title: Use of HbA(1C) testing to diagnose pre-diabetes in high risk African American children: a comparison with fasting glucose and HOMA-IR.
abstract: OBJECTIVE
  This study aimed to compare the discriminating power of HbA(1C) with other pre-diabetes diagnostic tests specifically in high-risk African American children.
  
  
  METHODS
  A cross-sectional analysis was performed on a sample of 172 children (70 boys and 102 girls) aged 9-11 years with BMI's above the 85th percentile. Fasting glucose, insulin and HbA(1C) were analyzed from the plasma samples.
  
  
  RESULTS
  Of the 172 participants included in this analysis, 21 (12.2%) had HbA(1C) concentrations above the cutoff of 5.7 used to identify pre-diabetes. None (0%) of these 21 participants, however, were observed to have a glucose concentration above the pre-diabetes cutoff of 110 mg/dl, and only 13 of 21 participants had HOMA-IR above the pre-diabetes cutoff of 2.5. When compared to the previously identified glucose cutoff of 110 mg/dl and HOMA-IR cutoff of 2.5 for pre-diabetes, HbA(1C) showed high specificity (88 and 93%, respectively) but very low sensitivity (0 and 21%, respectively). Glucose, insulin and HOMA-IR were significantly interrelated, but HbA(1C) was not significantly correlated with these biochemical prediabetes assessment variables, nor with anthropometric (BMIz, WC) risk factors.
  
  
  CONCLUSIONS
  Our results suggest that HbA(1C) had poor discrimination power to identify prediabetes in overweight and obese 9- to 11-year-old African American children. Future studies are recommended to compare the feasibility, sensitivity and predictive power of different screening tests currently recommended to avoid inadequacy when screening for prediabetes and diabetes.
authors.affiliation: Dr Robert C and Veronica Atkins Center for Weight and Health, University of California, Berkeley, CA 94720-3104, USA. sushma@berkeley.edu
authors.forename: Sushma
authors.initials: S
authors.lastname: Sharma
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Fleming
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D005215:Fasting / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008403:Mass Screening; D009765:Obesity / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D011236:Prediabetic State / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012923:Social Class; D014481:United States / Q000453:epidemiology; D014505:Urban Population
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human