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Evaluation of the hemoglobin a1c test in detecting pediatric prediabetes

Yıl 2023, , 1 - 5, 31.01.2023
https://doi.org/10.16899/jcm.1095786

Öz

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.

Destekleyen Kurum

none

Kaynakça

  • 1. Cameron FJ, Wherrett DK. Care of diabetes in children and adolescents: controversies, changes, and consensus. Lancet 2015;385(9982):2096-106.
  • 2. Nakagami T, Takahashi K, Suto C, et al. Diabetes diagnostic thresholds of the glycated hemoglobin A1c and fasting plasma glucose levels considering the 5-year incidence of retinopathy. Diabetes Res Clin Pract 2017;124:20-9.
  • 3. Campbell L, Pepper T, Shipman K. HbA1c: a review of non-glycaemic variables. J Clin Pathol 2019;72(1):12-9.
  • 4. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021;44(Suppl 1):15-S33. Erratum in: Diabetes Care 2021;44(9):2182.
  • 5. Kapadia CR. Are the ADA hemoglobin A (1c) criteria relevant for the diagnosis of type 2 diabetes in youth? Curr Diab Rep 2013;13(1):51-5.
  • 6. Malkani S, DeSilva T. Controversies on how diabetes is diagnosed. Curr. Opin. Endocrinol. Diabetes Obes 2012;19(2):97-103.
  • 7. Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J 2005;47(4):458-72.
  • 8. Lee JM, Gebremariam A, Wu EL, LaRose J, Gurney JG. Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia. Diabetes Care 2011;34(12):2597-602.
  • 9. Lippi G, Targher G. A laboratory standpoint on the role of hemoglobin A1c for the diagnosis of diabetes in childhood: more doubts than certainties?. Pediatr Diabetes 2011;12(3pt1):183-6.
  • 10. Vikøren TB, Berg JP, Berg TJ. Feilkilder ved bruk av hemoglobin A1c Tidsskr Nor Laegeforen 2014;134(4):417-21.
  • 11. Tarim O, Kucukerdogan A, Gunay U, et al. Effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus. Pediatr Int 1999;41:357- 62.
  • 12. Klonoff DC. Hemoglobinopathies and Hemoglobin A1c in Diabetes Mellitus. J Diabetes 2020;14(1):3-7.
  • 13. Kim MS, Jo DS, Lee DY. Comparison of HbA1c and OGTT for the diagnosis of type 2 diabetes in children at risk of diabetes. Pediatr Neonatol 2019;60(4):428-34.
  • 14.Nowicka P, Santoro N, Liu H, et al. Utility of hemoglobin A(1c) for diagnosing prediabetes and diabetes in obese children and adolescents. Diabetes care 2011;34(6):1306-11.
  • 15. Wallace AS, Wang D, Shin JI, et al. Screening and Diagnosis of Prediabetes and Diabetes in US Children and Adolescents. Pediatrics 2020;146(3):e20200265.
  • 16. Kaur G, Lakshmi P, Rastogi A, et al. Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis. PloS one 2020;15(11):e0242415.
  • 17.Jagannathan R, Sevick MA, Fink D, et al. The 1-hour post-load glucose level is more effective than HbA1c for screening dysglycemia. Acta diabetologica 2016;53(4):543-50.
  • 18. Kim HS. Blood Glucose Measurement: Is Serum Equal to Plasma? Diabetes Metab J 2016;40(5):365-6.
  • 19. Frank EA, Shubha MC, D'Souza CJ. Blood glucose determination: plasma or serum?. J Clin Lab Anal 2012;26(5):317-20.
  • 20.Ogawa E, Urakami T, Suzuki J, Yoshida A, Takahashi S, Mugishima H. Usefulness of HbA1c to diagnose diabetes among Japanese children detected by a urine glucose screening program in the Tokyo Metropolitan Area. Endocr J 2012;59(6):465-71.

