BACKGROUND: Hyperglycemia is one of the most common endocrine complications in children with β thalassemia major. Though the current diagnostic marker either requires fasting, has low reproducibility, or it is not an accurate for thalassemia patients. Glycated albumin (GA) is a quick and easy alternative marker for hyperglycemia detection and monitoring of glycemic control. However to date, no studies have analyzed the role of GA value in detection of hyperglycemia in children with thalassemia major. This study analyzed the value of GA as an alternative screening marker for hyperglycemia detection in children with β thalassemia major.METHODS: A single-blind prospective diagnostic test was conducted in 9 to 18 years old children with β thalassemia major and who were treated at the Dr. Moewardi Regional General Hospital between October 1, 2018 and December 31, 2019. In a single, fasted study visit, height, weight, fasting blood glucose (FPG), GA, oral glucose tolerance test (OGTT) were measured. The area under a receiver operating characteristic curve (AUC) was used to determine the cut-off value at which hyperglycemia prediction (OGTT ≥140 mg/dL) display optimal sensitivity and specificity. RESULTS: Among the 53 children with β thalassemia major, 1 (1.9%) had diabetes mellitus and 4 (7.5%) had prediabetes based on their OGTT values. The median GA value in this study was 10.9% (range: 7.6–12.4%). GA had a low AUC (0.646, p=0.287) for hyperglycemia detection in pediatric patients with β thalassemia major. At a cut-off of 11.45%, GA demonstrated 60% sensitivity and 60.4% specificity.CONCLUSION: GA cannot be used as an alternative marker for hyperglycemia detection in children with β thalassemia major.KEYWORDS: hyperglycemia, diabetes mellitus, prediabetes, β thalassemia major, glycated albumin

Background The National Indonesian Growth Chart (NIGC) is a new growth chart based on Indonesian population data. To date, the CDC 2000 or WHO 2007 charts have been widely used in Indonesia to assess the growth of 5-to-18-year-old children. Use of these reference charts may lead to inaccurate conclusions about children’s nutritional status, particularly when diagnosing short stature or obesity.  Objective To compare assessments of short stature and obesity in Indonesian urban schoolchildren and adolescents based on CDC, WHO, and NIGC reference charts. Methods Pooled anthropometric data [height, weight, and body mass index (BMI)] were collected cross-sectionally from healthy schoolchildren aged 6 to 18 years in Surakarta in 2013, 2016, 2018, and 2019. We created scatterplots for height, weight, and BMI and analyzed differences in height-for-age (HAZ) and BMI (BAZ) z-scores according to the CDC, WHO, and NIGC growth charts, then calculated differences in proportions of children identified as having short stature or obesity. Results We included 2,582 subjects; 63% were girls. Subjects’ mean age was 13.1 (SD 3.4) years. Mean differences in HAZ between the NIGC vs. CDC chart and NIGC vs. WHO chart were 1.44 (SD 0.01) and 1.39 (SD 0.00), respectively. Mean differences in BAZ between the NIGC vs. CDC chart and NIGC vs. WHO chart were 0.18 (SD 0.01) and 0.06 (SD 0.01), respectively. The prevalence of short stature was 9.91%, 11.62%, and 0.39% according to the WHO, CDC, and NIGC charts, respectively. The prevalence of obesity was 10.15%, 5.07%, and 11.77% according to the WHO, CDC, and NIGC charts, respectively. The prevalence of obesity according to the WHO, CDC, and NIGC was 7.44%, 2.95%, and 10.08%, respectively in girls and 14.76%, 8.69%, and 14.66%, respectively in boys. Conclusion The use of the NIGC resulted in a lower prevalence of short stature compared to the CDC or WHO charts. Compared to the WHO charts, the NIGC gave a similar prevalence of obesity overall and in boys, but a higher prevalence of obesity in girls. Compared to the CDC charts, the NIGC gave a higher prevalence of obesity both in boys and girls.