Pediatric Diabetes

 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?