Prediabetes — elevated blood glucose levels that aren’t quite high enough to diagnose diabetes — is often an afterthought when it comes to managing chronic conditions, among both people with it and their doctors. After all, it isn’t actually diabetes, and there may be other, more pressing health conditions — or patients — to worry about. But there’s growing evidence that even as it’s often shrugged off or overlooked, prediabetes is worth taking seriously to prevent developing type 2 diabetes — and all the health challenges, expenses and inconveniences that can come with it.
To get cutting-edge diabetes news, strategies for blood glucose management, nutrition tips, healthy recipes, and more delivered straight to your inbox, sign up for our free newsletter!
While managing prediabetes in adults is important, it may be even more crucial to identify and effectively manage prediabetes in youth (children and adolescents). That’s because in younger people, there’s a greater likelihood of developing diabetes and living with it for a long time — and the longer you have diabetes, the greater the likelihood you’ll develop serious complications. So a new set of guidelines for recognizing and managing prediabetes in youth, developed by a team of experts over several years, shouldn’t be taken lightly.
Published in the April 2020 edition of the Journal of Pediatrics, the guidelines cover who should be screened for prediabetes in youth, how screening and diagnosis should take place, and how prediabetes should be treated.
There are some unique considerations when screening youth, as opposed to adults, for prediabetes. For example, the authors of the guidelines write that while increased pediatric obesity is associated with rising rates of prediabetes, type 1 diabetes remains the most common type of diabetes in youth. This means that if elevated blood glucose is identified in any youth — including those who are obese — it’s crucial to follow up with testing to determine whether the person has prediabetes or the beginning stages of type 1 diabetes. While prediabetes can often be managed with lifestyle changes and possibly oral medications, type 1 diabetes requires taking insulin.
As noted in a press briefing on the new guidelines from Johns Hopkins Medicine, a 2019 survey of primary care doctors found that overall, doctors had major gaps in their knowledge of risk factors, diagnostic standards and treatment recommendations for prediabetes. This means that guidelines such as the new ones are an especially important tool to fill these gaps. The new guidelines include a flow chart to simplify and clarify what doctors should do at each step of prediabetes management.
The guidelines start with identifying young people who are at or above the 85th percentile of body-mass index (a measure of weight that takes height into account) for their age and sex. It’s then recommended to measure the person’s fasting blood glucose and HbA1c (a measure of long-term blood glucose control) levels. Using the two measurements, the person is placed in one of four different categories.
The first category, with HbA1c below 5.7% and fasting glucose below 100 mg/dl, means the person doesn’t have prediabetes.
The second category, with HbA1c between 5.7% and 6.0% and fasting glucose still below 100 mg/dl, means the person has prediabetes, with lifestyle modifications and education recommended as treatments.
The third category, with HbA1c between 6.0% and 6.5% and/or fasting glucose between 100 and 125 mg/dl, means the person has prediabetes and is at higher risk for progressing to type 2 diabetes. Referral to a pediatric endocrinologist should be considered, along with lifestyle recommendations and education.
The fourth category, with HbA1c above 6.5% and/or fasting glucose above 125 mg/dl, means the person may have type 2 diabetes and should possibly have the HbA1c test repeated or undergo an oral glucose tolerance test (OGTT). If a type 2 diagnosis is confirmed, referral to a pediatric endocrinologist is essential.
For anyone in the third or fourth categories, the guidelines state that after six months of trying lifestyle modifications, if HbA1c is still between 6.0% and 6.5%, the healthcare provider should consider prescribing metformin for prediabetes. There is no consensus, though, on whether metformin is clearly recommended in this situation.
“Our flow chart and strategies are suggested tools for the pediatric primary care provider, who may or may not have access to subspecialists such as pediatric endocrinologists,” says Sheela N. Magge, MD, lead author of the guidelines and associate professor of pediatrics at Johns Hopkins Medicine, in the press briefing. “As there are no conclusive data published, we hope that our paper will provide some needed guidance to pediatric clinicians caring for overweight and obese youth.”