Table Info

Parameter	P-value	OR (95% CI)
Female sex	0.001	1.888 (1.281–2.784)
LDL	0.001	1.484 (1.170–1.882)
TG	0.015	1.437 (1.074–1.924)
Age group (12–18)	0.030	1.562 (1.044–2.338)
HOMA-IR ≥ 4.1	< 0.001	3.374 (2.261–5.034)

Declarations

Author contributions

VYHL, JHMY, HYN, and LTWC: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was reviewed and approved by the Research Ethics Committee (Kowloon Central/Kowloon East) of Hospital Authority, Hong Kong Special Administrative Region (Reference No.: KC/KE-19-0043/ER-4).

Consent to participate

The need for patient consent was waived by the Research Ethics Committee (Kowloon Central/Kowloon East) of Hospital Authority for this retrospective cohort study because no personal identifiers or related information were obtained during the data collection process.

Consent to publication

Availability of data and materials

All relevant data are contained within the manuscript.

Funding

Not applicable.

Copyright

References

Mayer-Davis EJ, Kahkoska AR, Jefferies C, Dabelea D, Balde N, Gong CX, et al. ISPAD Clinical Practice Consensus Guidelines 2018: definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2018;19:7–19. [DOI] [PubMed] [PMC]

Centre for Health Protection; Department of Health. Obesity: a weighty health issue. Non-Commun Dis Watch [Internet]. 2018 Aug [cited 2022 Oct 1][About 6 p.]. Available from: https://www.chp.gov.hk/files/pdf/ncd_watch_august_2018.pdf

American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2020. Diabetes Care. 2020;43:S14–31. [DOI] [PubMed]

Weiss R, Taksali SE, Tamborlane WV, Burgert TS, Savoye M, Caprio S. Predictors of changes in glucose tolerance status in obese youth. Diabetes Care. 2005;28:902–9. [DOI] [PubMed]

Sacks DB. A1C versus glucose testing: a comparison. Diabetes Care. 2011;34:518–23. [DOI] [PubMed] [PMC]

Chaychenko T, Argente J, Spiliotis BE, Wabitsch M, Marcus C. Difference in insulin resistance assessment between European Union and Non-European Union Obesity Treatment Centers (ESPE Obesity Working Group Insulin Resistance Project). Horm Res Paediatr. 2020;93:622–33. [DOI] [PubMed]

Ng HY, Young JH, Huen KF, Chan LT. Acanthosis nigricans in obese Chinese children. Hong Kong Med J. 2014;20:290–6. [DOI]

Song Y, Manson JE, Tinker L, Howard BV, Kuller LH, Nathan L, et al. Insulin sensitivity and insulin secretion determined by homeostasis model assessment and risk of diabetes in a multiethnic cohort of women: the Women’s Health Initiative Observational Study. Diabetes Care. 2007;30:1747–52. [DOI] [PubMed] [PMC]

Lobstein T, Brinsden H, editors. Atlas of childhood obesityLondon: World Obesity Federation; 2019.

10.

Hauerslev M, Narang T, Gray N, Samuels TA, Bhutta ZA. Childhood obesity on the rise during COVID-19: a request for global leaders to change the trajectory. Obesity (Silver Spring). 2022;30:288–91. [DOI] [PubMed] [PMC]

11.

Selph S, Dana T, Bougatsos C, Blazina I, Patel H, Chou R. Screening for abnormal glucose and type 2 diabetes mellitus: a systematic review to update the 2008 U.S. Preventive Services Task Force Recommendation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 [cited 2022 Oct 1]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK293871/

12.

Kirkman MS. Why we should screen for type 2 diabetes in high-risk patients. Am J Prev Med. 2013;44:S371–4. [DOI] [PubMed]

13.

Gutch M, Kumar S, Razi SM, Gupta KK, Gupta A. Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab. 2015;19:160–4. [DOI] [PubMed] [PMC]

14.

