Español Other Languages. Prevent Type 2 Diabetes in Kids. Español Spanish Print. Minus Related Pages. Weight Matters People who are overweight—especially if they have excess belly fat—are more likely to have insulin resistance , kids included.

They may also have other conditions related to insulin resistance, including: High blood pressure High cholesterol Polycystic ovary syndrome. Activity Matters Being physically active lowers the risk for type 2 diabetes because it helps the body use insulin better, decreasing insulin resistance.

Age Matters Kids who get type 2 diabetes are usually diagnosed in their early teens. Being born to a mom with gestational diabetes diabetes while pregnant. Having one or more conditions related to insulin resistance. Take Charge, Family Style Parents can do a lot to help their kids prevent type 2 diabetes.

Here are some tips to get started: Mealtime Makeover Drink more water and fewer sugary drinks. Eat more fruits and vegetables. Make favorite foods healthier. Get kids involved in making healthier meals.

Eat slowly—it takes at least 20 minutes to start feeling full. Eat at the dinner table only, not in front of the TV or computer. Shop for food together. Teach your kids to read food labels to understand which foods are healthiest. Have meals together as a family as often as you can.

Serve small portions; let kids ask for seconds. Reward kids with praise instead of food. Getting Physical Aim for your child to get 60 minutes of physical activity a day, in several or minute sessions or all at once.

Start slow and build up. Keep it positive—focus on progress. Take parent and kid fitness classes together. Make physical activity more fun; try new things.

Ask kids what activities they like best—everyone is different. Encourage kids to join a sports team. Limit screen time to 2 hours a day.

Plan active outings, like hiking or biking. Take walks together. Move more in and out of the house—vacuuming, raking leaves, gardening. Turn chores into games, like racing to see how fast you can clean the house. Want to Limit Overeating? Limit TV Time. Encourage your kids to reach for fruit, the original fast food.

In this cohort, the average time to diagnosis was far longer in patients consistently taking metformin 43 months , in comparison to those not taking the prescribed medication 28 months or never prescribed metformin 29 months. HbA1C at diagnosis was also lower in patients taking metformin.

Patients taking their medication as prescribed may also have been making more impactful lifestyle changes or have had more regular follow-up for prediabetes management. Metformin monotherapy for T2D has higher failure rates in NHB adolescents [ 47 ].

Although not statistically significant, a greater percentage of NHB progressed to T2D during this study period. Further research is needed to determine if metformin use may help delay progression to T2D and whether there may be racial differences.

There are various limitations to this study, including missing data. It is known that patients with prediabetes and T2D have a high risk of loss to follow-up. It is possible that additional Prediabetes Clinic patients developed T2D during the study period without our knowledge because we did not contact patients to confirm their disease status or require clinic follow-up to be included in the cohort.

This is most likely in patients who became adults during the study period and could have sought care outside of our practice. It is less likely in the pediatric patients because most primary care providers in our area are uncomfortable managing prediabetes and T2D and there is a lack of competing pediatric endocrinology practices in our region.

Thus, although patients with alternate providers or those who never returned to clinic may have progressed to T2D without our knowledge, this is highly unlikely. Last, the COVID pandemic may have impacted our results as follow up, lifestyle habits, and overall rates of progression to diabetes were all affected by the pandemic.

In summary, only 6. Initial visit laboratory values, particularly HbA1C and nonfasting glucose, along with worsening obesity, may allow for risk stratification.

Fasting plasma glucose is less helpful. Preventing further worsening of obesity is an important intervention for T2D prevention in children and metformin may have a role in the management of pediatric prediabetes.

The authors acknowledge Cassandra Brady, MD, and Sharon Karp, PhD, APRN, CPNP-PC, FAANP, for their clinical work in the VUMC Pediatric Prediabetes Clinic. is supported by the National Institutes of Health F32DK This study was supported by Clinical Translational Science Award no.

