Screening markers of impaired glucose tolerance in the obese pediatric population

Horm Res Paediatr. 2010;73(2):102-7. doi: 10.1159/000277625. Epub 2010 Feb 9.

Abstract

Background: With the epidemic of childhood obesity, it is crucial to devise a simple screening protocol to predict impaired glucose tolerance (IGT) or pre-diabetes. The oral glucose tolerance test (OGTT), which is the gold standard for the diagnosis of IGT, is impractical for screening purposes. This pilot study was designed to formulate a simple, sensitive algorithm to predict IGT using clinical and laboratory parameters.

Methods: Ethnicity, family history of diabetes, pubertal status, BMI z-score, blood pressure, lipids, hemoglobin A1c (HbA1c) and OGTT data were retrospectively collected from 209 overweight multi-ethnic subjects aged 3-21 years. Multivariate logistic regression was used to determine independent predictors of IGT.

Results: HbA1c was the only significant predictor of IGT (p = 0.001), whereas fasting glucose was not. A cut-off of 5.5% had the best combined sensitivity (85.7%) and specificity (56.9%) with an odds ratio of 7.9 of having IGT when HbA1c is > or =5.5%. The remaining clinical parameters were not significant predictors of IGT.

Conclusion: While fasting blood glucose does not seem to be a predictor of IGT, we propose that HbA1c > or =5.5% can be used as a screening test to assess the risk of IGT and to determine who should undergo diagnostic OGTT. Large prospective studies validating our findings are warranted.

MeSH terms

  • Adolescent
  • Adult
  • Algorithms
  • Biomarkers
  • Child
  • Child, Preschool
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / metabolism
  • Female
  • Glucose / metabolism
  • Glucose Intolerance / complications
  • Glucose Intolerance / diagnosis*
  • Glucose Intolerance / epidemiology
  • Glucose Tolerance Test / standards*
  • Glycated Hemoglobin A / analysis*
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Male
  • Obesity / complications
  • Pilot Projects
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Young Adult

Substances

  • Biomarkers
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
  • Glucose