Diabetes screening in overweight and obese children and adolescents: choosing the right test

Ehehalt, Stefan; Wiegand, Susanna; Körner, Antje; Schweizer, Roland; Liesenkötter, Klaus-Peter; Partsch, Carl-Joachim; Blumenstock, Gunnar; Spielau, Ulrike; Denzer, Christian; Ranke, Michael B.; Neu, Andreas; Binder, Gerhard; Wabitsch, Martin; Kieß, Wieland; Reinehr, Thomas

doi:10.1007/s00431-016-2807-6

Cited by 29 publications

(22 citation statements)

References 33 publications

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“… 24 25 26 27 While the previous four studies in the pediatric populations only suggested an optimal cutoff point for prediabetes, we also evaluated the cutoff point for type 2 DM. In a recent study, Ehehalt et al 28 also reported an optimal HbA1c cutoff point for diabetes of 6.0%, with a sensitivity of 94.0% and a specificity of 92.9% in 4,848 German children. The differences in HbA1c cutoff points may reflect differences in study populations.…”

Section: Discussionmentioning

confidence: 95%

HbA1c Cutoff for Prediabetes and Diabetes Based on Oral Glucose Tolerance Test in Obese Children and Adolescents

et al. 2018

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BackgroundOral glucose tolerance test (OGTT) is a traditional diagnostic tool for diabetes. Hemoglobin A1c (HbA1c) is an alternative method used in adults; however, its application in youths has been controversial. We evaluated the diagnostic performance of HbA1c and determined optimal cutoff points for detecting prediabetes and diabetes in youth.MethodsThis retrospective study included 389 obese children (217 boys, 55.8%) who had undergone simultaneous OGTT and HbA1c testing at six hospitals, Korea, between 2010 and 2016. Subjects were diagnosed with diabetes (fasting glucose ≥ 7.0 mmol/L; 2-hour glucose ≥ 11.1 mmol/L) or prediabetes (fasting glucose 5.6–6.9 mmol/L; 2-hour glucose 7.8–11.0 mmol/L). The diagnostic performance of HbA1c for prediabetes and diabetes was determined using the area under the receiver operating characteristic curve (AUC).ResultsAt diagnosis, 197 (50.6%) subjects had normoglycemia, 121 (31.1%) had prediabetes, and 71 (18.3%) had diabetes. The kappa coefficient for agreement between OGTT and HbA1c was 0.464. The optimal HbA1c cutoff points were 5.8% (AUC, 0.795; a sensitivity of 64.1% and a specificity of 83.8%) for prediabetes and 6.2% (AUC, 0.972; a sensitivity of 91.5% and a specificity of 93.7%) for diabetes. When HbA1c (≥ 6.2%) and 2-hour glucose level were used to diagnose diabetes, 100% were detected.ConclusionPediatric criteria for HbA1c remain unclear, therefore, we recommend the combination of fasting and 2-hour glucose levels, in addition to HbA1c, in the diagnosis of childhood prediabetes and diabetes.

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Section: Discussionmentioning

confidence: 95%

HbA1c Cutoff for Prediabetes and Diabetes Based on Oral Glucose Tolerance Test in Obese Children and Adolescents

et al. 2018

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“…Glycosylated hemoglobin or HbA1c is an established marker for long-term glycemic control in patients with diabetes [ 33 ]. HbA1c has been proposed as a screening tool for undiagnosed diabetes in adults [ 6 ] and children with overweight or obesity [ 8 ], but the evidence is still very limited. We found very little change in HbA1c levels from childhood to late adolescence, and there was no difference between the sexes.…”

Section: Discussionmentioning

confidence: 99%

“…Insulin resistance plays an important role in the development of youth-onset type 2 diabetes, an emerging disease in children and youth [ 4 ]. Homeostasis model assessment estimates insulin resistance (HOMA-IR) from fasting levels of insulin and glucose [ 5 ]; other measures that have been used to identify insulin resistance or diabetes include fasting insulin and glycosylated hemoglobin (HbA1c), respectively [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Percentile curves for cardiometabolic disease markers in Canadian children and youth: a cross-sectional study

