Obeziteli Çocuklarda Glikoz Metabolizma Bozukluklarının Erken Tespitinde HbA1c ve 1. Saat OGTT Plazma Glukoz Düzeyi OGTT'nin Yerini Alabilir mi?

Yıl 2025, Cilt: 9 Sayı: 3, 307 - 317, 31.12.2025

Meliha Esra Bilici , Ayşe Bilge Baklacı

Öz

Amaç: Bu çalışmanın amacı, obeziteli çocuk ve ergenlerde glukoz metabolizma bozuklğunu (prediyabet veya diyabet) belirlemede
HbA1c ve 1. Saat OGTT glukoz düzeylerinin tanısal performansını değerlendirmek ve karşılaştırmaktır.
Gereç ve Yöntemler: Çalışmaya, Nisan 2021 ile Eylül 2025 tarihleri arasında OGTT yapılmış olan 6-18 yaş arası obeziteli çocuklar
çalışmaya dahil edilmiş olup, çalışma grubu toplam 98 olgudan oluşmaktadır. Katılımcılar Amerikan Diyabet Birliği (ADA) kriterlerine
göre Normal glukoz metabolizması grubu (NGM, n=55) ve prediyabet (n=36) ile diyabetes mellitusu (n=7) içeren Glukoz metabolizma
bozukluğu grubu (GMB, n=43) olarak iki gruba ayrılmıştır. Antropometrik ve biyokimyasal parametreler gruplar arasında uygun
parametrik veya nonparametrik testler kullanılarak karşılaştırılmıştır. HbA1c ve 1. Saat OGTT plazma glukozunun (≥155 mg/dL)
GMB'yi saptamadaki tanısal performansı, alıcı işletim karakteristiği (ROC) eğrisi analizi, duyarlılık, özgüllük ve OGTT'ye dayalı tanı ile
uyum Cohen’s kappa testi kullanılarak değerlendirilmiştir.
Bulgular: BMI SDS, GMB grubunda NGM grubuna kıyasla anlamlı derecede daha yüksekti (2,6 ± 1,5'ye karşı 2,1 ± 1,4, p = 0,012). 1.
Saat OGTT plazma glukoz düzeyi, GMB'yi belirlemede mükemmel ayırt edici yetenek göstermiş (AUC = 0,835, p < 0,001), ≥155 mg/dL
eşik değerinde %65,1 duyarlılık ve %87,3 özgüllük sağlamıştır. Buna karşılık, HbA1c GMB için zayıf bir ayırt edici yetenek göstermiştir
(AUC = 0,598, p = 0,080). 1. saat OGTT plazma glukozu ile OGTT'ye dayalı tanı arasındaki uyum orta düzeydeyken (κ = 0,47, p <
0,001), HbA1c için istatistiksel olarak anlamlı bir uyum saptanmamıştır (κ = 0,136, p = 0,146).
Sonuç: Obez çocuklarda, 1. saat OGTT plazma glukoz düzeyi, HbA1c'ye kıyasla glukoz metabolizma bozukluklarını belirlemede daha
duyarlı ve doğru bir belirteçtir. Yüksek riskli pediatrik popülasyonların değerlendirmesinde 1. saat glukoz ölçümünün dahil edilmesi,
disgliseminin daha erken saptanmasını kolaylaştırabilir.

Anahtar Kelimeler

HbA1c , 1 saatlik OGTT glukozu , OGTT , Prediyabet , Çocukluk çağı obezitesi , ROC analizi

Etik Beyan

Bu çalışma Zonguldak Bülent Ecevit Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından onaylanmış olup Helsinki Deklarasyonu etik standartlarına uyulmuştur (onay tarihi: 1 Ekim 2025; onay numarası: 2025/17).

Destekleyen Kurum

Bu araştırma kamu, ticari veya kâr amacı gütmeyen sektörlerdeki herhangi bir fon kuruluşundan özel bir hibe almamıştır.

Teşekkür

Çalışmaya katılan çocuklar ve ailelerine teşekkür ederiz. Rutin klinik ve laboratuvar süreçlerde görev alan ilgili birimlere katkılarından dolayı teşekkür ederiz.

