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J Korean Med Sci. 2018 Mar 19;33(12):e93. doi: 10.3346/jkms.2018.33.e93.

HbA1c Cutoff for Prediabetes and Diabetes Based on Oral Glucose Tolerance Test in Obese Children and Adolescents.

Author information

1
Department of Pediatrics, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea.
2
Department of Pediatrics, The Catholic University of Korea Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
3
Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea. pedendo@snubh.org.
4
Department of Pediatrics, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Korea.
5
Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
6
Department of Pediatrics, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea.

Abstract

BACKGROUND:

Oral glucose tolerance test (OGTT) is a traditional diagnostic tool for diabetes. Hemoglobin A1c (HbA1c) is an alternative method used in adults; however, its application in youths has been controversial. We evaluated the diagnostic performance of HbA1c and determined optimal cutoff points for detecting prediabetes and diabetes in youth.

METHODS:

This retrospective study included 389 obese children (217 boys, 55.8%) who had undergone simultaneous OGTT and HbA1c testing at six hospitals, Korea, between 2010 and 2016. Subjects were diagnosed with diabetes (fasting glucose ≥ 7.0 mmol/L; 2-hour glucose ≥ 11.1 mmol/L) or prediabetes (fasting glucose 5.6-6.9 mmol/L; 2-hour glucose 7.8-11.0 mmol/L). The diagnostic performance of HbA1c for prediabetes and diabetes was determined using the area under the receiver operating characteristic curve (AUC).

RESULTS:

At diagnosis, 197 (50.6%) subjects had normoglycemia, 121 (31.1%) had prediabetes, and 71 (18.3%) had diabetes. The kappa coefficient for agreement between OGTT and HbA1c was 0.464. The optimal HbA1c cutoff points were 5.8% (AUC, 0.795; a sensitivity of 64.1% and a specificity of 83.8%) for prediabetes and 6.2% (AUC, 0.972; a sensitivity of 91.5% and a specificity of 93.7%) for diabetes. When HbA1c (≥ 6.2%) and 2-hour glucose level were used to diagnose diabetes, 100% were detected.

CONCLUSION:

Pediatric criteria for HbA1c remain unclear, therefore, we recommend the combination of fasting and 2-hour glucose levels, in addition to HbA1c, in the diagnosis of childhood prediabetes and diabetes.

KEYWORDS:

Diabetes Mellitus; Diagnosis; Glucose Tolerance Test; HbA1c; Prediabetic State

PMID:
29542302
PMCID:
PMC5852422
DOI:
10.3346/jkms.2018.33.e93
[Indexed for MEDLINE]
Free PMC Article

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