Pre-diabetes: Development in Children

Pre-diabetes is a well-known risk factor for both cardiovascular disease and type 2 diabetes mellitus. It also is considered as a disease by itself (1). Five to ten per cent of adults with this disease usually advance to diabetes mellitus. However, children and adolescents, who are with pre-diabetes, can turn back to normal compared to adults.

The rate of pre-diabetes varies according to the definition used, race, and age. Considerable variations in prevalence depend on whether pre-diabetes described by IFG (impaired fasting glucose) or IGT (impaired glucose tolerance). The occurrence of IFG is 13-40 % (2,3,4), while the rate of IGT is 2-5 % in children (5). About 20 % of children have HbA1c levels of 5.7-6.4 % (6). The frequency of pre-diabetes is considerably greater in obese pubertal children, who are with a family history of pre-diabetes.

Progression to diabetes mellitus from normal blood-glucose levels is a constant process. It usually takes several years to develop diabetes. Initially, a person gradually develops insulin resistance. Insulin resistance (IR) is a condition, in which certain cells are not able to react to the normal actions of insulin. Therefore, it is becoming difficult to regulate the blood-sugar level within the normal range. Insulin resistance is followed by a compensatory rise in insulin secretion. This particular phase lasts for several years. Insulin resistance is a characteristic feature of people with both IGT and IFG. However, the sites of insulin resistance are different (7). People with IFG mainly have the insulin resistance in the liver (hepatic insulin resistance), while individuals with IGT mostly have it in their muscles (muscle insulin resistance).

Insulin secretion is carried out by β cells in a gland called the pancreas. During the second stage of development of diabetes, these β cells fail to secrete adequate amounts of insulin to compensate insulin resistance. As β cell failure aggravates, blood-sugar gradually rises (hyperglycaemia), advancing from pre-diabetes to diabetes mellitus. This β cell failure is probably caused by a combination of environmental, genetic, and biochemical risk factors.

The prevalence of pre-diabetes and type 2 diabetes mellitus in children is rising in the modern society. It shows a faster pathophysiologic process among children (8).




Related Links:

How Do You Know You Have Pre-diabetes?
Is Your Child at Risk of Pre-diabetes?
How to Manage Pre-diabetes in Children? 
What is Diabetes Mellitus?

References

1. Grundy SM. Pre-diabetes, metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol. 2012;59:635-643.

2. Fagot-Campagna A, Saaddine JB, Flegal KM, Beckles GL; Third National Health and Nutrition Examination Survey. Diabetes, impaired fasting glucose, and elevated HbA1c in U.S. adolescents: the Third National Health and Nutrition Examination Survey. Diabetes Care. 2001;24:834-837.

3.  Williams DE, Cadwell BL, Cheng YJ, et al. Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in US adolescents, 1999-2000. Pediatrics. 2005;116:1122-1126.

4. May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999-2008. Pediatrics. 2012;129:1035-1041.

5. Li C, Ford ES, Zhao G, Mokdad AH. Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among U.S. adolescents: National Health and Nutrition Examination Survey 2005-2006. Diabetes Care. 2009;32:342-347.

6. Nowicka P, Santoro N, Liu H, et al. Utility of hemoglobin A(1c) for diagnosing prediabetes and diabetes in obese children and adolescents. Diabetes Care. 2011;34:1306-1311.

7. Tabak AG, Herder C, Rathmann W, Brunner EJ, Kivimaki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012;379:2279-2290.

8. Weiss R. Impaired glucose tolerance and risk factors for progression to type 2 diabetes in youth. Pediatr Diabetes. 2007;8 Suppl 9:70-75.