Hemoglobin A1c and Type 2 Diabetes Incidence Among Adolescents With Overweight and Obesity
Authors' conclusion
In this cohort study of adolescents with overweight and obesity, T2D risk increased substantially with baseline HbA1c above 6.0%. Risk varied by BMI, age, sex, and race and ethnicity. These findings suggest that diabetes surveillance in adolescents should be tailored to optimize identification among high-risk subgroups.
Study context
- Population
- Adolescents aged 10 to 17 years with body mass index (BMI) ≥85th percentile, hemoglobin A1c (HbA1c) measured 2010–2018, without preexisting diabetes; large California health care system
- Participants
- 74,552 adolescents
- Exposure
- Baseline HbA1c categories
- Outcome
- Incident T2D (cumulative incidence and multivariable hazard ratios (HRs), Cox regression)
- Follow-up
- Through 2019
Methodological detailsData 2010–2019 from a large California health care system
- Data 2010–2019 from a large California health care system
Main finding
As reported in the abstract
5 years
Each group vs HbA1c <5.5%Hazard ratio (95% CI)
HbA1c 5.5%-5.6%
1.7(1.3–2.2)
HbA1c 5.7%-5.8%
2.8(2.1–3.6)
HbA1c 5.9%-6.0%
9.3(7.2–12.1)
HbA1c 6.1%-6.2%
23.3(17.4–31.3)
HbA1c 6.3-6.4%
71.9(51.1–101.1)
Observational data: associations, not effects.
Further findings
Overall T2D incidence
- Developed diabetes
- 698 (0.9%)
- Had T2D
- 626 (89.7%)
- T2D incidence per 1000 person-years
- 2.1 (95% CI, 1.9-2.3)
- 5-year cumulative incidence
- 1.0% (95% CI, 0.9%-1.1%)
- 72 (10.3%) with type 1, secondary or other diabetes censored
Other independent indicators of T2D
- Asian or Pacific Islander race vs White, HR
- 1.7 (95% CI, 1.3-2.2)
- Higher BMI category, older age, female sex also independent indicators
- Black race or Hispanic ethnicity vs White not independent indicators
Stratified by race and ethnicity
- Incremental risk with higher HbA1c greater for Asian or Pacific Islander and White than for Black and Hispanic adolescents
Original publication
Hemoglobin A1c and Type 2 Diabetes Incidence Among Adolescents With Overweight and Obesity. JAMA Netw Open. Published 2 January 2024. doi:10.
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