Pediatrik prediyabetin tespitinde hemoglobin a1c testinin değerlendirilmesi

Yıl 2023, , 1 - 5, 31.01.2023
https://doi.org/10.16899/jcm.1095786

Öz

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

Kaynakça

  • 1. Cameron FJ, Wherrett DK. Care of diabetes in children and adolescents: controversies, changes, and consensus. Lancet 2015;385(9982):2096-106.
  • 2. Nakagami T, Takahashi K, Suto C, et al. Diabetes diagnostic thresholds of the glycated hemoglobin A1c and fasting plasma glucose levels considering the 5-year incidence of retinopathy. Diabetes Res Clin Pract 2017;124:20-9.
  • 3. Campbell L, Pepper T, Shipman K. HbA1c: a review of non-glycaemic variables. J Clin Pathol 2019;72(1):12-9.
  • 4. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021;44(Suppl 1):15-S33. Erratum in: Diabetes Care 2021;44(9):2182.
  • 5. Kapadia CR. Are the ADA hemoglobin A (1c) criteria relevant for the diagnosis of type 2 diabetes in youth? Curr Diab Rep 2013;13(1):51-5.
  • 6. Malkani S, DeSilva T. Controversies on how diabetes is diagnosed. Curr. Opin. Endocrinol. Diabetes Obes 2012;19(2):97-103.
  • 7. Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J 2005;47(4):458-72.
  • 8. Lee JM, Gebremariam A, Wu EL, LaRose J, Gurney JG. Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia. Diabetes Care 2011;34(12):2597-602.
  • 9. Lippi G, Targher G. A laboratory standpoint on the role of hemoglobin A1c for the diagnosis of diabetes in childhood: more doubts than certainties?. Pediatr Diabetes 2011;12(3pt1):183-6.
  • 10. Vikøren TB, Berg JP, Berg TJ. Feilkilder ved bruk av hemoglobin A1c Tidsskr Nor Laegeforen 2014;134(4):417-21.
  • 11. Tarim O, Kucukerdogan A, Gunay U, et al. Effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus. Pediatr Int 1999;41:357- 62.
  • 12. Klonoff DC. Hemoglobinopathies and Hemoglobin A1c in Diabetes Mellitus. J Diabetes 2020;14(1):3-7.
  • 13. Kim MS, Jo DS, Lee DY. Comparison of HbA1c and OGTT for the diagnosis of type 2 diabetes in children at risk of diabetes. Pediatr Neonatol 2019;60(4):428-34.
  • 14.Nowicka P, Santoro N, Liu H, et al. Utility of hemoglobin A(1c) for diagnosing prediabetes and diabetes in obese children and adolescents. Diabetes care 2011;34(6):1306-11.
  • 15. Wallace AS, Wang D, Shin JI, et al. Screening and Diagnosis of Prediabetes and Diabetes in US Children and Adolescents. Pediatrics 2020;146(3):e20200265.
  • 16. Kaur G, Lakshmi P, Rastogi A, et al. Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis. PloS one 2020;15(11):e0242415.
  • 17.Jagannathan R, Sevick MA, Fink D, et al. The 1-hour post-load glucose level is more effective than HbA1c for screening dysglycemia. Acta diabetologica 2016;53(4):543-50.
  • 18. Kim HS. Blood Glucose Measurement: Is Serum Equal to Plasma? Diabetes Metab J 2016;40(5):365-6.
  • 19. Frank EA, Shubha MC, D'Souza CJ. Blood glucose determination: plasma or serum?. J Clin Lab Anal 2012;26(5):317-20.
  • 20.Ogawa E, Urakami T, Suzuki J, Yoshida A, Takahashi S, Mugishima H. Usefulness of HbA1c to diagnose diabetes among Japanese children detected by a urine glucose screening program in the Tokyo Metropolitan Area. Endocr J 2012;59(6):465-71.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Araştırma
Yazarlar

Tuba Batur 0000-0002-8225-3153

Halil İbrahim Akbay 0000-0002-4303-7837

Erdem Çokluk 0000-0002-6205-5109

Ahmet Esendemir 0000-0002-8137-0403

Yayımlanma Tarihi 31 Ocak 2023
Kabul Tarihi 12 Aralık 2022
Yayımlandığı Sayı Yıl 2023

Kaynak Göster

AMA Batur T, Akbay Hİ, Çokluk E, Esendemir A. Evaluation of the hemoglobin a1c test in detecting pediatric prediabetes. J Contemp Med. Ocak 2023;13(1):1-5. doi:10.16899/jcm.1095786