Pediatrik prediyabetin tespitinde hemoglobin a1c testinin değerlendirilmesi

Abstract

Amaç: Hemoglobin A1c (HbA1c) testinin pediatrik prediyabet açısından tanısal performansının değerlendirilmesi, adolesan yaş grubu için cut-off değer belirlenmesi amaçlandı. Gereç ve Yöntem: Çalışma, yaşları 10-18 yıl arasında değişen toplam 379 çocuğa ait verinin retrospektif değerlendirilmesiyle gerçekleştirildi. Prediyabet vakaları glukoz [açlık ve 75 g oral glukoz tolerans testi (OGTT) 2. Saat (2. sa)] ve Hba1c kriterlerine göre belirlendi. Sensitivite, spesifite, pozitif prediktif değer (PPV), negatif prediktif değer (NPV) ve ROC (receiver-operating characteristic) analiziyle AUC (area under the curve); açlık ve OGTT 2 sa glukozu, HbA1c testlerinin her biri için hesaplandı. Bulgular: Bireylerin %2.1’i diabetes mellitus, %21.9’u prediyabet, %76.0’ı ise normoglisemi grubuna atandı. Prediyabette HbA1c testi için 5.7 değeri cut-off olarak alındığında sensitivite %53.0 olarak hesaplandı. HbA1c testi için AUC 0.83 olarak hesaplandı. HbA1c opimal cut-off değeri %5.55 olarak belirlendi. Bu değerde sensitivite %62.7, spesifite ise %93.0 olarak hesaplandı. Sonuç: Pediatrik yaşlarda prediyabet tanısında erişkin HbA1c kriterlerinin kullanımı glukoz ve HbA1c temelli test sonuçları arasındaki farklılıklar nedeniyle tartışmalı olsa da prediyabet taraması önemini korumaktadır. HbA1c ≥ 5.55 değerinin prediyabetli adolesanların risk açısından takip edilmesi ve kan glukoz düzeyiyle taranması konusunda faydalı olacağı kanaatindeyiz

Keywords

• hba1c
• pediatrik prediyabet
• tanısal performans

Evaluation of the hemoglobin a1c test in detecting pediatric prediabetes

Abstract

Aim: It was aimed to evaluate the diagnostic performance of the hemoglobin A1c (HbA1c) test in pediatric prediabetes, and to determine the cut-off value for the adolescent. Material and Method: This study was carried out by retrospectively evaluating the data of 379 adolescents aged between 10 and 18 years. Prediabetes was diagnosed based on glucose criteria, either the fasting glucose value or the 2-hour (2h) glucose value during a 75 g oral glucose tolerance test (OGTT), or HbA1c criteria. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for fasting, OGTT 2h glucose, and HbA1c. The area under the curve (AUC) was calculated for each test by receiver-operating characteristic analysis. Results: 2.1% of individuals were assigned to the diabetes mellitus group, 21.9% to the prediabetes group, and 76.0% to the normoglycemia group. When 5.7 was used as the threshold value for HbA1c in prediabetes, the sensitivity was 53.0%. The AUC was 0.83 for the HbA1c test. An HbA1c threshold of 5.55% was determined as the optimal cut-off for diagnosing prediabetes, with 62.7% sensitivity and 93.0% specificity. Conclusion: Although the use of adults’ HbA1c criteria for the diagnosis of prediabetes in the pediatric ages is controversial due to the differences between the results of glucose and HbA1c-based tests, prediabetes screening is still important. HbA1c≥5.55 will be useful to follow up on adolescents with prediabetes in terms of risk and to screen them with blood glucose.

Keywords

• hba1c
• pediatric prediabetes
• diagnostic performance

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