HbA1c percentiles and the association between BMI , age, gender, puberty, and HbA1c levels in healthy German children and adolescents

Abstract

Objective: The measurement of glycated hemoglobin (HbA1c) represents one way to detect type 1 and 2 diabetes in children at an early stage. However, to date, variations in HbA1c levels are not fully understood, even in healthy children. With this in mind, the present study aimed to establish HbA1c reference values in healthy children and to investigate the influence of various independent variables.Study Design and Methods: Two thousand four hundred fifty-five healthy children and adolescents aged between 0.5 and 18 years participated in the population-based cohort study LIFE Child, Germany. Age-and gender-dependent percentiles were estimated, enabling HbA1c values to be converted into standard deviation scores (SDS).Logistic regression models were applied to assess associations between HbA1c-SDS (as outcome) and age, gender, BMI, birth weight, physical activity, pubertal status, and socioeconomic status (SES; as explanatory variables).Results: The mean HbA1c value was 31.79 mmol/mol or 5.06% (SD = 3.3 mmol/mol, SD = 0.3%). Positive associations with HbA1c values were identified for age (b = 0.09, p < 0.001), gender (b = 0.25, p = 0.007), and BMI-SDS (b = 0.06, p < 0.001). In addition, obesity was related to higher HbA1c values (b = 0.29, p < 0.001). Compared to prepuberty, the pubertal and postpubertal stages were associated with higher HbA1c levels. Furthermore, higher SES was associated with higher HbA1c-SDS (b = 0.01, p = 0.04). Conclusion:The present study established HbA1c reference values based on a large sample of healthy German children and adolescents. Age, gender, SES, pubertal stage, and BMI were found to be associated with higher HbA1c levels.

Elevations in blood glucose before and after the appearance of islet autoantibodies in children

“…Although some studies have linked birth size to insulin sensitivity in childhood ( 24 ), relatively little is known about changes in insulin sensitivity during the first year of life. Greater BMI is associated with decreased insulin sensitivity ( 25 ) and higher glycated hemoglobin concentrations ( 26 ), which is consistent with our finding that higher BMI was associated with increased preprandial blood glucose until 1 year of age. However, BMI was not associated with postprandial blood glucose or with blood glucose values in toddlers.…”

Which Is the Most Appropriate Cut-Off of HbA1c for Prediabetes Screening in Caucasian Youths with Overweight or Obesity?

“…Despite the different ethnicity of our sample, we confirm the better performance of HbA1c ≥ 5.5%, in agreement with the multi-ethnic studies by Novicka et al [7] and Tsay et al [19], and the Chinese study by Poon et al [10]. In this context, it is interesting to note that the HbA1c value ≥ 5.5% corresponds to the 95th percentile reported by Hovestadt et al in 2455 young Germans (age 0.5-18 years) of whom 76.5% were normal weight [22].…”

Associations of childhood BMI traits with blood pressure and glycated haemoglobin in 6–9‐year‐old Samoan children

“…The prevalence of high HbA1c and elevated BP among the Samoan children included in our sample highlights the urgent need for preventive interventions in this setting and further research to characterize high‐risk groups. There were higher levels of HbA1c observed in the Samoan cohort compared to a healthy US population of 5‐9‐year‐olds, 30 6‐10‐year‐old children in China, 31 and 0.5‐18‐year‐old children in Germany 32 . They were also higher in mid‐childhood than at 14 years of age in the Pacific Island Families Study 14 .…”

“…There were higher levels of HbA1c observed in the Samoan cohort compared to a healthy US population of 5-9-year-olds, 30 6-10-year-old children in China, 31 and 0.5-18-yearold children in Germany. 32 They were also higher in mid-childhood than at 14 years of age in the Pacific Island Families Study. 14 While we expected that average BP in children would have increased as economic development and the nutrition transition progresses in Samoa, [33][34][35] the range of BPs in the Samoan cohort fell within or above the 2017 AAP recommended values 19 and previous summaries of BP data for children measured in Samoa in 1979-1993 and 2003 35,36 In the Samoan population characterized by high adiposity levels, further evaluation and early intervention should be recommended for all children with elevated CMD risk markers.…”