Abstract Body (Do not enter title and authors here): INTRODUCTION: Race, ethnicity, and elevated body mass index (BMI) are risk factors for pre-diabetes (preDM) among adolescents. We recently observed high preDM prevalence among aggregated US Asian and Pacific Islander (API) children with obesity, but disaggregated API subgroups were not studied.

AIM: To examine preDM prevalence among API subgroups compared to non-Hispanic White (NHW) adolescents with obesity.

METHODS: This retrospective study included 3233 API and 4150 NHW children age 13-17y with obesity and without DM identified at well-child visits in 2016-2019 with hemoglobin A1c (HA1c) measured within 1 year of the visit. Visit data included self-reported lifestyle behaviors, and measured BMI. PreDM (outcome) was defined by HA1c 5.7-6.4%. Obesity was categorized as Class 1-3 based on BMI % of the 95th BMI percentile. Four obesogenic behaviors reported on were: Fruit/vegetable intake<5 servings/day; sugary beverage intake >12 ounces/day; exercising <60 minutes/day; and screen time 2+ hours/day. A neighborhood deprivation index (NDI) was calculated using area of residence and 2010 US Census data. Log binomial regression examined the association of API ethnicity and preDM, reporting relative risk (RR) and 95% confidence intervals [CI].

RESULTS: The cohort included 210 Chinese, 900 Filipino, 200 South Asian, 132 Southeast Asian, 283 Native Hawaiian/Pacific Islander (NHPI), 1508 other/unspecified API ethnicity, and 4150 NHW children with obesity. Overall, 22.4% of API vs 9.4% of NHW children had preDM (p<0.001). PreDM ranged from 19.1% for Chinese, 21.7% for Filipino, 22.5% for South Asian, 24.2% for Southeast Asian, to 26.5% for NHPI subgroups. After adjusting for age, sex, NDI, obesity class, and obesogenic health behaviors, risk of preDM was about 3-fold higher (RR 2.9 [2.6-3.4] for API compared to NHW children, ranging from RR 2.5 [1.8-3.6] for Chinese, RR 2.8 [2.3-3.4] for Filipino, RR 3.1 [2.2- 4.4] for South Asian, RR 3.2 [2.1-4.9] for Southeast Asian, RR 3.3 [2.5-4.4] for NHPI, and RR 3.0 [2.5-3.5] for other/unspecified API children. Obesity severity (RR 1.4 [1.2-1.6] for Class 2 and RR 2.1 [1.7-2.6] for Class 3 compared to Class 1 obesity) was also associated with preDM risk.

CONCLUSION: PreDM risk was about 3-fold higher for API compared to NHW children with obesity, ranging 2.5-3.3-fold higher among major subgroups. This highlights the importance of preDM screening among API children with obesity and the heterogeneity of risk among API subgroups.