The Role of Haemoglobin A1c in Screening Obese Children and Adolescents for Glucose Intolerance and Type 2 Diabetes

Authors

  • Júlia Galhardo Unidade de Endocrinologia Pediátrica e Diabetes. Hospital de Dona Estefânia. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. Department of Clinical Sciences. Institute of Child Life & Health. University of Bristol. Bristol. Reino Unido.
  • Julian Shield Department of Clinical Sciences. Institute of Child Life & Health. University of Bristol. Bristol. Reino Unido. Paediatric Endocrinology, Diabetes and Metabolism Unit. Bristol Royal Hospital for Children. University Hospitals Bristol – NHS Foundation Trust. Bristol. Reino Unido.

DOI:

https://doi.org/10.20344/amp.5494

Keywords:

Adolescent, Child, Diabetes Mellitus, Type 2, Glucose Intolerance, Haemoglobin A, Glycosylated, Mass Screening, Obesity, Pediatric Obesity.

Abstract

Introduction: In 2012, an international expert committee in diabetes wrote in favor of screening adult and paediatric patients for glucose intolerance and type 2 diabetes using glycated haemoglobin. The aim of this study was to evaluate glycated haemoglobin utility as a screening tool in a young obese mainly Caucasian population.
Material and Methods: Children [(n = 266), body mass index z-score 3.35 ± 0.59, 90% Caucasian 90%, 55% female, median age 12.3 (range: 8.9 - 17.6) years old] recently referred to a tertiary hospital-based obesity clinic underwent a routine oral glicose tolerance test and glycated haemoglobin measurement. Exclusion criteria: abnormal forms of haemoglobin and conditions linked to increased erythrocyte turnover.
Results: The oral glicose tolerance test diagnosed 13 (4.9%) subjects as prediabetic but none as diabetic. According to glycated haemoglobin, 32 would be prediabetic (29 false positives) and one would be diabetic (when he was only glucose intolerant). On the other hand, 10 prediabetic patients would not have been identified (false negatives). Glycated haemoglobin receiver operator characteristic analysis area under the curve was 0.59 (CI 95% 0.40 - 0.78), confirming its reduced capacity to identify prediabetes. Better results were achieved when calculating receiver operator characteristic analysis area under the curve for fasting glucose (0.76;
CI 95% 0.66 - 0.87), homeostasis model assessment for insulin resistance (0.77; CI 95% 0.64 - 0.90) and triglycerides:HDL cholesterol ratio (0.81; CI 95% 0.66 - 0.96).
Discussion: In Paediatric populations, especially when mainly Caucasian, glycated haemoglobin does not seem to be a useful
screening tool for prediabetes.
Conclusion: For this reason, it would appear premature to advise it as a diagnostic tool until significantly more data is available. Homeostasis model assessment for insulin resistance and triglycerides: HDL cholesterol have higher precision and can be calculated using a fasting blood sample.

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Author Biography

Julian Shield, Department of Clinical Sciences. Institute of Child Life & Health. University of Bristol. Bristol. Reino Unido. Paediatric Endocrinology, Diabetes and Metabolism Unit. Bristol Royal Hospital for Children. University Hospitals Bristol – NHS Foundation Trust. Bristol. Reino Unido.

(1) Consultor em Diabetes e Endocrinologia Pediátrica; Bristol Royal Hospital for Children, University Hospitals Bristol – NHS Foundation Trust, Reino Unido

Professor de Diabetes, Metabolismo e Endocrinologia Pediátrica; Institute of Child Life & Health – Department of Clinical Sciences, South Bristol, University of Bristol, Reino Unido

Published

2015-05-29

How to Cite

1.
Galhardo J, Shield J. The Role of Haemoglobin A1c in Screening Obese Children and Adolescents for Glucose Intolerance and Type 2 Diabetes. Acta Med Port [Internet]. 2015 May 29 [cited 2023 Feb. 3];28(3):307-15. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/5494

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Original