title: Addressing prediabetes in childhood obesity treatment programs: support from research and current practice.
abstract: BACKGROUND
  Type 2 diabetes mellitus (T2DM) and prediabetes have increased in prevalence among overweight and obese children, with significant implications for long-term health. There is little published evidence on the best approaches to care of prediabetes among overweight youth or the current practices used across pediatric weight management programs.
  
  
  METHODS
  This article reviews the literature and summarizes current practices for screening, diagnosis, and treatment of prediabetes at childhood obesity treatment centers. Findings regarding current practice were based on responses to an online survey from 28 pediatric weight management programs at 25 children's hospitals in 2012. Based on the literature reviewed, and empiric data, consensus support statements on prediabetes care and T2DM prevention were developed among representatives of these 25 children's hospitals' obesity clinics.
  
  
  RESULTS
  The evidence reviewed demonstrates that current T2DM and prediabetes diagnostic parameters are derived from adult-based studies with little understanding of clinical outcomes among youth. Very limited evidence exists on preventing progression of prediabetes. Some evidence suggests that a significant proportion of obese youth with prediabetes will revert to normoglycemia without pharmacological management. Evidence supports lifestyle modification for children with prediabetes, but further study of specific lifestyle changes and pharmacological treatments is needed.
  
  
  CONCLUSIONS
  Evidence to guide management of prediabetes in children is limited. Current practice patterns of pediatric weight management programs show areas of variability in practice, reflecting the limited evidence base. More research is needed to guide clinical care for overweight youth with prediabetes.
authors: 1 Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine , Aurora, CO.
authors: Matthew A
authors: MA
authors: Haemer
authors: H Mollie
authors: HM
authors: Grow
authors: Cristina
authors: C
authors: Fernandez
authors: Gloria J
authors: GJ
authors: Lukasiewicz
authors: Erinn T
authors: ET
authors: Rhodes
authors: Laura A
authors: LA
authors: Shaffer
authors: Brooke
authors: B
authors: Sweeney
authors: Susan J
authors: SJ
authors: Woolford
authors: Elizabeth
authors: E
authors: Estrada
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D063766:Pediatric Obesity / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011236:Prediabetic State / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D015397:Program Evaluation; D061217:Weight Reduction Programs