Low association between fasting and OGTT stimulated glucose levels with HbA1c in overweight children and adolescents

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:10.1111/pedi.12461

Cited by 12 publications

(11 citation statements)

References 28 publications

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“…There was only a weak correlation between FPG, 2-hr PG, and HbA1c in German children and adolescents. 29 Only 7% of 4,004 European adults satisfied all three tests. 30 The discrepancy between HbA1c level and OGTT results was more remarkable in prediabetes than in diabetes.…”

Section: Discussionmentioning

confidence: 96%

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: 96%

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

et al. 2018

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“…When the ADA criteria were followed, there was a limited association between impaired fasting glucose and further metabolic derangement in our cohort, suggesting that, at least in children, the WHO criteria for impaired fasting glucose may be more suitable to address patients at risk of metabolic disturbances. Indeed, the postulated clinical relevance of isolated impaired fasting glucose or HbA1c 5.7% to 6.4% for risk of further metabolic derangement in childhood obesity is not only questionable, but apparently inexistent according to the data presented here. Hence, it should probably not be considered as diagnostic criteria in this age range, thus avoiding unnecessary complementary tests and psychological stress for patients and families.…”

Section: Discussionmentioning

confidence: 99%

Sex, puberty, and ethnicity have a strong influence on growth and metabolic comorbidities in children and adolescents with obesity: Report on 1300 patients (the Madrid Cohort)

et al. 2019

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Background:The capacity to correctly assess insulin resistance and its role in further obesity-associated metabolic derangement in children is under debate, and its determinants remain largely unknown. Objective:We investigated the association of the insulin secretion profile with other metabolic derangements and anthropometric features in children and adolescents with obesity, exploring the role of ethnicity. Patients and Methods:Growth and metabolic features, including fasting insulin levels and insulin secretory profile in an oral glucose tolerance test (OGTT), were analyzed according to ethnicity in 1300 patients with obesity (75.8% Caucasians/19.0% Latinos). Results:Height and bone age were influenced by sex, ethnicity, and insulinemia.Latino patients had higher insulin (P < .001), but similar glycemia both prepubertally and postpubertally, compared with Caucasians. Type 2 diabetes was uncommon (0.1%). Impaired glucose tolerance was associated to higher age, BMI, uric acid, and triglyceride levels (all P < .05), as was fasting hyperinsulinism. Impaired fasting glucose or HbA1c 5.7% to 6.4% showed no association with further metabolic derangement.A delayed insulin peak in the OGTT was associated to more severe metabolic disturbances. Conclusions:Obesity-associated hyperglycemia is unusual in our environment whereas fasting and late postprandial hyperinsulinemia are highly prevalent, with this being influenced by race and closely related with lipid metabolism impairment.

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“…Moreover, a large study of youth with overweight and obesity (n = 4848) showed only weak correlations between HbA1c and FPG (r = 0.18) and HbA1c and 2-hour OGTT glucose (r = 0.17). 35 It is clear that these measures-FPG, OGTT, and HbA1c-reflect distinct aspects of carbohydrate metabolism and resulting glycemia, and that these are associated with the discrepancies with the other 2 measures. Moreover, in some youth, the 75 g of dextrose present in an OGTT is less than the glycemic load they typically consume in one sitting.…”

Section: Meƞormin Dosingmentioning

confidence: 99%

Evaluation and Treatment of Prediabetes in Youth

Magge

Silverstein

Elder

et al. 2020

The Journal of Pediatrics

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Low association between fasting and OGTT stimulated glucose levels with HbA1c in overweight children and adolescents

Abstract: Because FPG, 2-hour glucose, and HbA1c correlated only weakly we propose that these parameters, particularly in the normal range, might reflect distinct aspects of carbohydrate metabolism.

Cited by 12 publications

References 28 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

Sex, puberty, and ethnicity have a strong influence on growth and metabolic comorbidities in children and adolescents with obesity: Report on 1300 patients (the Madrid Cohort)

Evaluation and Treatment of Prediabetes in Youth

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