Diabetes, pre-diabetes and insulin resistance screening in Native American children and youth

• Published in: International Journal of Obesity Vol. 37; no. 4; pp. 540 - 545
• Main Authors: Nsiah-Kumi, P A, Lasley, S, Whiting, M, Brushbreaker, C, Erickson, J M, Qiu, F, Yu, F, Larsen, J L
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-04-2013; Nature Publishing Group
• Subjects: 692/699/2743/137/773; 692/700/139; 692/700/1720; 692/700/478/174; Adolescent; Age; Age groups; Analysis; Biological and medical sciences; Blood Glucose - metabolism; Blood pressure; Body Mass Index; C-Reactive Protein - metabolism; Child; Child, Preschool; Children; Children & youth; Community involvement; Cross-Sectional Studies; Demographic aspects; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - prevention & control; Diabetes. Impaired glucose tolerance; Diagnosis; Early Diagnosis; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Ethnic groups; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting - blood; Female; Glucose; Glucose Tolerance Test; Health aspects; Health Promotion and Disease Prevention; Health risks; Homeostasis; Humans; Indians, North American - statistics & numerical data; Insulin; Insulin - blood; Insulin Resistance; Internal Medicine; Lipids; Lipids - blood; Male; Mass Screening; Medical sciences; Medical screening; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolism; Methods; Native American children; Native children & youth; Native North Americans; Nebraska - epidemiology; Obesity; pediatric-original-article; Prediabetic State - blood; Prevalence; Prevention; Prevention and actions; Prevention programs; Prospective Studies; Puberty; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk factors; Nebraska; United States; United States > US; USA; prevention of type 2 diabetes; epidemiology; insulin sensitivity and resistance; weight regulation and obesity; community-based participatory research; diabetes in childhood; Endocrinopathy; Amerindian; Type 2 diabetes; Pancreatic hormone; Mongoloid; Body weight; Epidemiology; Prevention; Regulation(control); Scientific research; Community action for health; Child; Nutritional status; Public health; Human; Obesity; Insulin sensitivity; Nutrition disorder; Community participation; Corporal biometry; Medical screening; Insulin; Target tissue resistance; Sensitivity resistance; Adolescent; Insulin resistance
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/ijo.2012.199

Objectives:
Early identification of pre-diabetes and insulin resistance (IR) provides an important window of opportunity for diabetes prevention. Little is known about the prevalence of pre-diabetes and IR in Native American (NA) youth. We designed a cross-sectional, community-based study of NA children to estimate the prevalence of diabetes, pre-diabetes and IR and their association with other diabetes risk factors.
Study Design:
NA children (5–18 years) were screened with body mass index (BMI), blood pressure, oral glucose tolerance test (OGTT), lipids, insulin and highly sensitive C-reactive protein (hsCRP), and calculated homeostatic model assessment of IR (HOMA-IR).
Results:
Mean age of the cohort (
n
=201) was 10.8±3.8 years (±s.d.; 94/107 M/F). BMI percentile for age and sex (BMI%) was elevated (⩾85th percentile) in 58.6% of 5–11 years and 51.1% of 12–18 years, and positively correlated with HOMA-IR, blood pressure, triglycerides and hsCRP (
P
<0.05). The prevalence rate for pre-diabetes and diabetes were 6.5% (3.5–10.8%) and 1.0% (0.1–3.6%), respectively. Mean HOMA-IR was greater in the older than younger age group while prevalence of pre-diabetes was the same. Those with pre-diabetes and diabetes had a greater HOMA-IR, abdominal circumference and BMI% than normal youth.
Conclusion:
In the first prospective, community-based screening for pre-diabetes, IR and diabetes in United States NA youth using OGTT, while the number of diabetes cases was low, pre-diabetes was found in a significant number of youth, particularly in those with BMI ⩾95th%. As proportions of pre-diabetes were similar in 5–11 and 12–18 year olds, diabetes risk begins early in NA youth.