et al. 2018

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BackgroundThe objective of this study to develop percentile curves for cardiometabolic disease markers in a population-based sample of Canadian children and youth.MethodsThe analysis used data from 6116 children and adolescents between 6 and 19 years of age who participated in the Canadian Health Measures Survey cycles 1 (2007/2009), 2 (2009/2011), and 3 (2012/2013). Total cholesterol, HDL cholesterol, and hemoglobin A1c levels as well as fasting levels of triglycerides, insulin, and homeostasis model assessment insulin resistance were measured using standardized procedures. Age- and sex-specific centiles for all markers were calculated using Cole and Green’s LMS method.ResultsWith the exception of hemoglobin A1c, all markers showed age- and sex-related differences during childhood and adolescence.ConclusionsWe have developed centile curves for cardiometabolic disease markers in Canadian children and adolescents and demonstrated age and sex differences that should be considered when evaluating these markers in this age group.

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“…In several studies and current recommendations, it had been concluded that HbA 1c can identify children with PD with similar confidence as compared with fasting glucose and OGTT 2-h glucose 7 , 8 , 47 . However, studies investigating the specificity and sensitivity for identifying PD found only low predictable value for HbA 1c , both in adults 48 – 50 and in Ob children and adolescents 8 , 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes, IFG and IGT are defined by glucose measures in the fasting state, as well as at 2-h during a standardized oral glucose tolerance test (OGTT). However, recent evidence shows that glucose and hemoglobin A 1c (HbA 1c ) levels rise already before the clinical diagnosis of diabetes 7 , 8 , allowing diagnosis of PD defined by IFG or IGT well before the onset of diabetes mellitus. According to recent ADA guidelines, to test for PD, fasting plasma glucose, OGTT 2-h blood glucose (BG) and HbA 1c levels, are considered as equally appropriate 7 .…”

Section: Introductionmentioning

confidence: 99%

Assessment of disturbed glucose metabolism and surrogate measures of insulin sensitivity in obese children and adolescents

2017

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BackgroundWith the rising prevalence of obesity and type 2 diabetes (T2D) in obese children, it is becoming imperative to detect disturbed glucose metabolism as early as possible in order to prevent T2D development.Subjects/MethodsCross-sectional study of 92 obese children (median age 11.7 years, 51% female) and 7 lean children (median age 11.4 years, 57% female) who underwent an oral glucose tolerance test (OGTT) in a tertiary pediatric care center. Glucose tolerance was assessed and different indices for β-cell function, insulin sensitivity and insulin secretion were calculated.ResultsNineteen obese children were identified with prediabetes (PD, 12 impaired glucose tolerance, 4 increased fasting glucose and 3 combined). Compared with the 73 obese children with normal glucose tolerance (nGT), subjects with PD had higher insulin resistance, but lower insulin sensitivity and β-cell function, although their glycated hemoglobin (HbA1c) levels were comparable. The Whole Body Insulin Sensitivity Index (WBISI) and β-cell function by Insulin Secretion-Sensitivity Index-2 (ISSI-2) strongly correlated with the OGTT glucose area under the curve 0–120 min (r = 0.392, p < 0.0002; r = 0.547, p < 0.0001, respectively). When testing the relation between early insulin response during OGTT by insulinogenic index and insulin sensitivity assessed by WBISI, a hyperbolic relationship between insulin secretion and insulin sensitivity was found. The calculated disposition index was lower in subjects with PD vs. nGT (median 459 vs. 792, p = 0.004). We identified the OGTT 30-min/120-min insulin ratio as a simple marker, which is significantly lower in obese children with vs. without PD (median 0.87 vs. 1.29, p = 0.021) and which has a better sensitivity and specificity for detecting PD than HbA1c among obese children.ConclusionsChildren with identified PD had changes of several markers for β-cell function, insulin sensitivity and resistance before changes in HbA1c occurred. The lower disposition index indicates that these children have already inadequate β-cell compensation for the degree of insulin resistance.

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Diabetes screening in overweight and obese children and adolescents: choosing the right test

Cited by 29 publications

References 33 publications

HbA1c Cutoff for Prediabetes and Diabetes Based on Oral Glucose Tolerance Test in Obese Children and Adolescents

HbA1c Cutoff for Prediabetes and Diabetes Based on Oral Glucose Tolerance Test in Obese Children and Adolescents

Percentile curves for cardiometabolic disease markers in Canadian children and youth: a cross-sectional study

Assessment of disturbed glucose metabolism and surrogate measures of insulin sensitivity in obese children and adolescents

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