title: Screening obese children and adolescents for prediabetes and/or type 2 diabetes in pediatric practices: a validation study.
abstract: BACKGROUND
  Increased prevalence of type 2 diabetes mellitus (T2DM) makes it important for pediatricians to use effective screening tools for risk assessment of prediabetes/T2DM in children.
  
  
  METHODS
  Children (n = 149) who had an oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) were studied. American Diabetes Association recommended screening criteria-HbA1c ≥5.7% and fasting plasma glucose (FPG) ≥100 mg/dL-were compared against OGTT. The homeostatic model assessment of insulin resistance (HOMA-IR), a mathematical index derived from fasting insulin and glucose, was compared with OGTT. We studied whether combining screening tests (HbA1c and fasting glucose or HbA1c and HOMA-IR) improved accuracy of prediction of the OGTT.
  
  
  RESULTS
  HbA1c of ≥5.7% had a sensitivity of 75% and specificity of 57% when compared with the OGTT. Combining screening tests (HbA1c ≥5.7% and FPG ≥100 mg/dL; HbA1c ≥5.7% and HOMA-IR ≥3.4) resulted in improved sensitivity (95.5% for each), with the HbA1c-FPG doing better than the HbA1c-HOMA-IR combination in terms of ability to rule out prediabetes (likelihood ratio [LR]) negative. 0.07 vs 0.14).
  
  
  CONCLUSIONS
  HbA1c of ≥5.7% provided fair discrimination of glucose tolerance compared with the OGTT. The combination of HbA1c and FPG is a useful method for identifying children who require an OGTT.
authors.affiliation: New York University School of Medicine, New York, NY, USA Preneet.brar@nyumc.org.
authors.forename: Preneet C
authors.initials: PC
authors.lastname: Brar
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mengwall
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Bonita H
authors.initials: BH
authors.lastname: Franklin
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Fierman
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D019540:Area Under Curve; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D018149:Glucose Intolerance / Q000097:blood; D005951:Glucose Tolerance Test / Q000379:methods; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D063766:Pediatric Obesity / Q000175:diagnosis* / Q000453:epidemiology; D011236:Prediabetic State / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D014481:United States
chemical_list: D006442:Glycated Hemoglobin
keywords: children & adolescents; insulin resistance; obesity; prediabetes/ Type 2 diabetes; screening tools