UL1 TR from the National Center for Advancing Translational Sciences. and N. have nothing to disclose. has research contracts with Novo Nordisk and Boehringer Ingelheim. Jensen ET , Dabelea D. Type 2 diabetes in youth: new lessons from the SEARCH Study.

Curr Diab Rep. Google Scholar. Imperatore G , Boyle JP , Thompson TJ , et al. Projections of type 1 and type 2 diabetes burden in the U. Diabetes Care. Wagenknecht LE , Lawrence JM , Isom S , et al. Trends in incidence of youth-onset type 1 and type 2 diabetes in the USA, results from the population-based SEARCH for Diabetes in Youth study.

Lancet Diabetes Endocrinol. Tönnies T , Brinks R , Isom S , et al. RISE Consortium. Metabolic contrasts between youth and adults with impaired glucose tolerance or recently diagnosed type 2 diabetes: II.

Observations using the oral glucose tolerance test. Kelsey MM , Zeitler PS. Insulin resistance of puberty. Zhang X , Gregg EW , Williamson DF , et al.

A1C level and future risk of diabetes: a systematic review. Diabetes Prevention Program Research Group. Hba1c as a predictor of diabetes and as an outcome in the diabetes prevention program: a randomized clinical trial. Nowicka P , Santoro N , Liu H , et al. Utility of hemoglobin A1c for diagnosing prediabetes and diabetes in obese children and adolescents.

Vajravelu ME , Lee JM. Identifying prediabetes and type 2 diabetes in asymptomatic youth: should HbA1c be used as a diagnostic approach?

American Diabetes Association Professional Practice Committee. Children and adolescents: standards of medical care in diabetes— Prevention or delay of type 2 diabetes and associated comorbidities: standards of medical care in diabetes— Lentferink YE , Knibbe CAJ , van der Vorst MMJ.

Efficacy of metformin treatment with respect to weight reduction in children and adults with obesity: A systematic review. Axon E , Atkinson G , Richter B , et al. Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev.

Esquivel Zuniga R , DeBoer MD. Prediabetes in adolescents: prevalence, management and diabetes prevention strategies. Diabetes Metab Syndr Obes. Shoemaker AH , Chung ST , Fleischman A ; Pediatric Endocrine Society Obesity Special Interest Group.

Trends in pediatric obesity management, a survey from the Pediatric Endocrine Society Obesity Committee. J Pediatr Endocrinol Metab. Al-Saeed AH , Constantino MI , Molyneaux L , et al.

An inverse relationship between age of type 2 diabetes onset and complication risk and mortality: the impact of youth-onset type 2 diabetes. Dart AB , Martens PJ , Rigatto C , Brownell MD , Dean HJ , Sellers EA. Earlier onset of complications in youth with type 2 diabetes.

Lawson C , Ahmed SN , Brady C , Shoemaker AH. A clinic-based approach to diagnosis and management of prediabetes in high-risk children and adolescents. J Endocr Soc.

Classification and diagnosis of diabetes: standards of medical care in diabetes— Harris PA , Taylor R , Thielke R , Payne J , Gonzalez N , Conde JG. Research electronic data capture REDCap —a metadata-driven methodology and workflow process for providing translational research informatics support.

J Biomed Inform. Trends in prediabetes among youths in the US from through JAMA Pediatr. Andes LJ , Cheng YJ , Rolka DB , Gregg EW , Imperatore G. Prevalence of prediabetes among adolescents and young adults in the United States, Cunningham SA , Hardy ST , Jones R , Ng C , Kramer MR , Narayan KMV.

Changes in the incidence of childhood obesity. Love-Osborne KA , Sheeder JL , Nadeau KJ , Zeitler P. Longitudinal follow up of dysglycemia in overweight and obese pediatric patients. Pediatr Diabetes. Kleber M , Lass N , Papcke S , Wabitsch M , Reinehr T.

One-year follow-up of untreated obese white children and adolescents with impaired glucose tolerance: high conversion rate to normal glucose tolerance.

