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Utility of Hemoglobin A(1c) for Diagnosing Prediabetes and Diabetes in Obese Children and Adolescents

Nowicka, Paulina LU ; Santoro, Nicola; Liu, Haibei; Lartaud, Derek; Shaw, Melissa M.; Goldberg, Rachel; Guandalini, Cindy; Savoye, Mary; Rose, Paulina and Caprio, Sonia (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:
author
organization
publishing date
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
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
2011-08-02 09:00:40
date last changed
2017-10-29 03:57:38
@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 &lt;5.7%), 21% at risk for diabetes (A1C 5.7-6.4%), and 1% with diabetes (A1C &gt;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},
  volume       = {34},
  year         = {2011},
}