title: Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia.
abstract: OBJECTIVE
  To assess performance of nonfasting tests to screen children for dysglycemia (prediabetes or diabetes).
  
  
  METHODS
  This was a cross-sectional study of 254 overweight or obese (BMI ≥85th percentile) children aged 10-17 years. Subjects came for two visits to a clinical research unit. For visit one, they arrived fasting and a 2-h glucose tolerance test and HbA(1c) and fructosamine testing were performed. For visit two, they arrived nonfasting and had a random plasma glucose, a 1-h 50-g nonfasting glucose challenge test (1-h GCT), and urine dipstick performed. The primary end point was dysglycemia (fasting plasma glucose ≥100 mg/dL or a 2-h postglucose ≥140 mg/dL). Test performance was assessed using receiver operating characteristic (ROC) curves and calculations of area under the ROC curve.
  
  
  RESULTS
  Approximately one-half of children were female, 59% were white, and 30% were black. There were 99 (39%) cases of prediabetes and 3 (1.2%) cases of diabetes. Urine dipstick, HbA(1c) (area under the curve [AUC] 0.54 [95% CI 0.47-0.61]), and fructosamine (AUC 0.55 [0.47-0.63]) displayed poor discrimination for identifying children with dysglycemia. Both random glucose (AUC 0.66 [0.60-0.73]) and 1-h GCT (AUC 0.68 [0.61-0.74]) had better levels of test discrimination than HbA(1c) or fructosamine.
  
  
  CONCLUSIONS
  HbA(1c) had poor discrimination, which could lead to missed cases of dysglycemia in children. Random glucose or 1-h GCT may potentially be incorporated into clinical practice as initial screening tests for prediabetes or diabetes and for determining which children should undergo further definitive testing.
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA. joyclee@umich.edu
authors.forename: Joyce M
authors.initials: JM
authors.lastname: Lee
authors.forename: Achamyeleh
authors.initials: A
authors.lastname: Gebremariam
authors.forename: En-Ling
authors.initials: EL
authors.lastname: Wu
authors.forename: Jennifer
authors.initials: J
authors.lastname: LaRose
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D044383:Black People; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003920:Diabetes Mellitus / Q000175:diagnosis*; D005215:Fasting; D005260:Female; D019270:Fructosamine / Q000097:blood; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D050177:Overweight / Q000150:complications* / Q000175:diagnosis; D011236:Prediabetic State / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D044465:White People
chemical_list: D001786:Blood Glucose; D019270:Fructosamine; D006442:Glycated Hemoglobin