title: A risk score for identifying overweight adolescents with dysglycemia in primary care settings.
abstract: OBJECTIVE
  To develop a clinical risk scoring system for identifying adolescents with dysglycemia (prediabetes or diabetes) who need further confirmatory testing and to determine whether the addition of non-fasting tests would improve the prediction of dysglycemia.
  
  
  METHODS
  A sample of 176 overweight and obese adolescents (10-17 years) had a history/physical exam, a 2-h oral glucose tolerance test, and non-fasting tests [hemoglobin A1c, 1-h glucose challenge test (GCT), and random glucose test] performed. Given the low number of children with diabetes, we created several risk scoring systems combining the clinical characteristics with non-fasting tests for identifying adolescents with dysglycemia and compared the test performance.
  
  
  RESULTS
  Sixty percent of participants were white and 32% were black; 39.2% had prediabetes and 1.1% had diabetes. A basic model including demographics, body mass index percentile, family history of diabetes, and acanthosis nigricans had reasonable test performance [area under the curve (AUC), 0.75; 95% confidence interval (95% CI), 0.68-0.82]. The addition of random glucose (AUC, 0.81; 95% CI, 0.75-0.87) or 1-h GCT (AUC, 0.82; 95% CI, 0.75-0.88) to the basic model significantly improved the predictive capacity, but the addition of hemoglobin A1c did not (AUC, 0.76; 95% CI, 0.68-0.83). The clinical score thresholds to consider for the basic plus random glucose model are total score cutoffs of 60 or 65 (sensitivity 86% and 65% and specificity 60% and 78%, respectively) and for the basic plus 1-h GCT model are total score cutoffs of 50 or 55 (sensitivity 87% and 73% and specificity 59% and 76%, respectively).
  
  
  CONCLUSIONS
  Pending a validation in additional populations, a risk score combining the clinical characteristics with non-fasting test results may be a useful tool for identifying children with dysglycemia in the primary care setting.
authors: Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA. joyclee@umich.edu
authors: Joyce M
authors: JM
authors: Lee
authors: Achamyeleh
authors: A
authors: Gebremariam
authors: Susan J
authors: SJ
authors: Woolford
authors: Beth A
authors: BA
authors: Tarini
authors: Melissa A
authors: MA
authors: Valerio
authors: Surair
authors: S
authors: Bashir
authors: Ashley J
authors: AJ
authors: Eason
authors: Preciosa Y
authors: PY
authors: Choi
authors: James G
authors: JG
authors: Gurney
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D010372:Pediatrics; D011236:Prediabetic State / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011320:Primary Health Care; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human