Tagi VM, Giannini C, Chiarelli F. Insulin resistance in children. Front Endocrinol. 2019;10:342. [DOI] [PubMed] [PMC]

15.

Castorani V, Polidori N, Giannini C, Blasetti A, Chiarelli F. Insulin resistance and type 2 diabetes in children. Ann Pediatr Endocrinol Metab. 2020;25:217–26. [DOI] [PubMed] [PMC]

16.

Tang Q, Li X, Song P, Xu L. Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: developments in research and prospects for the future. Drug Discov Ther. 2015;9:380–5. [DOI] [PubMed]

17.

Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care. 1999;22:1462–70. [DOI] [PubMed]

18.

Lorenzo C, Haffner SM, Stančáková A, Kuusisto J, Laakso M. Fasting and OGTT-derived measures of insulin resistance as compared with the euglycemic-hyperinsulinemic clamp in nondiabetic Finnish offspring of type 2 diabetic individuals. J Clin Endocrinol Metab. 2015;100:544–50. [DOI] [PubMed]

19.

Cree-Green M, Triolo TM, Nadeau KJ. Etiology of insulin resistance in youth with type 2 diabetes. Curr Diab Rep. 2013;13:81–8. [DOI] [PubMed] [PMC]

20.

Brufani C, Ciampalini P, Grossi A, Fiori R, Fintini D, Tozzi A, et al. Glucose tolerance status in 510 children and adolescents attending an obesity clinic in Central Italy. Pediatr Diabetes. 2010;11:47–54. [DOI] [PubMed]

21.

Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346:802–10. [DOI] [PubMed]

22.

Rosenbaum M, Fennoy I, Accacha S, Altshuler L, Carey DE, Holleran S, et al. Racial/ethnic differences in clinical and biochemical type 2 diabetes mellitus risk factors in children. Obesity. 2013;21:2081–90. [DOI] [PubMed] [PMC]

23.

Maruf FA, Aronu U, Chukwuegbu K, Aronu AE. Influence of gender on prevalence of overweight and obesity in Nigerian schoolchildren and adolescents. Tanzan J Health Res. 2013;15:247–51. [DOI] [PubMed]

24.

Bloch CA, Clemons P, Sperling MA. Puberty decreases insulin sensitivity. J Pediatr. 1987;110:481–7. [DOI] [PubMed]

25.

Huan Y, DeLoach S, Keith SW, Pequignot EC, Falkner B. High blood pressure and obesity increase the risk of abnormal glucose tolerance in young adult African Americans. J Clin Hypertens. 2011;13:397–403. [DOI] [PubMed] [PMC]

26.

Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005;54:1615–25. [DOI] [PubMed]

27.

Ng HY. Acanthosis nigricans in obese adolescents: prevalence, impact, and management challenges. Adolesc Health Med Ther. 2016;8:1–10. [DOI] [PubMed] [PMC]

28.

Leite NC, Salles GF, Araujo AL, Villela-Nogueira CA, Cardoso CR. Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus. Liver Int. 2009;29:113–9. [DOI] [PubMed]

29.

Bugianesi E, McCullough AJ, Marchesini G. Insulin resistance: a metabolic pathway to chronic liver disease. Hepatology. 2005;42:987–1000. [DOI] [PubMed]

30.

Sanyal AJ, Campbell-Sargent C, Mirshahi F, Rizzo WB, Contos MJ, Sterling RK, et al. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. Gastroenterology. 2001;120:1183–92. [DOI] [PubMed]

31.

Steinberger J, Moorehead C, Katch V, Rocchini AP. Relationship between insulin resistance and abnormal lipid profile in obese adolescents. J Pediatr. 1995;126:690–5. [DOI] [PubMed]

32.

Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics. 2005;115:e500–3. [DOI] [PubMed]

33.

Singh B, Saxena A. Surrogate markers of insulin resistance: a review. World J Diabetes. 2010;1:36–47. [DOI] [PubMed] [PMC]

34.