Can HbA1c and 1-Hour Glucose Replace OGTT in Obese Children in Early Detection of Glucose Metabolism Disorders?

Öz

Aim: This study aims to evaluate and compare the diagnostic performance of HbA1c and 1-hour plasma OGTT glucose levels for
identifying glucose metabolism disorders (prediabetes or diabetes) in obese children and adolescents.
Material and Methods: Children aged 6–18 years with obesity who underwent OGTT between April 2021 and September 2025 were
included, yielding a total of 98 cases in the study cohort. Participants were primarily categorized according to American Diabetes
Association (ADA) criteria into two main groups: Normal glucose metabolism (NGM, n=55) and Glucose metabolism disorder (GMD,
n=43), which included both prediabetes (n=36) and diabetes mellitus (n=7). Anthropometric and biochemical parameters were
compared between groups using appropriate parametric or nonparametric tests. The diagnostic performance of HbA1c and 1-hour
OGTT-PG (≥155 mg/dL) for detecting GMD was evaluated using receiver operating characteristic (ROC) curve analysis, sensitivity,
specificity, and agreement (Cohen’s kappa) with the OGTT-based diagnosis..
Results: BMI SDS was significantly higher in the GMD group compared to the NGM group (2.6 ± 1.5 vs. 2.1 ± 1.4, p = 0.012). The
1-hour OGTT-PG level showed excellent discriminative ability for identifying GMD (AUC = 0.835, p < 0.001), with a sensitivity of
65.1% and specificity of 87.3% at the ≥155 mg/dL cut-off. In contrast, HbA1c demonstrated weak discriminative ability for GMD (AUC= 0.598, p = 0.080). Agreement between 1-hour OGTT-PG and OGTT-based diagnosis was moderate (κ = 0.47, p < 0.001), whereas
HbA1c alone did not show statistically significant concordance (κ = 0.136, p = 0.146).
Conclusion: In children with obesity, the 1-hour OGTT-PG level is a more sensitive and accurate marker for identifying glucose
metabolism disorders than HbA1c. Incorporating the 1-hour OGTT-PG measurement into the assessment of high-risk pediatric
populations may facilitate the earlier detection of dysglycemia.

Anahtar Kelimeler

HbA1c , 1-hour OGTT-PG , OGTT , Prediabetes , Pediatric obesity , ROC analysis

Etik Beyan

This study was approved by the Zonguldak Bulent Ecevit University Clinic Research Ethics Committee and adhered to the ethical standards of the Declaration of Helsinki (approval date: October 1, 2025; approval number: 2025/17).

Destekleyen Kurum

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Teşekkür

We thank the children and their families for their participation. We also acknowledge the assistance of departments responsible for routine laboratory and clinical evaluations.

