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Prediabetes in children and adolescents in the United States: prevalence estimates and comorbidities – a population analysis

“Prediabetes” is the term used to define an intermediate glycemic state between normoglycemia and diabetes. It is a proven risk factor for diabetes and cardiovascular disease (CVD). In 2015, 84.1 million Americans aged 18 and older had prediabetes [1]. About 193,000 Americans under the age of 20 are estimated to have diagnosed diabetes [1], but there is a lack of prevalence estimates available for prediabetes in this age group [2]. Therefore, we sought to explore the prevalence of prediabetes in children and adolescents in the US and its comorbidities in a large “real world” population database. We performed a retrospective case cohort analysis using a deidentified, cloud-based multi-institutional data analytics and research platform (Explorys Inc. – https:// www.explorys.com/the-platform.html [accessed April 1, 2018]) that includes data from inpatient/outpatient clinical encounters from 360 medical centers in the US between 1999 and 2016. Explorys uses Systemized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) for medical terms and Logical Observation Identifiers Names and Codes (LOINC) for laboratory values. The diagnosis of “prediabetes” was made based on the American Diabetes Association (ADA) definition [3]: the presence of either one of the following: (1) impaired fasting glucose (IFG) (100–125 mg/dL) or (2) impaired glucose tolerance (IGT) (140–199 mg/dL) or (3) Glycated hemoglobin (HbA1c) between 5.7 and 6.4%. We included all children and adolescents between age 5 and 19 years who satisfied the above criteria. Individuals with a diagnosis of diabetes mellitus (DM) including type 1 and type 2 DM, gestational DM and familial/drug induced cause of hypercholesterolemia or hypertriglyceridemia were excluded. We studied the prevalence of the following cardiovascular comorbidities in prediabetes – hypertension (queried as a diagnosis defined by SNOMED-CT), obesity (body mass index [BMI] > 95th centile) and dyslipidemia (any one of the following): (a) serum low-density lipoprotein-cholesterol (LDL-C) > 130 mg/dL, (b) serum