Issue 15, January 2010
5.Check early to predict early

     A new study reveals that child hood office measures (waist circumference, body mass index [BMI], systolic and diastolic blood pressure, and parental diabetes) and laboratory measures (glucose, triglyceride, high-density lipoprotein cholesterol, and insulin levels) could help predict T2DM risk.

     John A. Morrison, PhD, (Cincinnati Children's Hospital Medical Centre in Cincinnati, Ohio) and colleagues conducted a study at urban and suburban schools. 1067 girls enrolled in the National Growth and Health Study at age 10 years and 822 schoolchildren aged 6 to 18 years at entry in the Princeton Follow-up Study had follow-up evaluations at 9 and 26 years.

     In the Princeton Follow-up Study, predictors of T2DM at age 39 years were childhood systolic blood pressure and BMI in the top fifth percentile and black race (area under the receiver-operator curve [AUC], 0.698). When childhood glucose levels of 100 mg/dL or more and high-density lipoprotein cholesterol in the bottom fifth percentile and triglyceride concentration in the top fifth percentile were added as explanatory variables, AUC increased to 0.717 and 0.709, respectively. The likelihood of T2DM at age 39 years was 2% if childhood BMI, systolic blood pressure, and diastolic blood pressure were all lower than the 75th percentile, and this decreased further to 1% if the parents had no diabetes.

     "Our data have practical clinical value in assessment of preteen-aged and teenaged children, since children with SBP [systolic blood pressure], triglyceride, BMI, and insulin in the top fifth percentile, a glucose concentration of at least 100 mg/dL, and a parent with diabetes could be targeted for primary prevention of T2DM through diet, exercise, and possibly insulin-sensitizing drug intervention, with special focus on overweight children with a positive family history of DM," the study authors conclude.
"Office-based childhood measures predict the presence and absence of future T2DM 9 and 26 years after baseline," the study authors write. "Childhood insulin measurement improves prediction, facilitating approaches to primary prevention of T2DM."

Source: Arch Pediatr Adolesc Med. 2010;164:53-60

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