Screening for type 2 diabetes in obese youth.

Abstract

OBJECTIVE:

To assess available blood tests as potential screening tools for impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM).

METHODS:

We studied 468 obese (BMI mean: 34.4 kg/m(2)) children, including a subgroup with serum fasting insulin levels of >15 microIU/mL. Fasting laboratory tests included measurements of serum glucose and insulin, hemoglobin A1c (HbA1c), and 1,5-anhydroglucitol (insulin-resistant subgroup only) levels. An oral glucose-tolerance test was performed on each patient, and 2-hour postload serum glucose and insulin levels were obtained. Fasting blood glucose (BG), Homeostasis Model of Assessment for Insulin Resistance (HOMA-IR), HbA1c, and 1,5-anhydroglucitol values were used as predictors for exceeding various 2-hour BG cut-offs. Receiver operator characteristic curves were fitted to determine area-under-the-curve values as measures of screening efficacy.

RESULTS:

In the insulin-resistant subgroup, 3 (2%) patients had T2DM and 23 (12%) had IGT. Optimal sensitivity and specificity to detect T2DM were, respectively, 99% and 96% at HbA1c >or= 6.0%, and 96% and 88% at 1,5-anhydroglucitol < 17.0 microg/mL, with lower values for fasting BG and the HOMA-IR. In the entire study group, 9 (2%) patients had T2DM and 44 (9%) had IGT. Optimal sensitivity and specificity to detect T2DM were, respectively, 86% and 85% at HbA1c levels of 5.7%, 88%, and 93% at a fasting BG level of 104 mg/dL, and 62% and 70% at an HOMA-IR of 7.9.

CONCLUSIONS:

HbA1c, 1,5-anhydroglucitol, and fasting BG levels are good predictors of T2DM in obese children, whereas HOMA-IR values are not. HbA1c and 1,5-anhydroglucitol are excellent predictors of T2DM in insulin-resistant obese children.

• Authors: Shuchi Shah, Bassil M Kublaoui, Jon D Oden, Perrin C White
• Journal: Pediatrics (Pediatrics) Vol. 124 Issue 2 Pg. 573-9 (Aug 2009) ISSN: 1098-4275 [Electronic] United States
• PMID: 19620188 (Publication Type: Journal Article)

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Insulin
• hemoglobin A1c protein, human
• 1,5-anhydroglucitol
• Deoxyglucose

Topics

• Adolescent
• Age Factors
• Blood Glucose (metabolism)
• Body Mass Index
• Child
• Deoxyglucose (blood)
• Diabetes Mellitus, Type 2 (blood, diagnosis, epidemiology)
• Female
• Glucose Tolerance Test
• Glycated Hemoglobin (metabolism)
• Humans
• Hyperglycemia (blood, diagnosis, epidemiology)
• Insulin (blood)
• Insulin Resistance (physiology)
• Male
• Mass Screening
• Obesity (blood, epidemiology)
• Predictive Value of Tests
• ROC Curve
• Texas