Mary Ellen Vajravelu1,2, Joyce M Lee3, Rachana Shah1,2, Justine Shults1,4, Sandra Amaral2,5, Andrea Kelly1,2. 1. Division of Endocrinology & Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 2. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. 3. Susan B Meister Child Health Evaluation and Research Center, Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, Michigan, USA. 4. Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 5. Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Abstract
BACKGROUND: Prediabetes awareness in adults has been associated with improved weight management. Whether youth with prediabetes diagnosis experience similar improvements is unknown. OBJECTIVE: To investigate the association between prediabetes identification and body mass index (BMI) trajectory in overweight and obese adolescents. SUBJECTS: Youth who were followed longitudinally in a large academic-affiliated primary care network and who were overweight/obese while 10 to 18 years old. METHODS: Retrospective cohort study. Subjects were categorized as "screened" if at least 1 hemoglobin A1c (HbA1c) result was available. Time series analysis was used to determine the difference in difference (DID) in BMI Z-score (BMI-Z) slope before and after HbA1c between: (a) screened youth found to have prediabetes-range HbA1c (5.7%-6.4%, 39-46 mmol/mol) versus normal HbA1c and (b) screened versus age-matched unscreened obese youth. RESULTS: A total of 4184 (55.6% female) screened subjects (median follow-up 9.7 years) were included. In which, 637 (15.2%) had prediabetes-range HbA1c. Prediabetes was associated with a greater decrease in BMI-Z slope than normal HbA1c (DID: -0.023/year [95% CI: -0.042 to -0.004]). When compared to age-matched unscreened subjects (n = 2087), screened subjects (n = 2815) experienced a greater decrease in BMI-Z slope after HbA1c than unscreened subjects at a matched age (DID: -0.031/y [95% CI -0.042 to -0.021]). CONCLUSIONS: BMI-Z trajectory improved more among youth with prediabetes-range HbA1c but also stabilized in screened youth overall. Prospective studies are needed to identify provider- and patient-level drivers of this observation.
BACKGROUND: Prediabetes awareness in adults has been associated with improved weight management. Whether youth with prediabetes diagnosis experience similar improvements is unknown. OBJECTIVE: To investigate the association between prediabetes identification and body mass index (BMI) trajectory in overweight and obese adolescents. SUBJECTS: Youth who were followed longitudinally in a large academic-affiliated primary care network and who were overweight/obese while 10 to 18 years old. METHODS: Retrospective cohort study. Subjects were categorized as "screened" if at least 1 hemoglobin A1c (HbA1c) result was available. Time series analysis was used to determine the difference in difference (DID) in BMI Z-score (BMI-Z) slope before and after HbA1c between: (a) screened youth found to have prediabetes-range HbA1c (5.7%-6.4%, 39-46 mmol/mol) versus normal HbA1c and (b) screened versus age-matched unscreened obese youth. RESULTS: A total of 4184 (55.6% female) screened subjects (median follow-up 9.7 years) were included. In which, 637 (15.2%) had prediabetes-range HbA1c. Prediabetes was associated with a greater decrease in BMI-Z slope than normal HbA1c (DID: -0.023/year [95% CI: -0.042 to -0.004]). When compared to age-matched unscreened subjects (n = 2087), screened subjects (n = 2815) experienced a greater decrease in BMI-Z slope after HbA1c than unscreened subjects at a matched age (DID: -0.031/y [95% CI -0.042 to -0.021]). CONCLUSIONS: BMI-Z trajectory improved more among youth with prediabetes-range HbA1c but also stabilized in screened youth overall. Prospective studies are needed to identify provider- and patient-level drivers of this observation.
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