Relationship Between Parental Diabetes and Presentation of Metabolic and Glycemic Function in Youth With Type 2 Diabetes: Baseline Findings From the TODAY Trial

Abstract

Objective: Children whose parents have diabetes are at increased risk for developing type 2 diabetes. This report assessed relationships between parental diabetes status and baseline demographics, anthropometrics, metabolic measurements, insulin sensitivity, and β-cell function in children recently diagnosed with type 2 diabetes.

Research design and methods: The sample included 632 youth (aged 10-17 years) diagnosed with type 2 diabetes for <2 years who participated in the TODAY clinical trial. Medical history data were collected at baseline by self-report from parents and family members. Youth baseline measurements included an oral glucose tolerance test and other measures collected by trained study staff.

Results: Youth exposed to maternal diabetes during pregnancy (whether the mother was diagnosed with diabetes prior to pregnancy or had gestational diabetes mellitus) were diagnosed at younger ages (by 0.6 years on average), had greater dysglycemia at baseline (HbA1c increased by 0.3% [3.4 mmol/mol]), and had reduced β-cell function compared with those not exposed (C-peptide index 0.063 vs. 0.092). The effect of maternal diabetes on β-cell function was observed in non-Hispanic blacks and Hispanics but not whites. Relationships with paternal diabetes status were minimal.

Conclusions: Maternal diabetes prior to or during pregnancy was associated with poorer glycemic control and β-cell function overall but particularly in non-Hispanic black and Hispanic youth, supporting the hypothesis that fetal exposure to aberrant metabolism may have long-term effects. More targeted research is needed to understand whether the impact of maternal diabetes is modified by racial/ethnic factors or whether the pathway to youth-onset type 2 diabetes differs by race/ethnicity.

Trial registration: ClinicalTrials.gov NCT00081328.

© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Figures

Figure 1

Insulin sensitivity (inverse fasting insulin) and β-cell function (CPI and CPoDI) were compared by maternal (left) and paternal (right) diabetes status. Maternal diabetes was categorized as during pregnancy, after pregnancy, or never diagnosed; paternal diabetes categories are ever or never diagnosed. Testing was performed separately for each parent in models adjusted for participant’s sex, race/ethnicity, and age at baseline, and significant (P < 0.05) comparison categories are shown linked. Variables were log transformed to normalize the distributions. oDI, oral disposition index.

Figure 2

β-Cell function measures (CPI and CPoDI) were compared by maternal diabetes status and participant’s self-reported race/ethnicity. Maternal diabetes (DM) status was categorized as ever or never diagnosed. The interaction between maternal diabetes status and participant’s race/ethnicity was tested in models adjusting for participant’s sex and age at baseline, and significant (P < 0.05) comparison categories are shown linked. Variables were log transformed to normalize the distributions. oDI, oral disposition index.