Preemies face higher risk of diabetes as children and young adults

By Lisa Rapaport

(Reuters Health) - Babies who are born too early may be more likely to develop diabetes as children and young adults than full-term infants, a new study suggests.

In a study of children up to age 18, those born before 37 weeks' gestation were 21% more likely that those born at full term to develop type 1 diabetes, the less common form of the disease that typically appears in childhood or young adulthood. Kids born prematurely were also 26% more likely to develop type 2 diabetes in childhood.

And preemies were 24% more likely to develop type 1 diabetes and 49% more likely to develop type 2 diabetes by the time they were 43 years old.

"Preterm birth interrupts normal development of multiple organ systems, including the pancreas where insulin-producing cells are formed, which may potentially contribute to later development of diabetes," said lead study author Dr. Casey Crump of the Icahn School of Medicine at Mount Sinai in New York City.

Pregnancy normally lasts about 40 weeks, and babies born after 37 weeks of gestation are considered full-term. Babies born prematurely - earlier than 37 weeks - often have difficulty breathing and digesting food in the weeks after birth. Preemies can also encounter longer-term challenges such as impaired vision, hearing and cognitive skills, as well as social and behavioral problems.

Some previous research suggests that preemies have an increased risk of developing so-called insulin resistance, a failure to respond normally to the hormone insulin.

In type 1 diabetes, the pancreas can't produce insulin. In the type 2 form of the disease, which is often linked to obesity and aging, the body can't properly use or make enough insulin to convert blood sugar into energy.

For the current study, researchers examined data on almost 4.2 million babies born in Sweden from 1973 to 2014. Most were followed until they were at least 22 years old.

Overall, 0.7% of the babies in the study population went on to develop type 1 diabetes and just 0.1% developed type 2 diabetes, the researchers report in Diabetologia.

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"Parents should know that most children who were born preterm will have good health in childhood and adulthood," Crump said by email. "However, they also have modestly increased risks of diabetes that persist into adulthood."

Overall, the risk tended to be higher for preemie girls. Boys who arrived early were about 20% more likely to develop type 1 diabetes during the study, while girls had about a 30% greater likelihood.

With type 2 diabetes, female preemies were 60% more likely to develop this disease during childhood than full-term babies, while preemie males didn't have an increased risk. For young adults in the study, women who were preemies had a 75% increased risk of type 2 diabetes and men who were preterm had a 28% increased risk.

Many people in the study had siblings included in the analysis. Shared genetics and family circumstances appeared to explain some, but not all, of the increased risk of diabetes for preemies.

The study wasn't designed to prove whether preterm birth influences susceptibility to diabetes.

Even so, the results underscore that preemies need to take steps to prevent diabetes later in life, said Ciaran Phibbs of the VA Palo Alto Health Care System and Stanford University School of Medicine in California.

"The home environment is an important factor, especially for type 2 diabetes," Phibbs, who wasn't involved in the study, said by email. This includes things like diet and exercise habits, which can impact the risk of obesity, which is higher for preemies than for full-term babies and is a risk factor for diabetes, he said.

"Individuals who were born preterm can help prevent diabetes by following a healthy lifestyle across the life course, including a healthy diet, regular physical activity, and maintaining a normal weight," Crump advised.

SOURCE: https://bit.ly/2LCQrpq Diabetologia, online December 3, 2019.

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