title: Diabetes, pre-diabetes and insulin resistance screening in Native American children and youth.
abstract: OBJECTIVE
  Early identification of pre-diabetes and insulin resistance (IR) provides an important window of opportunity for diabetes prevention. Little is known about the prevalence of pre-diabetes and IR in Native American (NA) youth. We designed a cross-sectional, community-based study of NA children to estimate the prevalence of diabetes, pre-diabetes and IR and their association with other diabetes risk factors.
  
  
  METHODS
  NA children (5-18 years) were screened with body mass index (BMI), blood pressure, oral glucose tolerance test (OGTT), lipids, insulin and highly sensitive C-reactive protein (hsCRP), and calculated homeostatic model assessment of IR (HOMA-IR).
  
  
  RESULTS
  Mean age of the cohort (n=201) was 10.8 ± 3.8 years (± s.d.; 94/107 M/F). BMI percentile for age and sex (BMI%) was elevated (≥ 85 th percentile) in 58.6% of 5-11 years and 51.1% of 12-18 years, and positively correlated with HOMA-IR, blood pressure, triglycerides and hsCRP (P<0.05). The prevalence rate for pre-diabetes and diabetes were 6.5% (3.5-10.8%) and 1.0% (0.1-3.6%), respectively. Mean HOMA-IR was greater in the older than younger age group while prevalence of pre-diabetes was the same. Those with pre-diabetes and diabetes had a greater HOMA-IR, abdominal circumference and BMI% than normal youth.
  
  
  CONCLUSIONS
  In the first prospective, community-based screening for pre-diabetes, IR and diabetes in United States NA youth using OGTT, while the number of diabetes cases was low, pre-diabetes was found in a significant number of youth, particularly in those with BMI ≥ 95 th%. As proportions of pre-diabetes were similar in 5-11 and 12-18 year olds, diabetes risk begins early in NA youth.
authors.affiliation: Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198-4085, USA. pnkumi@unmc.edu
authors.forename: P A
authors.initials: PA
authors.lastname: Nsiah-Kumi
authors.forename: S
authors.initials: S
authors.lastname: Lasley
authors.forename: M
authors.initials: M
authors.lastname: Whiting
authors.forename: C
authors.initials: C
authors.lastname: Brushbreaker
authors.forename: J M
authors.initials: JM
authors.lastname: Erickson
authors.forename: F
authors.initials: F
authors.lastname: Qiu
authors.forename: F
authors.initials: F
authors.lastname: Yu
authors.forename: J L
authors.initials: JL
authors.lastname: Larsen
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D042241:Early Diagnosis; D005215:Fasting / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test; D006706:Homeostasis; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood*; D008297:Male; D008403:Mass Screening; D009329:Nebraska / Q000453:epidemiology; D011236:Prediabetic State / Q000097:blood*; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin; D008055:Lipids; D002097:C-Reactive Protein