Ethnic minority adolescent girls with obesity have higher risk of type 2 diabetes

Presenter: Veronica Njuguna, MD, of Kaiser Permanente, Oakland, CA

Among obese adolescent girls, those who are Black, Latina, or Asian or Pacific Islander have about a 2-fold higher risk of type 2 diabetes mellitus (T2DM) than non-Hispanic White girls, according to a study led by Veronica Njuguna, MD, of Kaiser Permanente, Oakland, CA, presented at the 2023 American College of Cardiology annual meeting.1

T2DM is a metabolic disorder associated with insulin resistance and pancreatic beta-cell insufficiency. Its incidence has increased in US adolescents from 9 per 100,000 per year in 2002–2003 to 13.8 per 100,000 per year in 2014–2015, an annual percent change of 4.8%.2 The increase parallels the adolescent obesity epidemic, which affects 1 in 5 teens.3

“Efforts to improve cardiometabolic health in adolescents with obesity should address the needs of racial and ethnic minority populations at higher risk,” said Dr. Njuguna.

Dr. Njuguna led a study to examine T2DM prevalence in adolescent girls with obesity in various racial or ethnic groups. This retrospective cross-sectional study included 39,426 girls age 13 through 17 with obesity who had well-child visits with measured body mass index in a Northern California health plan from 2012 through 2018. Race and ethnicity were determined from health record data. Obesity was classified as moderate or severe. Diabetes was determined by coded diagnoses within 1 year of the visit, including the subset with T2DM diagnosis.

This was a racially and ethnically diverse group, of whom 42% were Latina, 27% were non-Hispanic White, 16% Black, 11% Asian or Pacific Islander, and 5% other or unknown; two-thirds had moderate obesity and one-third had severe obesity.

Of the 39,426 girls, 304 (0.8%) had T2DM; 214 in the age 13 through 15 group and 90 in the age 16 or 17 group. T2DM prevalence increased with obesity level: 141 (0.5%) among girls with moderate obesity and 163 (1.3%) among girls with severe obesity. T2DM prevalence was higher in Black (1.9%), Asian/Pacific Islander (1.9%), and Latina (1.2%) girls with severe obesity than non-Hispanic White (0.7%) girls.

In multivariable analyses adjusting for age and obesity severity, the odds of T2DM were 2.5-fold higher for Asian/Pacific Islander girls, 2.3-fold higher for Black girls, and 1.7-fold for Latina girls vs non-Hispanic White girls.

Dr. Njuguna concluded: “T2DM prevalence was low in adolescent girls with obesity, but the risk was nearly 2-fold higher for Latina girls and more than 2-fold higher for Asian/Pacific Islander and Black girls compared to non-Hispanic White girls. The disproportionate burden of T2DM among adolescents in minority groups highlights the need to target these at-risk populations, especially given the adverse cardiometabolic outcomes of T2DM in youth.”

Although the overall prevalence of T2DM was low, the disproportionate burden in minority populations highlights the importance of screening at-risk groups with high body mass index to reduce T2DM adverse outcomes,4 including efforts focusing on screening and surveillance in at-risk groups. “Our study draws from a large US population receiving healthcare; future studies should examine marginalized uninsured populations. Future studies should also consider the possibility of applying selected evidence-based adult interventions among at-risk children, which have been shown to improve cardiometabolic and cardiovascular outcomes among adults,” said Dr. Njuguna.

References

  1. Njuguna V, Ramalingam N, Chandra M, Darbinian J, Lo J.Type 2 diabetes prevalence in a diverse cohort of adolescent girls with obesity (abstract). J Am Coll Cardiol 2023 Mar; 81(8 Suppl):1814. doi:10.1016/S0735-1097(23)02258-1
  2. Divers J, Mayer-Davis EJ, Lawrence JM, et al. Trends in incidence of type 1 and type 2 diabetes among youths — selected counties and Indian reservations, United States, 2002–2015. MMWR Morb Mortal Wkly Rep 2020; 69(6):161–165. doi:10.15585/mmwr.mm6906a3
  3. Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999–2016 [published correction appears in Pediatrics 2018 Sep;142(3):]. Pediatrics 2018; 141(3):e20173459. doi:10.1542/peds.2017-3459
  4. Khil J, Darbinian JA, Guo L, et al. Ethnic diversity and burden of polycystic ovary syndrome among US adolescent females. J Pediatr Endocrinol Metab 2022; 35(6):821–825. doi:10.1515/jpem-2022-0160

Disclosures: 

Veronica Njuguna: Nothing to disclose

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