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Glycated haemoglobin as a screening test for abnormal glucose homeostasis in childhood obesity

A Kumbhojkar1,2, V Saraff1, P Nightingale3

  • 1Department of Endocrinology & Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK.

Diabetic Medicine : a Journal of the British Diabetic Association
|November 30, 2019
PubMed

Insights

In obese children, HbA1c reliably detects type 2 diabetes but is less sensitive for impaired glucose homeostasis. This offers a cost-effective screening alternative to oral glucose tolerance testing (OGTT).

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Mellitus Research

Background:

  • Childhood obesity is a growing concern, increasing the risk of type 2 diabetes mellitus and abnormal glucose homeostasis.
  • Accurate and efficient diagnostic methods are crucial for early detection and management of these conditions in pediatric populations.
  • The role of HbA1c as a screening tool compared to the established oral glucose tolerance testing (OGTT) requires further elucidation in this demographic.

Purpose of the Study:

  • To determine the prevalence of type 2 diabetes mellitus and abnormal glucose homeostasis in obese children.
  • To evaluate the predictive accuracy of HbA1c in diagnosing these conditions.
  • To compare the diagnostic utility of HbA1c with OGTT in pediatric obesity.

Main Methods:

  • Retrospective analysis of data from 156 overweight or obese children undergoing routine OGTT between 2012 and 2016.
  • Systematic recording of anthropometric data, comorbidities, risk factors, fasting glucose, insulin, HbA1c, and 120-min post-OGTT glucose levels.
  • Receiver operating characteristic (ROC) curve analysis to determine optimal HbA1c thresholds for diagnosing type 2 diabetes, impaired fasting glucose (IFG), and impaired glucose tolerance (IGT).

Main Results:

  • The proportion of abnormal glucose homeostasis among the studied children was 39%, with 8% diagnosed with type 2 diabetes.
  • HbA1c ≥ 42 mmol/mol (6.0%) demonstrated high specificity (95%) and sensitivity (85%) for detecting type 2 diabetes.
  • HbA1c showed moderate performance for IFG (sensitivity 78%) and lower sensitivity (55%) for IGT, indicating variability in detecting milder glucose abnormalities.

Conclusions:

  • HbA1c is a reliable tool for detecting type 2 diabetes in asymptomatic obese children, serving as a practical alternative to the more resource-intensive OGTT.
  • While HbA1c is less sensitive for diagnosing impaired fasting glucose and impaired glucose tolerance compared to OGTT, its utility in identifying overt diabetes is significant.
  • The findings support the use of HbA1c as a valuable initial screening marker for type 2 diabetes in pediatric obesity, potentially streamlining diagnostic pathways.
Abstract

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