Among kids with type 2 diabetes (T2D), obesity was common but far from universal in a look at the condition worldwide.
In fact, only 75% of pediatric cases were found to also have obesity, with a rate of 77% at the time of diagnosis, according to a systematic review and meta-analysis of nearly 9,000 kids with T2D published in JAMA Network Open.
Although only 4.2% of children with type 2 diabetes in the Americas had a BMI in the normal range, this was more common in other parts of the world like Oceania (16.4%) and Asia (14%), M. Constantine Samaan, MD, MSc, of McMaster Children's Hospital in Hamilton, Ontario, and colleagues found.
While acknowledging the low to moderate risk of bias, variable levels of evidence, and high heterogeneity, Samaan's group pointed to potential impact on care: "Understanding the contribution of body mass to the evolution of insulin resistance, glucose intolerance, and T2D and its comorbidities and complications is crucial for creating personalized interventions to improve outcomes."
Obesity within diabetes differed between boys and girls. Only 59% of females with type 2 diabetes had obesity; on the other hand, 79% of males had comorbid diabetes and obesity. This translated into a 2.1-times higher prevalence of obesity for males with type 2 diabetes versus females (95% CI 1.33-3.31, P=0.03).
Beyond sex differences, a slew of racial differences emerged as well. 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%
- Indigenous patients: 76.73%
- Asian patients: 64.50%
These findings really underscore how BMI-based measures to screen for and predict diabetes in youth are lacking, Samaan's group explained. While most guidelines advise looking for an elevated BMI as the first sign of diabetes, the researchers said that guidelines should instead recommend a more comprehensive and "more sophisticated" screening approach. They suggested incorporating other diabetes risk factors like 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. The decline in beta cell function in children with T2D is 20% or greater per annum, which is almost double the rate seen in adult T2D."
Ultimately, Samaan's group advised 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. The majority of studies included 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. The charts now extend to a BMI of 60, and severe obesity is defined as 120% of the 95th percentile, reflecting the rising prevalence of greater degrees of obesity among kids and teens.
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 also treated with insulin, diet alone, or a combination of approaches.
Disclosures
Samaan and co-authors reported no disclosures.
Primary Source
JAMA Network Open
Source Reference: Cioana M, et al "The prevalence of obesity among children with type 2 diabetes" JAMA Netw Open 2022; DOI: 10.1001/jamanetworkopen.2022.47186.
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