Usefulness of Combined Use of HbA1c and Fasting Plasma Glucose for Screening of Glucose Intolerance and Diabetes in Children and Adolescents

Presentation Number: MON 624
Date of Presentation: April 3rd, 2017

Jong Seo Yoon*1, Cheol Hwan So1, Hae Sang Lee1, Jung Sub Lim2 and Jin Soon Hwang3
1Ajou University School of Medicine, Suwon, Korea, Republic of (South), 2Korea Cancer Center Hospital, Seoul, Korea, Republic of (South), 3Ajou University, School of Medicine, Suwon City, Korea, Republic of (South)

Abstract

Purpose Cutoff points of fasting plasma glucose (FPG) and HbA1c for diagnosis of impaired glucose tolerance (IGT) and diabetes mellitus (DM) were based on the study performed in adult populations, without consideration of studies from the pediatric population. To date, there is no consensus on whether cutoff points of FPG and HbA1c are appropriate for the pediatric populations. The aim of this study was to determine the clinical usefulness of FPG and HbA1c as a screeng tool for identifying IGT and type 2 DM in pediatric populations.

Methods In a retrospective, single center study was conducted form April 2003 to May 2016. We studied 236 overweight or obese children and adolescents aged 4 to 17 years. All subjects had an oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) and HbA1c measurement. We used receiver operating characteristic (ROC) curve to obtain the sensitivity, specificity and optimal cutoff point of HbA1c and FPG for identifying IGT and type 2 DM.

Results Of 236 children and adolescents enrolled (median age 10.4 years [standard deviation, 2.8 years]), 145 had normal glucose tolerance, 52 had IGT and 39 had type 2 DM according to the result of OGTT. Based on the ROC curve, the optimal cutoff point of HbA1c to assess type 2 DM was >6.2%, with 94.7% sensitivity and 95.5% specificity (AUC 0.979, 95% CI 0.823-0.994). The optimal cutoff point of FPG to assess type 2 DM was >105mg/dl, with 92.3% sensitivity and 96.5% specificity (AUC 0.983, 95% CI 0.823-0.994), respectively. And if we use HbA1c >6.2% and FPG >105mg/dl in combination, then the sensitivity and specificity were 94.9% and 93.4%, respectively. When assessing HbA1c and FPG to detect IGT, HbA1c >5.7% had 61.5% of sensitivity and 53.8% of specificity (AUC 0.983, 95% CI 0.470-0.747) and FPG>105mg/dl had 55.8% of sensitivity and 52.2% of specificity (AUC 0.983, 95% CI 0.470-0.747), respectively. And if we use HbA1c >5.7% and FPG >93mg/dl in combination, then the sensitivity and specificity were 78.8% and 39.1%, respectively.

Conclusions Our results show that HbA1c and FPG, especially when used in combination, have a considerably high sensitivity in screening IGT and DM in pediatric population. Therefore, combined use of HbA1c and FPG are useful in screening for IGT and type 2 DM in pediatric populations.

 

Nothing to Disclose: JSY, CHS, HSL, JSL, JSH