508 - Increased prevalence of pre-diabetes among children with overweight/obesity and elevated blood pressure

Poster Number: 508
Publication Number: 508.238

Rashmi Pashankar, Johns Hopkins Children's Center, Baltimore, MD, United States; Kevin Psoter, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Raquel G. Hernandez, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States; Sheela N. Magge, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Tammy M. Brady, Johns Hopkins University, Baltimore, MD, United States

Background: The prevalence of prediabetes in youth has been rising, with a current prevalence estimate of 18% in adolescents.  Prediabetes in adults is associated with cardiovascular disease (CVD) risk factors. Limited data suggests this association is also present in children.

Objective: To (1) determine the prevalence of prediabetes in a population of children referred to a subspecialty clinic with overweight/obesity and elevated blood pressure (BP) and (2) explore how prediabetes associates with CVD risk factors in an at-risk pediatric population.

Design/Methods: We performed a longitudinal analysis of consecutive children referred for evaluation of overweight/obesity and elevated BP in a multidisciplinary obesity hypertension clinic.  For this study, prediabetes was defined as 5.7% ≤ hemoglobin A1c (HbA1c) ≤ 6.4% within 3 months of a clinic visit in patients without a diagnosis of diabetes or metformin use.  We compared characteristics of children with prediabetes to those without prediabetes (HbA1c < 5.7%). Multivariable linear and logistic regression based on generalized estimating equations to account for repeated measurements in children was used to explore the association of prediabetes and CVD risk factors including BP index (mean BP/95th %ile BP), left ventricular mass index (LVMI), left ventricular hypertrophy (LVH; LVMI ≥ 95th %ile), diastolic dysfunction (E/A < 1.62), and non-HDL-cholesterol levels.

Results: Between 2/2015-11/2021 there were 63 youth eligible for inclusion in the study. The mean age of the sample was 14 years, 68% were male, 87% were black race, mean BMI was 39.6 kg/m2, mean BMI z-score was 2.6, 37% were hypertensive, 73% had LVH, 27% had diastolic dysfunction. Using adult definitions of obesity class, roughly half (47.7%) were class 3 or greater (BMI ≥ 40kg/m2) and 56% had prediabetes (Table 1). There were no significant differences in CVD risk factors between the prediabetic group and normoglycemic group before or after adjustment for age, sex, and race (Tables 1 and 2). Conclusion(s): In our cohort of overweight/obese children with elevated BP, the prevalence of prediabetes was substantially higher than the national average. Within our sample, prediabetes did not have a significant association with CVD risk factors. Despite this, LVH, diastolic dysfunction, and hypertension were highly prevalent overall, highlighting the elevated CVD risk of this vulnerable population.
Characteristics of Youth Presenting for Evaluation in an Obesity Hypertension Clinic, with and without Pre-Diabetesa: Chronic steroid use defined as any oral steroid use or inhaled corticosteroid > 1000 mcg/day
b: Poverty level defined as percent of individuals living under the poverty level in the patient's neighborhood
c: Hypertension defined as mean systolic or diastolic BP≥95th percentile for children < 13 years or mean systolic or diastolic BP ≥ 130/80 for children ≥13 years
Association of Pre-diabetes with Cardiovascular Disease Risk Factors among children with overweight/obesity and elevated blood pressure1: Adjusted for age, sex, and race