Diabet Med. Galderisi A , Giannini C , Weiss R , et al. Trajectories of changes in glucose tolerance in a multiethnic cohort of obese youths: an observational prospective analysis. Lancet Child Adolesc Health.

Nwosu BU. The progression of prediabetes to type 2 diabetes in children and adolescents in the United States: current challenges and solutions. Parajuli S , Jasmin G , Sirak H , Lee AF , Nwosu BU.

Prediabetes: adherence to nutrition visits decreases HbA1c in children and adolescents. Front Endocrinol. Weiss R , Taksali SE , Tamborlane WV , Burgert TS , Savoye M , Caprio S. Predictors of changes in glucose tolerance status in obese youth. Lee JM , Gebremariam A , Wu EL , LaRose J , Gurney JG.

Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia. Metabolic abnormalities underlying the different prediabetic phenotypes in obese adolescents. J Clin Endocrinol Metab. Kelsey MM , Zeitler PS , Drews K , Chan CL. Normal hemoglobin A1c variability in early adolescence: adult criteria for prediabetes should be applied with caution.

J Pediatr. Körner A , Wiegand S , Hungele A , et al. Longitudinal multicenter analysis on the course of glucose metabolism in obese children. Int J Obes Lond. Liu LL , Lawrence JM , Davis C , et al. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study.

Hamman RF , Wing RR , Edelstein SL , et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Copeland KC , Zeitler P , Geffner M , et al. Characteristics of adolescents and youth with recent-onset type 2 diabetes: the TODAY cohort at baseline.

Mayer-Davis EJ , Lawrence JM , Dabelea D , et al. Incidence trends of type 1 and type 2 diabetes among youths, — N Engl J Med. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Magge SN , Wolf RM , Pyle L , et al. The coronavirus disease pandemic is associated with a substantial rise in frequency and severity of presentation of youth-onset type 2 diabetes.

Impact of insulin and metformin versus metformin alone on β-cell function in youth with impaired glucose tolerance or recently diagnosed type 2 diabetes. Khokhar A , Umpaichitra V , Chin VL , Perez-Colon S. Metformin use in children and adolescents with prediabetes.

Pediatr Clin North Am. Knowler WC , Barrett-Connor E , Fowler SE , et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

Bassols J , Martínez-Calcerrada JM , Osiniri I , et al. Effects of metformin administration on endocrine-metabolic parameters, visceral adiposity and cardiovascular risk factors in children with obesity and risk markers for metabolic syndrome: A pilot study.

PLoS One. Srinivasan S , Ambler GR , Baur LA , et al. Randomized, controlled trial of metformin for obesity and insulin resistance in children and adolescents: improvement in body composition and fasting insulin. Atabek ME , Pirgon O. Use of metformin in obese adolescents with hyperinsulinemia: a 6-month, randomized, double-blind, placebo-controlled clinical trial.

TODAY Study Group ; Zeitler P , Hirst K. A clinical trial to maintain glycemic control in youth with type 2 diabetes. Shoemaker A , Cheng P , Gal RL , et al.

Predictors of loss to follow-up among children with type 2 diabetes. Horm Res Paediatr. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Sign In or Create an Account. Navbar Search Filter Journal of the Endocrine Society This issue Endocrine Society Journals Endocrinology and Diabetes Books Journals Oxford Academic Mobile Enter search term Search.

Endocrine Society Journals. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume 7. Article Contents Abstract. Materials and Methods.

Data Availability. Journal Article. Risk Factors for Progression to Type 2 Diabetes in a Pediatric Prediabetes Clinic Population. Natasha Belsky , Natasha Belsky. Vanderbilt University School of Medicine, Nashville, TN , USA.

Oxford Academic. Jaclyn Tamaroff. Division of Pediatric Endocrinology, Vanderbilt University Medical Center, Nashville, TN , USA. Ashley H Shoemaker. Correspondence: Ashley Shoemaker, MD, MSCI, Vanderbilt University Medical Center, 21st Ave South, Suite , Nashville, TN , USA.

