title: Diabetes screening in overweight and obese children and adolescents: choosing the right test.
abstract: Type 2 diabetes can occur without any symptoms, and health problems associated with the disease are serious. Screening tests allowing an early diagnosis are desirable. However, optimal screening tests for diabetes in obese youth are discussed controversially. We performed an observational multicenter analysis including 4848 (2668 female) overweight and obese children aged 7 to 17 years without previously known diabetes. Using HbA1c and OGTT as diagnostic criteria, 2.4% (n = 115, 55 female) could be classified as having diabetes. Within this group, 68.7% had HbA1c levels ≥48 mmol/mol (≥6.5%). FPG ≥126 mg/dl (≥7.0 mmol/l) and/or 2-h glucose levels ≥200 mg/dl (≥11.1 mmol/l) were found in 46.1%. Out of the 115 cases fulfilling the OGTT and/or HbA1c criteria for diabetes, diabetes was confirmed in 43.5%. For FPG, the ROC analysis revealed an optimal threshold of 98 mg/dl (5.4 mmol/l) (sensitivity 70%, specificity 88%). For HbA1c, the best cut-off value was 42 mmol/mol (6.0%) (sensitivity 94%, specificity 93%).
  
  
  CONCLUSIONS
  HbA1c seems to be more reliable than OGTT for diabetes screening in overweight and obese children and adolescents. The optimal HbA1c threshold for identifying patients with diabetes was found to be 42 mmol/mol (6.0%). What is Known: • The prevalence of obesity is increasing and health problems related to type 2 DM can be serious. However, an optimal screening test for diabetes in obese youth seems to be controversial in the literature. What is New: • In our study, the ROC analysis revealed for FPG an optimal threshold of 98 mg/dl (5.4 mmol/l, sensitivity 70%, specificity 88%) and for HbA1c a best cut-off value of 42 mmol/mol (6.0%, sensitivity 94%, specificity 93%) to detect diabetes. Thus, in overweight and obese children and adolescents, HbA1c seems to be a more reliable screening tool than OGTT.
authors.affiliation: Public Health Department of Stuttgart, Department of Pediatrics, Dental Health Care, Health Promotion and Social Services, Schloßstraße 91, 70176, Stuttgart, Germany.|Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ehehalt
authors.affiliation: Department of Pediatric Endocrinology and Diabetes, Charité Children's Hospital, Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany. susanna.wiegand@charite.de.
authors.forename: Susanna
authors.initials: S
authors.lastname: Wiegand
authors.affiliation: Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Liebigstraße 20a, D-04103, Leipzig, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Körner
authors.affiliation: Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Schweizer
authors.affiliation: Endokrinologikum Berlin am Gendarmenmarkt, Friedrichstraße 76, Jägerstraße 61, 10117, Berlin, Germany.
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Liesenkötter
authors.affiliation: Endokrinologikum Hamburg, Lornsenstraße 4-6, 22767, Hamburg, Germany.
authors.forename: Carl-Joachim
authors.initials: CJ
authors.lastname: Partsch
authors.affiliation: Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Liebigstraße 20a, D-04103, Leipzig, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Spielau
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, Department of Pediatrics and Adolescent Medicine, Ulm University, Eythstr. 24, D-89073, Ulm, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Denzer
authors.affiliation: Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ranke
authors.affiliation: Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Neu
authors.affiliation: Pediatric Endocrinology and Diabetes, University Children's Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Binder
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, Department of Pediatrics and Adolescent Medicine, Ulm University, Eythstr. 24, D-89073, Ulm, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wabitsch
authors.affiliation: Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Liebigstraße 20a, D-04103, Leipzig, Germany.
authors.forename: Wieland
authors.initials: W
authors.lastname: Kiess
authors.affiliation: Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children's Hospital, University Witten/Herdecke, Dr. F. Steiner Str. 5, D-45711, Datteln, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinehr
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D063766:Pediatric Obesity; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Children; Diabetes; HbA1c; OGTT; Overweight; Screening