Kaynakça

• 1. De Sanctis V, Soliman A, Daar S, Tzoulis P, Di Maio S, Kattamis C. Oral glucose tolerance test: Ηow to maximize its diagnostic value in children and adolescents. Acta Biomed. 2022 Oct 26;93(5):e2022318. doi: 10.23750/abm.v93i5.13615.
• 2. Bergman M, Abdul-Ghani M, DeFronzo RA, Manco M, Sesti G, Fiorentino TV, Ceriello A, Rhee M, Phillips LS, Chung S, Cravalho C, Jagannathan R, Monnier L, Colette C, Owens D, Bianchi C, Del Prato S, Monteiro MP, Neves JS, Medina JL, Macedo MP, Ribeiro RT, Filipe Raposo J, Dorcely B, Ibrahim N, Buysschaert M. Review of methods for detecting glycemic disorders. Diabetes Res Clin Pract. 2020 Jul;165:108233. doi: 10.1016/j.diabres.2020.108233. Epub 2020 Jun 1. Erratum in: Diabetes Res Clin Pract. 2021 Oct;180:108632. doi: 10.1016/j. diabres.2020.108632. PMID: 32497744; PMCID: PMC7977482.
• 3. Kasturi K, Onuzuruike AU, Kunnam S, Shomaker LB, Yanovski JA, Chung ST. Two- vs one-hour glucose tolerance testing: Predicting prediabetes in adolescent girls with obesity. Pediatr Diabetes. 2019 Mar;20(2):154-159. doi: 10.1111/pedi.12803. Epub 2018 Dec 27. PMID: 30520201; PMCID: PMC6361688.
• 4. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes–2020. Diabetes Care. 2020;43(Suppl 1):S14–S31. doi: 10.2337/dc20-S002.
• 5. Bergman M, Manco M, Sesti G, Dankner R, Pareek M, Jagannathan R, Chetrit A, Abdul-Ghani M, Buysschaert M, Olsen MH, Nilsson PM, Medina JL, Roth J, Groop L, Del Prato S, Raz I, Ceriello A. Petition to replace current OGTT criteria for diagnosing prediabetes with the 1-hour plasma post-load plasma glucose ≥ 155 mg/dl (8.6 mmol/L). Diabetes Res Clin Pract. 2018 Dec;146:18-33. doi: 10.1016/j.diabres.2018.09.017. Epub 2018 Sep 28. PMID: 30273707.
• 6. Nam HK, Cho WK, Kim JH, Rhie YJ, Chung S, Lee KH, Suh BK. HbA1c Cutoff for Prediabetes and Diabetes Based on Oral Glucose Tolerance Test in Obese Children and Adolescents. J Korean Med Sci. 2018 Mar 19;33(12):e93. doi: 10.3346/ jkms.2018.33.e93. PMID: 29542302; PMCID: PMC5852422.
• 7. Kostopoulou E, Skiadopoulos S, Partsalaki I, Rojas Gil AP, Spiliotis BE. Repetitiveness of the oral glucose tolerance test in children and adolescents. World J Clin Pediatr. 2021 May 9;10(3):29-39. doi: 10.5409/wjcp.v10.i3.29.
• 8. Nowicka P, Santoro N, Liu H, Lartaud D, Shaw MM, Goldberg R, Guandalini C, Savoye M, Rose P, Caprio S. Utility of hemoglobin A(1c) for diagnosing prediabetes and diabetes in obese children and adolescents. Diabetes Care. 2011 Jun;34(6):1306- 11. doi: 10.2337/dc10-1984. Epub 2011 Apr 22. P
• 9. Khokhar A, Naraparaju G, Friedman M, Perez-Colon S, Umpaichitra V, Chin VL. Comparison of A1C to Oral Glucose Tolerance Test for the Diagnosis of Prediabetes in Overweight and Obese Youth. Clin Diabetes. 2017;35(3):133-140. doi:10.2337/ cd16-0037
• 10. Eames, Jared DO; Rupert, Jedda MD. How accurate is HbA1c in diagnosing diabetes in children?. Evidence-Based Practice 24(6):p 41-42, June 2021.
• 11. Menke A, Casagrande S, Cowie CC. Contributions of A1c, fasting plasma glucose, and 2-hour plasma glucose to prediabetes prevalence: NHANES 2011–2014. Ann Epidemiol 2018;28(681–5) e2.
• 12. Li G, Han L, Wang Y, Zhao Y, Li Y, Fu J, Li M, Gao S, Willi SM. Evaluation of ADA HbA1c criteria in the diagnosis of pre-diabetes and diabetes in a population of Chinese adolescents and young adults at high risk for diabetes: a cross-sectional study. BMJ Open. 2018 Aug 8;8(8):e020665. doi: 10.1136/bmjopen- 2017-020665. PMID: 30093511; PMCID: PMC6089273.