Email: Ashley. Shoemaker vumc. Editorial decision:. Corrected and typeset:. PDF Split View Views. Select Format Select format. ris Mendeley, Papers, Zotero. enw EndNote. bibtex BibTex. txt Medlars, RefWorks Download citation.

Permissions Icon Permissions. Close Navbar Search Filter Journal of the Endocrine Society This issue Endocrine Society Journals Endocrinology and Diabetes Books Journals Oxford Academic Enter search term Search. Abstract Background. prediabetes , type 2 diabetes , pediatric endocrinology.

Table 1. Baseline characteristics and laboratory Findings.

Research shows that lifestyle change programs can cut the risk of developing type 2 diabetes by more than half. If your child has been diagnosed with prediabetes or you have concerns your child is at risk for developing diabetes, Express Scripts® Pharmacy is here to help.

More kids and teens are being diagnosed with prediabetes than in the past, but there are things parents can do to delay or prevent diabetes. What is prediabetes? Stith believes this is in part because more children are overweight and obese.

They have a BMI at or above the 85th percentile. Pediatric Pre-Diabetes Doctors and Providers. Perrin White, MD Pediatric Endocrinologist. Soumya Adhikari, MD Pediatric Endocrinologist. Abha Choudhary, MD Pediatric Endocrinologist. Alissa Doll, MD Pediatric Anesthesiologist. Melissa Ham, MD Pediatric Endocrinologist.

Huay-Lin Lo, MD Pediatric Endocrinologist. Muniza Mogri, MD Pediatric Endocrinologist. Sudha Mootha, MD Pediatric Endocrinologist. Nivedita Patni, MD Pediatric Endocrinologist. Amanda Shaw, MD Pediatric Endocrinologist. Ming Yang, MD Pediatric Endocrinologist.

Initial visit HbA1C mean difference, 0. In a multivariable model Fig. Age was also included in the model but did not reach statistical significance HR, 0. Multivariate analysis of progression from prediabetes to type 2 diabetes T2D. On average, it took The average age at T2D diagnosis was Males progressed at a greater rate than females Fig.

Compared with baseline, BMI increased an average of 4. Patients were not started on any glucagon-like peptide-1 receptor agonists GLP1RA or other glucose-lowering therapy except metformin before diagnosis.

At T2D diagnosis, 6 patients required insulin, 1 was prescribed a GLP1RA, and the remaining 28 patients were treated with metformin monotherapy. The average A1c at diagnosis was 8. Diabetes-free survival analysis of the progression from prediabetes to type 2 diabetes T2D in males and females.

Of the 36 patients who progressed, 23 were prescribed metformin at their initial clinic visit. Patients who were taking metformin as prescribed had the lowest average HbA1C 7. Time to T2D diagnosis and HbA1c by metformin prescribing practices and medication compliance. Over the past 3 decades, there has been a sharp increase in the incidence and prevalence of childhood obesity, prediabetes, and T2D; at least 1 in 5 adolescents are estimated to have prediabetes [ ].

Well-established determinants predicting the natural history of prediabetes in youth is lacking because definitions and screening recommendations are based on long-term health outcomes in adults American Diabetes Association.

Thus, there is a critical need for a longitudinal follow-up of at-risk youth to allow us to identify and target patients for prevention and early intervention. Further characterization of diabetes pathophysiology could help primary care physicians and endocrinologists manage and stratify risk in the large number of patients screening positive for prediabetes.

This report describes a large, multiethnic, clinical cohort from the United States with long-term follow-up of children and adolescents with prediabetes. During our 7-year study period, only 6. There is 1 published study reporting higher rates of progression in a group of patients who did not comply with nutrition follow-up; That study did not provide information on criteria used for diagnosis of T2D or HbA1C values for patients diagnosed with T2D.

