Pubertal Stage–Based One‐hour Postload Glucose Thresholds Improve Identification of Prediabetes and Type 2 Diabetes in Children With Overweight or Obesity

AIMS: One-hour postload plasma glucose (1h-PG) is an early marker of dysglycemia in adults, but its utility in children and adolescents is uncertain because insulin sensitivity changes during growth and puberty. We aimed to establish age- and pubertal stage-specific 1h-PG thresholds for identifying prediabetes and Type 2 diabetes (T2D) in children with overweight or obesity. MATERIALS AND METHODS: In this cross-sectional study, 4344 children and adolescents with overweight or obesity underwent an oral glucose tolerance test. Participants were classified into four groups: normal glucose tolerance (NGT) with normal 1 h-PG, NGT with elevated 1 h-PG, prediabetes and T2D. Insulin resistance and β-cell function indices were assessed. Participants were stratified by chronological age and pubertal stage. The optimal 1h-PG cut-offs were obtained via receiver operating characteristic (ROC) and age- and pubertal stage-based thresholds were compared for diagnostic performance. These thresholds were then validated in two independent cohorts. RESULTS: Among individuals with NGT, those with elevated 1h-PG exhibited greater insulin resistance, impaired β-cell function and a higher insulin area under the curve (29 916 vs. 23 524, p < 0.001). 1 h-PG levels increased with pubertal progression. Pubertal stage-specific thresholds showed superior discrimination compared with age-based stratification and adult cut-offs. Compared with adult thresholds (8.6 mmol/L for prediabetes and 11.6 mmol/L for T2D), a prepubertal cut-off of 7.78 mmol/L improved sensitivity for prediabetes (75.40% vs. 56.68%) and a pubertal cut-off of 10.48 mmol/L improved sensitivity for T2D (89.47% vs. 73.68%). CONCLUSIONS: Elevated 1h-PG proved to be a practical marker for identifying early metabolic dysfunction in children and adolescents with euglycemia. Given that widely used adult-derived cut-offs (8.6 and 11.6 mmol/L) are suboptimal for pediatric populations, we established pubertal stage-specific thresholds that outperformed both age-specific and adult-derived cut-offs. These stage-specific thresholds may serve as an effective screening tool for diabetes risk in children and adolescents with overweight or obesity.