Denver Health and Hospitals, University of Colorado School of Medicine, Denver, Colorado.
University of Colorado School of Medicine, Aurora, Colorado.
Pediatr Diabetes. 2018 Mar;19(2):199-204. doi: 10.1111/pedi.12570. Epub 2017 Aug 30.
To examine factors related to progression of dysglycemia in overweight and obese youth in a large primary care setting.
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.
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 < .001) and HRPD (P = .003).
Most adolescents with an initial prediabetes or diabetes-range A1c did not have a diabetes-range A1c on follow up. Moreover, prediabetes-range A1c values do not all convey equal risk for the development of diabetes, with lower rates of progression for youth with initial A1c <6%. In youth with prediabetes-range A1c, BMI stabilization was associated with improvement of glycemia.
在大型初级保健环境中，研究超重和肥胖青少年中与血糖恶化相关的因素。
通过电子病历（EMR）回顾性地确定了 BMI > 85 百分位数且首次 A1c 为 5.7%-7.9%（39-63mmol/mol）的 10-18 岁青少年。血糖水平定义为低范围糖尿病前期（LRPD；A1c 5.7%-5.9%[39-41mmol/mol]）、高范围糖尿病前期（HRPD；A1c 6.0%-6.4%[42-46mmol/mol]）或糖尿病范围（A1c 6.5%-7.9%[48mmol/mol]）。从 EMR 中提取随访 A1c 和 BMI。随访在开始使用糖尿病药物时截止。
在 11000 名青少年中，有 547 名青少年基线时出现血糖异常（平均年龄 14.5±2.2 岁，70%为西班牙裔，23%为非西班牙裔黑人，7%为其他）。其中，206 名青少年为 LRPD，282 名青少年为 HRPD，59 名青少年为糖尿病。有 420 名（77%）青少年可进行随访 A1c 检测，根据 A1c 类别，中位随访时间为 12-22 个月。在随访检测时，基线时为 LRPD 的青少年中，有 4%的 A1c 处于糖尿病范围，基线时为 HRPD 的青少年中，有 8%的 A1c 处于糖尿病范围，基线时为糖尿病范围 A1c 的青少年中，有 33%的 A1c 处于糖尿病范围。LRPD（P<0.001）和 HRPD（P=0.003）的 BMI 增加与 A1c 恶化呈线性相关。
大多数初始为糖尿病前期或糖尿病范围 A1c 的青少年在随访时未出现糖尿病范围 A1c。此外，糖尿病前期范围 A1c 值并不能都预示着糖尿病发生的同等风险，初始 A1c<6%的青少年进展率较低。在糖尿病前期范围 A1c 的青少年中，BMI 稳定与血糖改善相关。
