Predittività dell'emoglobina glicata nei confronti dell'OGTT in una popolazione pediatrica italiana sovrappeso/obesa

Translated title of the contribution: Predictive value of glycated hemoglobin or OGTT in Italian overweight/obese children

M. C. Pellegrin, G. Tornese, E. Faleschini, O. Radillo, A. Ventura

Research output: Contribution to journalArticle

Abstract

Background. Recently glycated hemoglobin (A1c) ≥ 48 mmol/mol has been included among the diagnostic criteria for type 2 diabetes mellitus (DM2) in adults, while borderline levels of 39-47 mmol/mol indicate impaired glycemia (pre-diabetes). In overweight/obese children an oral glucose tolerance test (OGTT) is used to screen for DM2 and pre-diabetic status (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]). A1c could therefore theoretically replace OGTT as a screening test in children at risk for DM2, IFG, IGT, or insulin resistance (IR)

Methods. Italian patients aged less than 18 years, consecutively assessed for overweight/obesity (BMI > 85th percentile) in our Pediatric Endocrinology Outpatient Care Unit between July 2011 and December 2012, were included. A1c was determined for each patient (IFCC method) and an OGTT was done (blood glucose and insulin levels at 0, 60 and 120 min)

Results. Data were collected from 225 patients (105 males), mean age 11.2 ± 3.2 years and mean BMI 27.6 ± 4.7 (77% with BMI > 95th percentile). Mean A1c was 36.2 ± 4.9 mmol/mol (range 16-50). Three cases had IFG, 12 IGT and 83 IR. In 71 cases (32%) with borderline A1c, none had IFG, 5 had IGT, and 37 had IR. The only child known to be diabetic had borderline A1c. Sensitivity and specificity were 0, 67.6% for IFG, 41.6, 68.8% for IGT, 45.1, 76.1% for IR.

Conclusions. A1c is not sensitive enough for detecting diabetic and pre-diabetic status, so it would not be a reliable tool. Given the intermediate specificity of borderline A1c 39-47 mmol/mol to identify pre-diabetic status, confirmation with an OGTT is always advisable. In our series, borderline A1c was better at predicting IR.

Original languageItalian
Pages (from-to)194-199
Number of pages6
JournalGiornale Italiano di Diabetologia e Metabolismo
Volume34
Issue number4
Publication statusPublished - Dec 1 2014

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Glucose Intolerance
Glycosylated Hemoglobin A
Glucose Tolerance Test
Insulin Resistance
Fasting
Glucose
Endocrinology
Only Child
Ambulatory Care
Type 2 Diabetes Mellitus
Blood Glucose
Obesity
Insulin
Pediatrics
Sensitivity and Specificity

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

@article{b6fd5125832c4e6686465c1654300cca,
title = "Predittivit{\`a} dell'emoglobina glicata nei confronti dell'OGTT in una popolazione pediatrica italiana sovrappeso/obesa",
abstract = "Background. Recently glycated hemoglobin (A1c) ≥ 48 mmol/mol has been included among the diagnostic criteria for type 2 diabetes mellitus (DM2) in adults, while borderline levels of 39-47 mmol/mol indicate impaired glycemia (pre-diabetes). In overweight/obese children an oral glucose tolerance test (OGTT) is used to screen for DM2 and pre-diabetic status (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]). A1c could therefore theoretically replace OGTT as a screening test in children at risk for DM2, IFG, IGT, or insulin resistance (IR) Methods. Italian patients aged less than 18 years, consecutively assessed for overweight/obesity (BMI > 85th percentile) in our Pediatric Endocrinology Outpatient Care Unit between July 2011 and December 2012, were included. A1c was determined for each patient (IFCC method) and an OGTT was done (blood glucose and insulin levels at 0, 60 and 120 min)Results. Data were collected from 225 patients (105 males), mean age 11.2 ± 3.2 years and mean BMI 27.6 ± 4.7 (77{\%} with BMI > 95th percentile). Mean A1c was 36.2 ± 4.9 mmol/mol (range 16-50). Three cases had IFG, 12 IGT and 83 IR. In 71 cases (32{\%}) with borderline A1c, none had IFG, 5 had IGT, and 37 had IR. The only child known to be diabetic had borderline A1c. Sensitivity and specificity were 0, 67.6{\%} for IFG, 41.6, 68.8{\%} for IGT, 45.1, 76.1{\%} for IR.Conclusions. A1c is not sensitive enough for detecting diabetic and pre-diabetic status, so it would not be a reliable tool. Given the intermediate specificity of borderline A1c 39-47 mmol/mol to identify pre-diabetic status, confirmation with an OGTT is always advisable. In our series, borderline A1c was better at predicting IR.",
author = "Pellegrin, {M. C.} and G. Tornese and E. Faleschini and O. Radillo and A. Ventura",
year = "2014",
month = "12",
day = "1",
language = "Italian",
volume = "34",
pages = "194--199",
journal = "Giornale Italiano di Diabetologia",
issn = "1593-6104",
publisher = "UTET Periodici Scientifici srl",
number = "4",

