Among children with type 2 diabetes (T2D), obesity was common but far from universal compared to the global situation.
In fact, only 75% of pediatric cases were found to be obese, with a rate of 77% at the time of diagnosis, according to a systematic review and meta-analysis of nearly 9,000 children with T2D. Open Jama Network.
Although only 4.2% of children with type 2 diabetes in the US had a BMI in the normal range, this was the case in Oceania (16.4%) and Asia (14%), M. Constantine was more common in other parts of the world, such as Saman, MD. , MSc at McMaster Children’s Hospital in Hamilton, Ontario, and colleagues found.
Acknowledging the low-to-moderate risk of bias, variable levels of evidence, and high heterogeneity, Saman’s group pointed out the potential implications for care: “Understanding the contribution of insulin resistance, glucose intolerance, and body mass to the development of T2D and its covariates. And the complications for creating personalized interventions to improve outcomes.” are important.”
Obesity within diabetes is different between boys and girls. Only 59% of women with type 2 diabetes had obesity; On the other hand, 79% of men had comorbid diabetes and obesity. It showed a significantly higher risk for men and women with type 2 diabetes (95% CI 1.33-3.31, P= 0.03).
Beyond gender differences, racial differences also emerged. Asian patients with T2D had the lowest prevalence of comorbid obesity while white patients had the highest:
- White patients: 89.86%
- African American and African Canadian patients: 84.47%
- Middle Eastern patients: 82.19%
- Hispanic and Latino patients: 81.30%
- Tribal Patients: 76.73%
- Asian patients: 64.50%
Regional differences also emerged around the world, reflecting late ethnic differences. The highest prevalence of obesity among children with T2D was in North America (81%), the Middle East (78%), Oceania (74%), Asia (69%), and Europe (68%).
These findings underscore the paucity of BMI-based measures that actually screen for and predict diabetes in young adults, Saman’s group said. While many guidelines recommend looking for a high BMI as the first sign of diabetes, the researchers said the guidelines should instead recommend a more comprehensive and “more sophisticated” screening approach. They suggest including other diabetes risk factors such as family history, lifestyle, hormones, growth, markers of insulin resistance, and insulin production capacity—just to name a few.
“The 2 main mechanisms driving T2D include insulin resistance and insulin deficiency,” they said. “In children with T2D, beta cell dysfunction manifests with substantial impairments in first- and second-phase insulin secretion, and children with T2D and normal weight have lower insulin secretory capacity than patients with T2D and obesity. Decline in beta cell function in children. Per year with T2D 20% or more, which is almost double the rate seen in adult T2D.”
Finally, Samaan’s group advises that when screening for type 2 diabetes in children, obesity should be considered as a risk factor and not a prerequisite, especially when other risk factors are present.
The meta-analysis included data from 53 studies, with a total of 8,942 participants. Most studies used the 95th percentile of BMI for age and sex to define obesity.
After the study’s publication, the CDC updated the BMI-for-age growth charts, expanding them to include children and adolescents with severe obesity. Charts now extend to a BMI of 60, and severe obesity is defined as 120% of the 95th percentile, reflecting the increasing prevalence of obesity among children and adolescents.
The most common risk factors for type 2 diabetes in the meta-analysis were family history and maternal gestational diabetes. Acanthosis nigricans, polyuria, and polydipsia were the top clinical presentations. Most youth were treated with oral hypoglycemic agents, while others were treated with insulin, diet alone, or a combination of approaches.
Saman and co-authors have no disclosures.
Open Jama Network
Source Reference: Cioana M, et al “Prevalence of obesity in children with type 2 diabetes” JAMA Netw Open 2022; DOI: 10.1001/jamanetworkopen.2022.47186.