

The impetus to complete this survey of current practice and review of current evidence stems from the high prevalence of childhood and adolescent obesity, increasing diagnosis of prediabetes and T2DM, and interest in earlier identification and prevention.22,23 The primary aims of the article are to identify practices supported by evidence and report consensus of current practice among childhood obesity specialists for two areas: (1) screening of obese children and adolescents for prediabetes and T2DM and (2) prevention of progression from prediabetes to T2DM. …

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