• 13. Di Bonito P, Licenziati MR, Corica D, Wasniewska M, Di Sessa A, Miraglia del Giudice E, Morandi A, Maffeis C, Faienza MF, Mozzillo E, et al. Which Is the Most Appropriate Cut-Off of HbA1c for Prediabetes Screening in Caucasian Youths with Overweight or Obesity? International Journal of Environmental Research and Public Health. 2023; 20(2):928. https://doi. org/10.3390/ijerph20020928
• 14. Peplies J, Jiménez-Pavón D, Savva SC, Buck C, Günther K, Fraterman A, Russo P, Iacoviello L, Veidebaum T, Tornaritis M, De Henauw S, Mårild S, Molnár D, Moreno LA, Ahrens W; IDEFICS consortium. Percentiles of fasting serum insulin, glucose, HbA1c and HOMA-IR in pre-pubertal normal weight European children from the IDEFICS cohort. Int J Obes (Lond). 2014 Sep;38 Suppl 2:S39-47. doi: 10.1038/ijo.2014.134. PMID: 25376219.
• 15. Fiorentino TV, Marini MA, Succurro E, Andreozzi F, Perticone M, Hribal ML, Sciacqua A, Perticone F, Sesti G. One-Hour Postload Hyperglycemia: Implications for Prediction and Prevention of Type 2 Diabetes. J Clin Endocrinol Metab. 2018 Sep 1;103(9):3131-3143. doi: 10.1210/jc.2018-00468. PMID: 30020454.
• 16. Yeşiltepe Mutlu G, Özsu E, Çizmecioğlu FM, Hatun Ş. Can HbA1c and one-hour glucose concentration in standard OGTT be used for evaluation of glucose homeostasis in childhood? J Clin Res Pediatr Endocrinol. 2013;5(2):80-4. doi: 10.4274/Jcrpe.889. PMID: 23748058; PMCID: PMC3701926.
• 17. Ha J, Chung ST, Bogardus C, Jagannathan R, Bergman M, Sherman AS. One-hour glucose is an earlier marker of dysglycemia than two-hour glucose. Diabetes Res Clin Pract. 2023 Sep;203:110839. doi: 10.1016/j.diabres.2023.110839. Epub 2023 Jul 21. PMID: 37482221; PMCID: PMC10592221.
• 18. Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD). Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu – 2024. https://file.temd.org.tr/Uploads/publications/ guides/documents/diabetesmellitus2024.pdf. Erişim tarihi: 26 Haziran 2024.
• 19. Çatalçam S, Uzaldi EB, Arpaci DK, Bayraktaroglu T, Bilici M. Üçüncü Basemak Bir Hastaneye Başvuran Riskli Popülasyonda Oral Glukoz Tolerans Testi ile Diabetes Mellitus ve Prediyabet Prevalansının Tespiti. Türkiye Diyabet ve Obezite Dergisi. 2023;7(2):123-130.doi: 10.25048/tjdo.2017.18
• 20. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F, ve ark. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Türk Pediatri Arşivi. 2015;50(2):1-14. DOI: 10.5152/tpa.2015.2900
• 21. Kramer CK, Vuksan V, Choi H, Zinman B, Retnakaran R. Emerging parameters of the insulin and glucose response on the oral glucose tolerance test: reproducibility and implications for glucose homeostasis in individuals with and without diabetes. Diabetes Res Clin Pract. 2014 Jul;105(1):88-95. doi: 10.1016/j.diabres.2014.04.023. Epub 2014 Apr 28.
• 22. Brar PC, Mehta S, Brar A, Pierce KA, Albano A, Bergman M. Value of 1-hour OGTT-PG During an Oral Glucose Tolerance Test in a Multiethnic Cohort of Obese Children and Adolescents. Clinical Medicine Insights: Endocrinology and Diabetes. 2023;16. doi:10.1177/11795514231177206
• 23. Park SK, Ryoo JH, Oh CM, Choi JM, Jung JY. 1-Hour and 2-Hour Postload Glucose Level on Oral Glucose Tolerance Test and the Risk of Incident Metabolic Syndrome. J Clin Endocrinol Metab. 2019 Feb 1;104(2):539-549. https://doi. org/10.1210/jc.2018-01102
• 24. Lee MH, Febriana E, Lim M, Baig S, Shen L, Dalakoti M, Chew N, Loh TP, Chan M, Chia KS, Kong AP, Cook AR, Halter JB, Magkos F, Toh SA. Performance of the 1 h oral glucose tolerance test in predicting type 2 diabetes and association with impaired β-cell function in Asians: a national prospective cohort study. Lancet Reg Health West Pac. 2024 Dec 31;54:101278. doi: 10.1016/j.lanwpc.2024.101278. PMID: 39840148; PMCID: PMC11750441.
