Utility of Hemoglobin A(1c) for Diagnosing Prediabetes and Diabetes in Obese Children and Adolescents
(2011) In Diabetes Care 34(6). p.1306-1311- Abstract
- OBJECTIVE-Hemoglobin A(1c) (A1C) has emerged as a recommended diagnostic tool for identifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1C with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking. RESEARCH DESIGN AND METHODS-We studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1C measurement. These tests were repeated after a follow-up time of similar to 2 years in 218 subjects. RESULTS-At baseline, subjects were stratified according to A1C... (More)
- OBJECTIVE-Hemoglobin A(1c) (A1C) has emerged as a recommended diagnostic tool for identifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1C with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking. RESEARCH DESIGN AND METHODS-We studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1C measurement. These tests were repeated after a follow-up time of similar to 2 years in 218 subjects. RESULTS-At baseline, subjects were stratified according to A1C categories: 77% with normal glucose tolerance (A1C <5.7%), 21% at risk for diabetes (A1C 5.7-6.4%), and 1% with diabetes (A1C >6.5%). In the at risk for diabetes category, 47% were classified with prediabetes or diabetes, and in the diabetes category, 62% were classified with type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1C was 0.81 (95% Cl 0.70-0.92). The threshold for identifying type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1C and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time. CONCLUSIONS-The American Diabetes Association suggested that an A1C of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1C by itself represents a poor diagnostic tool for prediabetes and type 2 diabetes in obese children and adolescents. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/2056703
- author
- Nowicka, Paulina LU ; Santoro, Nicola ; Liu, Haibei ; Lartaud, Derek ; Shaw, Melissa M. ; Goldberg, Rachel ; Guandalini, Cindy ; Savoye, Mary ; Rose, Paulina and Caprio, Sonia
- organization
- publishing date
- 2011
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Diabetes Care
- volume
- 34
- issue
- 6
- pages
- 1306 - 1311
- publisher
- American Diabetes Association
- external identifiers
-
- wos:000291846200010
- scopus:80052002158
- pmid:21515842
- ISSN
- 1935-5548
- DOI
- 10.2337/dc10-1984
- language
- English
- LU publication?
- yes
- id
- cfa9ccd7-cb9c-4a05-9be1-0378eb1e6230 (old id 2056703)
- date added to LUP
- 2016-04-01 14:05:14
- date last changed
- 2022-04-06 08:40:29
@article{cfa9ccd7-cb9c-4a05-9be1-0378eb1e6230, abstract = {{OBJECTIVE-Hemoglobin A(1c) (A1C) has emerged as a recommended diagnostic tool for identifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1C with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking. RESEARCH DESIGN AND METHODS-We studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1C measurement. These tests were repeated after a follow-up time of similar to 2 years in 218 subjects. RESULTS-At baseline, subjects were stratified according to A1C categories: 77% with normal glucose tolerance (A1C <5.7%), 21% at risk for diabetes (A1C 5.7-6.4%), and 1% with diabetes (A1C >6.5%). In the at risk for diabetes category, 47% were classified with prediabetes or diabetes, and in the diabetes category, 62% were classified with type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1C was 0.81 (95% Cl 0.70-0.92). The threshold for identifying type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1C and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time. CONCLUSIONS-The American Diabetes Association suggested that an A1C of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1C by itself represents a poor diagnostic tool for prediabetes and type 2 diabetes in obese children and adolescents.}}, author = {{Nowicka, Paulina and Santoro, Nicola and Liu, Haibei and Lartaud, Derek and Shaw, Melissa M. and Goldberg, Rachel and Guandalini, Cindy and Savoye, Mary and Rose, Paulina and Caprio, Sonia}}, issn = {{1935-5548}}, language = {{eng}}, number = {{6}}, pages = {{1306--1311}}, publisher = {{American Diabetes Association}}, series = {{Diabetes Care}}, title = {{Utility of Hemoglobin A(1c) for Diagnosing Prediabetes and Diabetes in Obese Children and Adolescents}}, url = {{http://dx.doi.org/10.2337/dc10-1984}}, doi = {{10.2337/dc10-1984}}, volume = {{34}}, year = {{2011}}, }