Singh Y, Garg MK, Tandon N, Marwaha RK. A study of insulin resistance by HOMA-IR and its cut-off value to identify metabolic syndrome in urban Indian adolescents. J Clin Res Pediatr Endocrinol. 2013;5:245–51. [DOI] [PubMed] [PMC]

35.

Nsiah-Kumi PA, Beals J, Lasley S, Whiting M, Brushbreaker C, Erickson J, et al. Body mass index percentile more sensitive than acanthosis nigricans for screening Native American children for diabetes risk. J Natl Med Assoc. 2010;102:944–9. [DOI] [PubMed]

36.

International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327–34. [DOI] [PubMed] [PMC]

37.

Vajravelu ME, Lee JM. Identifying prediabetes and type 2 diabetes in asymptomatic youth: should HbA1c be used as a diagnostic approach? Curr Diab Rep. 2018;18:43. [DOI] [PubMed] [PMC]

38.

Magge SN, Silverstein J, Elder D, Nadeau K, Hannon TS. Evaluation and treatment of prediabetes in youth. J Pediatr. 2020;219:11–22. [DOI] [PubMed] [PMC]

39.

Nowicka P, Santoro N, Liu H, Lartaud D, Shaw MM, Goldberg R, et al. Utility of hemoglobin A_1c for diagnosing prediabetes and diabetes in obese children and adolescents. Diabetes Care. 2011;34:1306–11. [DOI] [PubMed] [PMC]

40.

Khokhar A, Naraparaju G, Friedman M, Perez-Colon S, Umpaichitra V, Chin VL. Comparison of A1C to oral glucose tolerance test for the diagnosis of prediabetes in overweight and obese youth. Clin Diabetes. 2017;35:133–40. [DOI] [PubMed] [PMC]

41.

Haemer MA, Grow HM, Fernandez C, Lukasiewicz GJ, Rhodes ET, Shaffer LA, et al. Addressing prediabetes in childhood obesity treatment programs: support from research and current practice. Child Obes. 2014;10:292–303. [DOI] [PubMed] [PMC]

42.

van der Aa MP, Fazeli Farsani S, Kromwijk LA, de Boer A, Knibbe CA, van der Vorst MM. How to screen obese children at risk for type 2 diabetes mellitus? Clin Pediatr. 2014;53:337–42. [DOI] [PubMed]

43.

Poon SW, Wong WH, Tsang AM, Poon GW, Tung JY. Who should return for an oral glucose tolerance test? A proposed clinical pathway based on retrospective analysis of 332 children. J Pediatr Endocrinol Metab. 2021;34:877–84. [DOI] [PubMed]

44.

Chen ME, Aguirre RS, Hannon TS. Methods for measuring risk for type 2 diabetes in youth: the oral glucose tolerance test (OGTT). Curr Diab Rep. 2018;18:51. [DOI] [PubMed]

45.

Libman IM, Barinas-Mitchell E, Bartucci A, Robertson R, Arslanian S. Reproducibility of the oral glucose tolerance test in overweight children. J Clin Endocrinol Metab. 2008;93:4231–7. [DOI] [PubMed] [PMC]

46.

Ranucci C, Pippi R, Buratta L, Aiello C, Gianfredi V, Piana N, et al. Effects of an intensive lifestyle intervention to treat overweight/obese children and adolescents. Biomed Res Int. 2017;2017:8573725. [DOI] [PubMed] [PMC]

47.

Esquivel Zuniga R, DeBoer MD. Prediabetes in adolescents: prevalence, management and diabetes prevention strategies. Diabetes Metab Syndr Obes. 2021;14:4609–19. [DOI] [PubMed] [PMC]

48.

Khokhar A, Umpaichitra V, Chin VL, Perez-Colon S. Metformin use in children and adolescents with prediabetes. Pediatr Clin North Am. 2017;64:1341–53. [DOI] [PubMed]