Identifying adolescents with increased cardiometabolic risk—Simple, but challenging

The prevalence of increased cardiometabolic risk, such as insulin resistance and type 2 diabetes, has increased worldwide in adolescents.1 Insulin resistance and type 2 diabetes in childhood and adolescence predict insulin resistance, type 2 diabetes, and preclinical atherosclerosis23 as well as retinal and kidney disease4 in adulthood. In addition to the individual-level burden of these diseases, the economic costs of type 2 diabetes are measured in billions of US dollars.56 Therefore, to counteract these adverse effects and increased economic burden, the early identification of children and adolescents with increased risk of insulin resistance and type 2 diabetes is essential. However, objective methods, such as fasting blood samples or glucose tolerance tests, may not be commonly available or feasible at, for example, school healthcare centers due to the costs and the lack of appropriately trained laboratory staff. Therefore, indirect, affordable, and feasible indicators helping to identify youth with increased risk of cardiometabolic diseases are warranted.