Our standard protocol for baseline evaluation in the Vanderbilt Prediabetes Clinic allowed us to examine numerous risk factors for progression to T2D. We found higher baseline HbA1C, fasting C-peptide, and 2-hour glucose to be associated with progression to T2D. In our multivariable analysis, both HbA1C and the 2-hour glucose were strong independent predictors of progression.

Importantly, FPG was not associated with progression to T2D, similar to previous findings from a smaller cohort [ 30 ]. There is debate in pediatrics about how to best screen for T2D risk [ 9 , 31 ]. Our group and others have showed that HbA1C, FPG, and 2-hour glucose are poorly correlated to each other and measure different underlying pathology [ 19 , 32 ].

Impaired glucose tolerance may be associated with more severe insulin resistance and reduced insulin secretion [ 32 ]. Elevations in these measures can be transient, particularly in adolescents, in whom puberty can lead to insulin resistance [ 25 , 27 , 30 , 33 , 34 ].

The presence of more than 1 glucose abnormality may better predict risk of T2D progression [ 25 , 32 ]. Based on our data, HbA1C plus a nonfasting glucose may be a feasible way to identify high-risk pediatric patients in a clinical setting.

In addition to laboratory measures, worsening obesity is strongly associated with T2D progression [ 35 ]. In our cohort, patients who progressed to T2D had a higher BMI at baseline and saw continued gains with an average increase of 4.

The Diabetes Prevention Program demonstrated that in adults, weight loss was the main predictor of reduced T2D incidence [ 36 ]. In pediatric patients, stabilizing weight may also reduce T2D risk.

There are now multiple antiobesity medications approved in children 12 years and older. Although these medications have not been evaluated for treatment of prediabetes, the data suggest that treatment of obesity may be an important step for prevention of progression to T2D.

Historically, population-based studies have described a higher incidence and prevalence of T2D in females compared with males [ 37 , 38 ]. In our cohort, although more females were referred to the clinic because of prediabetes A recent nationwide study described that during the pandemic, there was an increase in proportion of adolescent male youths diagnosed with T2D [ 38 ].

It is unclear why we saw a higher percentage of T2D in males, but perhaps because of the historical lower prevalence of T2D in males and less societal stigma surrounding male obesity, males were farther along in disease progression by the time of the Prediabetes Clinic referral.

In addition, this male predominance fits with the previously described demographics of our clinic population. Nationwide data have identified profound racial and ethnic disparities in the incidence and prevalence of T2D in youth [ 30 , 39 ]. The highest burden of diabetes is in American Indian and non-Hispanic Black NHB youth [ 1 ].

Our study showed no significance in differences in the progressor vs nonprogressor groups based on race or ethnicity. Our Prediabetes Clinic population is enriched for NHB patients. Vanderbilt resides in Davidson County, which is gov population estimates July 1, Our overall Prediabetes Clinic population was Because our data were collected retrospectively, we were limited by data available in the medical record.

There was a high degree of missing data for ethnicity Importantly, patients evaluated in the Prediabetes Clinic were less likely to present with severe T2D than other patients with new-onset T2D at Vanderbilt and in published data.

In contrast, the average HbA1C of T2D progressors in this smaller cohort evaluated in the Prediabetes Clinic was 8. It is possible that the clinic model of identifying high-risk patients, counseling families on diabetes risk and symptoms of diabetes, and engaging primary care physicians for future monitoring contributed to earlier diagnosis.

There is debate surrounding metformin's role in diabetes prevention in children [ 41 , 42 ]. Clinical trials in the prediabetes population, some of which have included children, have indicated the metformin may help delay progression to diabetes, pointing to the improvement in BMI and body composition [ ].

In this cohort, the average time to diagnosis was far longer in patients consistently taking metformin 43 months , in comparison to those not taking the prescribed medication 28 months or never prescribed metformin 29 months.

