FRI587 Risks For Type 2 Diabetes Progression In A Pediatric Prediabetes Clinic Population
Authors: Belsky Natasha A , Tamaroff Jaclyn , Shoemaker Ashley Hall 
Published: October 2023

Disclosure: N.A. Belsky: None. J. Tamaroff: None. A.H. Shoemaker: None.

Background: Pediatric type 2 diabetes (T2D) is increasing in prevalence, yet the pathophysiology and disease progression is less understood than in adults. It is unclear what definition of pediatric prediabetes predicts progression to T2D or long-term morbidity. Strategies are needed to better identify at risk individuals who could benefit from close follow up and early intervention. This study utilized a Pediatric Prediabetes Clinic to assess what factors may be associated with increased risk of progression to T2D in children over time. Methods: We conducted a retrospective chart review of the initial visit for all children referred to the clinic over 7 years. Inclusion criteria included hemoglobin A1c and ≥1 glucose result from an oral glucose tolerance test. Children with type 1 diabetes, MODY, or T2D on initial visit were excluded. Patients were assigned to either the T2D progression or non-progression group for further analysis based on 2022 ADA criteria. Additional information was manually charted for the T2D progression group from each visit from initial presentation through diagnosis of T2D. Results: 552 patients were included, 6.5% (n= 36) progressed to T2D over 2.4 ± 1.5 years. At the initial visit, T2D progressors had a higher BMI (mean difference 4.4 kg/m2, p = 0.002) and weight (mean difference 14.2 kg, p = 0.004). Initial visit HbA1c (5.7± 0.3 vs. 6.0±0.3%, p &lt;0.001), 2h glucose (141±28 vs. 114±2mg/dL, p &lt;0.001) and fasting c-peptide (4.8±2.1 vs. 3.6±2.0 ng/mL, p = 0.001) were also higher in the T2D progression group. On a fasting lipid panel, triglycerides (138±64 vs. 109±59 mg/dL, p = 0.015) were higher and HDL was lower (38±5 vs. 41±9 mg/dL, p = 0.003) in T2D progressors. Fasting plasma glucose was not significantly different between groups. Mean age at T2D diagnosis was 14.9 years (range 9.9 – 18.3 years). In a multivariable model, male sex (HR 2.4, p = 0.012), initial visit HbA1c (HR 1.3 per 0.1% increase, p &lt;0.001), and 2-hour glucose level (HR 1.2 per 10 mg/dL increase, p = 0.014) were all predictive of increased likelihood of progression over time, while age did not reach significance (HR 0.9, p = 0.05). On average, patients who progressed to T2D had an increase in BMI of 4.2 kg/m2 from initial visit to time of T2D diagnosis and children consistently taking metformin took longer to progress (43 ± 21 vs. 26 ± 16 months, p= 0.016). Discussion: Overall, few patients with prediabetes developed T2D over the 7-year period, highlighting the importance of identifying which patients should receive early intervention and close follow-up. Initial visit laboratory values (particularly HbA1c and non-fasting glucose) and weight trajectory may allow for risk stratification, while fasting plasma glucose is less helpful. Preventing further worsening of obesity and metformin therapy could be important interventions for diabetes prevention in children.

Presentation: Friday, June 16, 2023