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T1 - Predittività dell'emoglobina glicata nei confronti dell'OGTT in una popolazione pediatrica italiana sovrappeso/obesa

AU - Pellegrin, M. C.

AU - Tornese, G.

AU - Faleschini, E.

AU - Radillo, O.

AU - Ventura, A.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Background. Recently glycated hemoglobin (A1c) ≥ 48 mmol/mol has been included among the diagnostic criteria for type 2 diabetes mellitus (DM2) in adults, while borderline levels of 39-47 mmol/mol indicate impaired glycemia (pre-diabetes). In overweight/obese children an oral glucose tolerance test (OGTT) is used to screen for DM2 and pre-diabetic status (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]). A1c could therefore theoretically replace OGTT as a screening test in children at risk for DM2, IFG, IGT, or insulin resistance (IR) Methods. Italian patients aged less than 18 years, consecutively assessed for overweight/obesity (BMI > 85th percentile) in our Pediatric Endocrinology Outpatient Care Unit between July 2011 and December 2012, were included. A1c was determined for each patient (IFCC method) and an OGTT was done (blood glucose and insulin levels at 0, 60 and 120 min)Results. Data were collected from 225 patients (105 males), mean age 11.2 ± 3.2 years and mean BMI 27.6 ± 4.7 (77% with BMI > 95th percentile). Mean A1c was 36.2 ± 4.9 mmol/mol (range 16-50). Three cases had IFG, 12 IGT and 83 IR. In 71 cases (32%) with borderline A1c, none had IFG, 5 had IGT, and 37 had IR. The only child known to be diabetic had borderline A1c. Sensitivity and specificity were 0, 67.6% for IFG, 41.6, 68.8% for IGT, 45.1, 76.1% for IR.Conclusions. A1c is not sensitive enough for detecting diabetic and pre-diabetic status, so it would not be a reliable tool. Given the intermediate specificity of borderline A1c 39-47 mmol/mol to identify pre-diabetic status, confirmation with an OGTT is always advisable. In our series, borderline A1c was better at predicting IR.

AB - Background. Recently glycated hemoglobin (A1c) ≥ 48 mmol/mol has been included among the diagnostic criteria for type 2 diabetes mellitus (DM2) in adults, while borderline levels of 39-47 mmol/mol indicate impaired glycemia (pre-diabetes). In overweight/obese children an oral glucose tolerance test (OGTT) is used to screen for DM2 and pre-diabetic status (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]). A1c could therefore theoretically replace OGTT as a screening test in children at risk for DM2, IFG, IGT, or insulin resistance (IR) Methods. Italian patients aged less than 18 years, consecutively assessed for overweight/obesity (BMI > 85th percentile) in our Pediatric Endocrinology Outpatient Care Unit between July 2011 and December 2012, were included. A1c was determined for each patient (IFCC method) and an OGTT was done (blood glucose and insulin levels at 0, 60 and 120 min)Results. Data were collected from 225 patients (105 males), mean age 11.2 ± 3.2 years and mean BMI 27.6 ± 4.7 (77% with BMI > 95th percentile). Mean A1c was 36.2 ± 4.9 mmol/mol (range 16-50). Three cases had IFG, 12 IGT and 83 IR. In 71 cases (32%) with borderline A1c, none had IFG, 5 had IGT, and 37 had IR. The only child known to be diabetic had borderline A1c. Sensitivity and specificity were 0, 67.6% for IFG, 41.6, 68.8% for IGT, 45.1, 76.1% for IR.Conclusions. A1c is not sensitive enough for detecting diabetic and pre-diabetic status, so it would not be a reliable tool. Given the intermediate specificity of borderline A1c 39-47 mmol/mol to identify pre-diabetic status, confirmation with an OGTT is always advisable. In our series, borderline A1c was better at predicting IR.

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