Screening markers of impaired glucose tolerance in the obese pediatric population.
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.


CONCLUSIONS
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.
Tsay
J
J
Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA.
Pomeranz
C
C
Hassoun
A
A
Zandieh
S O
SO
Rutledge
J
J
Vogiatzi
M G
MG
Oberfield
S E
SE
Motaghedi
R
R
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000378:metabolism; D018149:Glucose Intolerance / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005951:Glucose Tolerance Test / Q000592:standards*; D006442:Glycated Hemoglobin / Q000032:analysis* / Q000378:metabolism; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D055815:Young Adult
D015415:Biomarkers; D005947:Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human