• 25. Jagannathan R, Sevick MA, Li H, Fink D, Dankner R, Chetrit A, Roth J, Bergman M. Elevated 1-hour OGTT-PG levels are associated with dysglycemia, impaired beta-cell function, and insulin sensitivity: a pilot study from a real world health care setting. Endocrine. 2016 Apr;52(1):172-5. doi: 10.1007/ s12020-015-0746-z. Epub 2015 Sep 29. PMID: 26419850; PMCID: PMC5319479.
• 26. Ohn JH, Kwak SH, Cho YM, Lim S, Jang HC, Park KS, Cho NH. 10-year trajectory of β-cell function and insulin sensitivity in the development of type 2 diabetes: a community-based prospective cohort study. Lancet Diabetes Endocrinol. 2016 Jan;4(1):27-34. doi: 10.1016/S2213-8587(15)00336-8. Epub 2015 Nov 11. PMID: 26577716.
• 27. Jagannathan R, Chetrit A, Abdul-Ghani M, Buysschaert M, Olsen MH, Nilsson PM, Medina JL, Roth J, Groop L, Del Prato S, Raz I, Ceriello A. Petition to replace current OGTT criteria for diagnosing prediabetes with the 1-hour post-load plasma glucose ≥ 155 mg/dl (8.6 mmol/L). Diabetes Res Clin Pract. 2018 Dec;146:18-33. doi: 10.1016/j.diabres.2018.09.017. Epub 2018 Sep 28. PMID: 30273707
• 28. Luo Y, Luo D, Li M, Tang B. Insulin Resistance in Pediatric Obesity: From Mechanisms to Treatment Strategies. Pediatr Diabetes. 2024 Jun 28;2024:2298306. doi: 10.1155/2024/2298306. PMID: 40302954; PMCID: PMC12016791.
• 29. Bennett CM, Guo M, Dharmage SC. HbA1c as a screening tool for detection of type 2 diabetes: a systematic review. Diabetes Care. 2007;30(2):335–341. doi:10.2337/dc06-2032
• 30. Şahin N, Araslı A, Aycan Z. Is the 1st hour plasma glucose level in OGTT an important parameter in children with normal glucose tolerance? Turk Klin J Med Sci. 2020;40(1):1-9. doi:10.5336/medsci.2019-71852
• 31. American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S20-S42. doi: 10.2337/dc24-S002. PMID: 38078589; PMCID: PMC10725812.
• 32. 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 Aug;60(4):428-434. doi: 10.1016/j.pedneo. 2018.11.002. Epub 2018 Nov 9. PMID: 30497969.
• 33. Abdul-Ghani MA, Lyssenko V, Tuomi T, DeFronzo RA, Groop L. The shape of the glucose curve during oral glucose tolerance test: physiological characterization and clinical implications. Diabetes Care. 2009;32(7):1423–1429. doi:10.2337/dc08-2448
• 34. Manco M, Panunzi S, Macfarlane DP, Golay A, Melander O, Konrad T, Petrie JR, Mingrone G, Mari A, Nolan JJ; Relationship between insulin sensitivity and cardiovascular risk (RISC) Study Group. One-hour plasma glucose identifies insulin resistance and beta-cell dysfunction in individuals with normal glucose tolerance: cross-sectional data from the RISC study. Diabetes Metab Res Rev. 2010;26(7):584–592. doi:10.1002/ dmrr.1120
• 35. Muratoğlu Şahin N, Araslı Yılmaz A, Aycan Z. Normal Glukoz Toleransına Sahip Çocuklarda OGTT’de 1. Saat Plazma Glukoz Yüksekliği Önemli Bir Parametre midir? Turkiye Klinikleri Journal of Medical Sciences. 2020;40(1):1-9. doi: 10.5336/medsci.2019-71852.
• 36. Bergman M. The 1-hour OGTT-PG: Common Link Across the Glycemic Spectrum. Front Endocrinol (Lausanne). 2021 Sep 7;12:752329. doi: 10.3389/fendo.2021.752329. PMID: 34557166; PMCID: PMC8453142.
• 37. Paddock E, Looker HC, Piaggi P, Knowler WC, Krakoff J, Chang DC. One-Hour Plasma Glucose Compared With Two- Hour Plasma Glucose in Relation to Diabetic Retinopathy in American Indians. Diabetes Care. 2018;41(6):1212-1217. doi:10.2337/dc17-1900