HbA1C at diagnosis was also lower in patients taking metformin. Patients taking their medication as prescribed may also have been making more impactful lifestyle changes or have had more regular follow-up for prediabetes management.

Metformin monotherapy for T2D has higher failure rates in NHB adolescents [ 47 ]. Although not statistically significant, a greater percentage of NHB progressed to T2D during this study period. Further research is needed to determine if metformin use may help delay progression to T2D and whether there may be racial differences.

There are various limitations to this study, including missing data. It is known that patients with prediabetes and T2D have a high risk of loss to follow-up. It is possible that additional Prediabetes Clinic patients developed T2D during the study period without our knowledge because we did not contact patients to confirm their disease status or require clinic follow-up to be included in the cohort.

This is most likely in patients who became adults during the study period and could have sought care outside of our practice. It is less likely in the pediatric patients because most primary care providers in our area are uncomfortable managing prediabetes and T2D and there is a lack of competing pediatric endocrinology practices in our region.

Thus, although patients with alternate providers or those who never returned to clinic may have progressed to T2D without our knowledge, this is highly unlikely. Last, the COVID pandemic may have impacted our results as follow up, lifestyle habits, and overall rates of progression to diabetes were all affected by the pandemic.

In summary, only 6. Initial visit laboratory values, particularly HbA1C and nonfasting glucose, along with worsening obesity, may allow for risk stratification. Fasting plasma glucose is less helpful. Preventing further worsening of obesity is an important intervention for T2D prevention in children and metformin may have a role in the management of pediatric prediabetes.

The authors acknowledge Cassandra Brady, MD, and Sharon Karp, PhD, APRN, CPNP-PC, FAANP, for their clinical work in the VUMC Pediatric Prediabetes Clinic. is supported by the National Institutes of Health F32DK This study was supported by Clinical Translational Science Award no.

UL1 TR from the National Center for Advancing Translational Sciences. and N. have nothing to disclose. has research contracts with Novo Nordisk and Boehringer Ingelheim. Jensen ET , Dabelea D. Type 2 diabetes in youth: new lessons from the SEARCH Study.

Curr Diab Rep. Google Scholar. Imperatore G , Boyle JP , Thompson TJ , et al. Projections of type 1 and type 2 diabetes burden in the U. Diabetes Care. Wagenknecht LE , Lawrence JM , Isom S , et al. Trends in incidence of youth-onset type 1 and type 2 diabetes in the USA, results from the population-based SEARCH for Diabetes in Youth study.

Lancet Diabetes Endocrinol. Tönnies T , Brinks R , Isom S , et al. RISE Consortium. Metabolic contrasts between youth and adults with impaired glucose tolerance or recently diagnosed type 2 diabetes: II. Observations using the oral glucose tolerance test. Kelsey MM , Zeitler PS. Insulin resistance of puberty.

Zhang X , Gregg EW , Williamson DF , et al. A1C level and future risk of diabetes: a systematic review. Diabetes Prevention Program Research Group. Hba1c as a predictor of diabetes and as an outcome in the diabetes prevention program: a randomized clinical trial.

Nowicka P , Santoro N , Liu H , et al. Utility of hemoglobin A1c for diagnosing prediabetes and diabetes in obese children and adolescents.

Vajravelu ME , Lee JM. Identifying prediabetes and type 2 diabetes in asymptomatic youth: should HbA1c be used as a diagnostic approach? American Diabetes Association Professional Practice Committee. Children and adolescents: standards of medical care in diabetes— Prevention or delay of type 2 diabetes and associated comorbidities: standards of medical care in diabetes— Lentferink YE , Knibbe CAJ , van der Vorst MMJ.

Efficacy of metformin treatment with respect to weight reduction in children and adults with obesity: A systematic review. Axon E , Atkinson G , Richter B , et al. Drug interventions for the treatment of obesity in children and adolescents.

Cochrane Database Syst Rev. Esquivel Zuniga R , DeBoer MD.