Prevalence of obesity in pediatric type 2 diabetes

Not all children with type 2 diabetes (T2D) will present with obesity, according to a recent study published in JAMA Network Open.

A rise in pediatric T2D has correlated with increasing rates of obesity in children. Additionally, pediatric obesity has been associated with a greater risk of developing T2D, which increases cardiovascular risk. T2D can also lead to complications such as nephropathy, dyslipidemia, polycystic ovary syndrome, and nonalcoholic fatty liver disease.

The factors which lead to T2D are not entirely understood, but health inequities and socioeconomic factors have been associated with increased risk and greater outcomes. Children with obesity are more likely to be screened for obesity, although it is not known how common obesity is among pediatric patients with T2D.

It is important to determine whether factors besides obesity impact T2D prevalence, as treatment and outcomes may be impacted in children with T2D not caused by obesity. Understanding the prevalence of obesity in the pediatric T2D population can lead to improved screening guidelines for the disease.

To understand the association between obesity and T2D in pediatric patients, investigators conducted a systematic review. Primary observational studies were included if they featured a sample size of 10 or more participants reporting the prevalence of obesity in children with T2D.

T2D was defined by random plasma glucose of at least 200 mg/dL, fasting plasma glucose of at least 127.9 mg/dL, or 2-hour plasma glucose of at least 200 mg/dL after oral glucose tolerance test. Obesity was defined as body mass index (BMI) in the 95th percentile or greater, with BMI between the 85th and 95th percentiles defining overweight.

Journal articles, conference abstracts, and gray literature were searched. Studies were excluded if they reported on gestational diabetes, and searches were restricted to human studies.The primary outcome of the study was prevalence of obesity among children with T2D.

Data was collected on author names, title, year of publication, country, study design, age at T2D diagnosis, age at study enrollment, diabetes duration, sample size, hemoglobin A1c values, lipid profiles, and prevalence of reference-range weight, overweight, and obesity.

Acanthosis nigricans, polyuria, and polydipsia were the most common clinical presentations observed. Family history of T2D and maternal gestational diabetes were the risk factors most often reported, with oral hypoglycemic agents being the most common treatment. Insulin, diet changes, and combination therapies were also forms of treatment

Across 53 studies, there were 8942 participants, and the prevalence of obesity in pediatric patients with T2D was 75.27%. This prevalence was consistent across study designs. Obesity prevalence at the time of T2D was 77.24% when taking data from 30 studies.

The prevalence of overweight widely varied, ranging from 0% to 43.40%.Dyslipidemia prevalence across 31 studies was 4% to 87.5%, and dyslipidemia profiles were mixed.

In male patients, prevalence of obesity was 78.65%, compared to 59.20% in female patients. White patients had an obesity prevalence of 89.86%, compared to 84.47% in Black patients, and 64.5% in Asian patients.

This data indicated that not all pediatric patients were present with obesity at the time of T2D diagnosis. Other factors may have a significant role in T2D development. Investigators recommended further studies on the role of obesity and other mechanisms on diabetes genesis in children.

Reference

Cioana M, Deng J, Nadarajah A, Hou M, Qiu Y, Song Jie Chen S, et al. The prevalence of obesity among children with type 2 diabetes: A systematic review and meta-analysis. JAMA Netw Open. 2022;5(12):e2247186. doi:10.1001/jamanetworkopen.2022.47186