From the Guidelines
The recommended treatment for adolescents with prediabetes primarily focuses on lifestyle modifications, including at least 60 minutes of moderate-to-vigorous physical activity daily and a healthy eating pattern that emphasizes nutrient-dense foods and decreases calorie-dense, nutrient-poor foods, as outlined in the most recent guidelines 1.
Key Recommendations
- Encourage adolescents with prediabetes to participate in at least 60 minutes of moderate to vigorous physical activity daily, including muscle and bone strength training at least 3 days a week, to improve insulin sensitivity and overall health 1.
- Foster healthy eating patterns that focus on nutrient-dense, high-quality foods and reduce the intake of calorie-dense, nutrient-poor foods, particularly sugar-added beverages, to manage weight and improve metabolic health 1.
- Decrease sedentary behavior, which is crucial for preventing the progression of prediabetes to type 2 diabetes in adolescents 1.
Lifestyle Interventions
Lifestyle modifications are the cornerstone of managing prediabetes in adolescents. These interventions should be based on a chronic care model, emphasizing long-term weight management and offered in the context of diabetes care 1. Regular monitoring of blood glucose levels and BMI is essential to track progression and adjust the treatment plan as necessary.
Considerations for Medication
While lifestyle modifications are the primary approach, in certain cases, such as adolescents with obesity or a strong family history of type 2 diabetes who have not responded to lifestyle interventions, medication like metformin may be considered. However, the decision to initiate medication should be made on a case-by-case basis, taking into account the individual's health status, response to lifestyle changes, and potential risks and benefits of medication.
Importance of Early Intervention
Addressing prediabetes in adolescence is critical because it is a period when lifestyle habits are formed, and early intervention can prevent the progression to type 2 diabetes, which has significant implications for morbidity, mortality, and quality of life 1.
From the Research
Recommended Treatment for Adolescents with Prediabetes
The recommended treatment for adolescents with prediabetes involves lifestyle modification, including increases in physical activity and dietary improvements, as the first-line approach 2. This is crucial in reducing the degree of obesity and insulin resistance, which are key factors in the development of type 2 diabetes mellitus (T2DM).
Lifestyle Modifications
- Increases in physical activity
- Dietary improvements, such as nutrition education and behavior modification
- Reverting obesity through lifestyle modification is an important step to prevent the progression to diabetes 3
Pharmacological Interventions
- Metformin treatment may be considered for more moderate cases of prediabetes, especially in adolescents with severe obesity and comorbidities 2, 4
- Metformin has been shown to improve metabolic parameters, such as insulin sensitivity and BMI, in adolescents with type 1 diabetes mellitus (T1DM) 4
- Metformin may also be effective in preventing the progression of prediabetes to T2DM in high-risk individuals, particularly those with higher baseline Body Mass Index (BMI) and higher Fasting Plasma Glucose (FPG) concentrations 5
Current Practice and Research Gaps
- There is limited evidence on the best approaches to care of prediabetes among overweight youth or the current practices used across pediatric weight management programs 6
- More research is needed to guide clinical care for overweight youth with prediabetes and to develop effective interventional strategies to reduce the diabetes risk at the population level 6, 5