Screening for Prediabetes and Diabetes in a Longitudinal Study of Children and Adolescents

Background:
With the rising rates of childhood obesity in the U.S., reports suggest that an increasing number of children in the U.S. now have Type 2 Diabetes Mellitus (T2DM), a disease which was once believed to occur only in adults. Screening tests are important tools for both disease detection and for disease prevention in the case of T2DM. Detection of T2DM is important given that complications of T2DM such as hyperosmolar coma can be fatal, and that uncontrolled diabetes can lead to earlier onset of serious microvascular and macrovascular complications, such as neuropathy, renal disease, and retinopathy.

Even more importantly, screening tests can be used for identifying children with prediabetes, who are at high-risk for developing T2DM, for diabetes prevention interventions. The CDC estimates that approximately 2.5 million children in the U.S. potentially qualify for diabetes screening, highlighting the need for development of efficient and cost-effective screening strategies. Studies are therefore needed to develop practical, evidence-based, non-fasting screening tests which are easily accessible to primary care pediatric providers and their patients. Given the increasing rates of obesity and prediabetes in the US pediatric population, conventional biomarkers such as HbA1c have been recommended for use and to identify novel metabolomic biomarkers that can predict insulin resistance and prediabetes in a pediatric population. Identification of metabolomic biomarkers will provide greater insight into the pathogenesis of type 2 diabetes risk in children and adolescents, which may differ from that in adults. 

Objectives:

1. To evaluate screening strategies for detecting prediabetes and diabetes in overweight and obese children/adolescents and young adults

Research Topics & Methods:
Participants who are 8-17 years old with a BMI percentile greater than or equal to 85th percentile, will complete four study visits at the University of Michigan. With the parent’s permission, results may be forwarded to the participant’s pediatrician.

• Visit 1 Two-hour oral glucose tolerance test where the child will be required to fast 12 hours prior and an IV catheter will be placed for laboratory tests to be drawn. An oral glucose load will be administered and bloods will be drawn at 30 minute intervals over the 2 hours.
• Visit 2 (within 1-5 weeks) One-hour non-fasting glucose challenge test where laboratory tests will be drawn at 2 time points and a 50 gram oral glucose load will be administered.

FOUR MONTHS – FIVE YEARS LATER

• Visit 3 Two-hour oral glucose tolerance test where the child will be required to fast 12 hours prior and an IV catheter will be placed for laboratory tests to be drawn. An oral glucose load will be administered and bloods will be drawn at 30 minute intervals over the 2 hours.
• Visit 4 (within 1-5 weeks) Two-hour oral glucose tolerance test where the child will be required to fast 12 hours prior and an IV catheter will be placed for laboratory tests to be drawn. An oral glucose load will be administered and bloods will be drawn at 30 minute intervals over the 2 hours.