Utility of Hemoglobin A1c for Diagnosing Prediabetes and Diabetes in Obese Children and Adolescents
Open Access
- 20 May 2011
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 34 (6), 1306-1311
- https://doi.org/10.2337/dc10-1984
Abstract
OBJECTIVE: Hemoglobin A1c (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 ∼2 years in 218 subjects. RESULTS: At baseline, subjects were stratified according to A1C categories: 77% with normal glucose tolerance (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% CI 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.Keywords
This publication has 23 references indexed in Scilit:
- Common Variants at 10 Genomic Loci Influence Hemoglobin A1C Levels via Glycemic and Nonglycemic PathwaysDiabetes, 2010
- Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic AdultsThe New England Journal of Medicine, 2010
- Prevalence of Diabetes and High Risk for Diabetes Using A1C Criteria in the U.S. Population in 1988–2006Diabetes Care, 2010
- Diagnosis and Classification of Diabetes MellitusDiabetes Care, 2010
- A1C and Diabetes Diagnosis: The Rancho Bernardo StudyDiabetes Care, 2009
- International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of DiabetesDiabetes Care, 2009
- Differences in A1C by Race and Ethnicity Among Patients With Impaired Glucose Tolerance in the Diabetes Prevention ProgramDiabetes Care, 2007
- Hemoglobin A1c Predicts Diabetes but Not Cardiovascular Disease in Nondiabetic WomenAmerican Journal Of Medicine, 2007
- Comparison of Laboratory Test Frequency and Test Results Between African-Americans and Caucasians With Diabetes: Opportunity for Improvement: Findings from a large urban health maintenance organizationDiabetes Care, 1997
- Race-Related Differences in Metabolic Control Among Adults With DiabetesSouthern Medical Journal, 1992