Utility of hemoglobin A1c to screen for impaired glucose tolerance

Main Article Content

Edy K. Ginting
Aditiawati Aditiawati
Irfanuddin Irfanuddin

Abstract

Background Childhood obesity is associated with an increased
likelihood for having impaired glucose tolerance, dyslipidemia,
and diabetes. Hemoglobin Ale (HbAl c) h as emerged as a
recommended diagnostic tool for identifying diabetes and persons
at risk for the disease. This recommendation was based on data
in adults, showing the relationship between HbAl C and the
future development of diabetes . However, studies in the pediatric
population have been limited and no stan dard values of HbAlc
levels in children have been established.
Objective To evaluate HbAlc as a test for impaired glucose
tolerance in obese children and adolescents and to identify the
optimal HbAlc thresh old level (cut off poin t).
Methods We studied 65 obese and 4 overweight children (BMI 2::
+ 2 SD for age and gender) aged 10-15 years in Palembang. All
subjects underwent HbAlc and oral glucose tolerance tests.
Results Nineteen out of 69 subjects (28%) had impaired glucose
tolerance. Based on the receiver operating characteristic curve,
the optimal cut off point of HbAlc related to impaired glucose
tolerance as diagnosed by oral glucose tolerance test was found to
be 5.25%, with 63% sensitivity and 64% specificity, 40% positive
predictive value, and 82% negative predictive value. The area
under the receiver operating ch aracteristic curve was O .68 7
(95%CI 0.541-0.833; P < 0.00 1).
Conclusion A HbAlc cut off value of 5.25% may be used as a
screening tool to identify children and adolescents with impaired
glucose tolerance.

Article Details

How to Cite
1.
Ginting E, Aditiawati A, Irfanuddin I. Utility of hemoglobin A1c to screen for impaired glucose tolerance. PI [Internet]. 31Aug.2014 [cited 30Sep.2020];54(4):223-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/643
Section
Articles
Received 2016-09-16
Accepted 2016-09-16
Published 2014-08-31

References

1. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW. Body mass index and mortality in a prospective cohort of US adults. N Engl J Med. 1999;341:1097-105.
2. Giugliano R, Carneiro EC. Factors associated with obesity in school children. J Pediatr. 2004;80:17-22.
3. Lillioja S, Mott DM, Howard BV, Bennett PH, Yki-Jarvinen H, Freymond D, etal. Impaired glucose tolerance as a disorder of insulin action. Longitudinal and cross-sectional studies in Pima Indians. N Engl J Med. 1988;318:1217-25.
4. Holtz C, Smith TM, Winters FD. Childhood obesity. J Am Osteopath Assoc. 1999;99:366-71.
5. Sasaki N, Kobayashi K, Kida K, Tajima N, Matsuura N. Assessment of OGTT in Japanese children based on new diagnostic criteria of diabetes mellitus. Proceedings of the Joint Pediatric Endocrinology Meeting; 2001 Jul 7-9; Montreal, Canada.
6. Weiss R, Cali A, Caprio S. Pathogenesis of insulin resistance and glucose intolerance in childhood obesity. In: Freemark M, editor. Pediatric obesity: etiology, pathogenesis, and treatment. New York: Springe; 2010. p.234-42.
7. Rohlfing CL, Little RR, Wiedmeyer HM, England JD, Madsen R, Harris MI, et al. Use of GHb (HbAlc) in screening for undiagnosed diabetes in the U.S. population. Diabetes Care. 2000;23:187-91.
8. Edelman D, Olsen MK, Dudley TK, Harris AC, Oddone EZ. Utility of hemoglobin A1c in predicting diabetes risk. J Gen Intern Med. 2004;19:1175-80.
9. Pradhan AD, Rifai N, Buring JE, Ridker PM. Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women. Am J Med. 2007;120:720-7.
10. Lee HS, Park HK, Hwang JS. HbAlc and glucose intolerance in obese children and adolescents. Diabet Med. 2012;129:102-5.
11. Arifin E. Perbandingan toleransi glukosa pada anak sekolah dasar dengan berat badan normal, overweight dan obesitas di kecamatan ilir timur I, Palembang [thesis] [Palembang, Indonesia]: Sriwijaya University; 2008.
12. Nowicka P, Santoro N, Liu H, Lartaud D, Shaw MM, Goldberg R, et al. Utility of hemoglobin A(lc) for diagnosing prediabetes and diabetes in obese children and adolescents. Diabetes Care. 2011;34:1306-11.
13. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl. 1) :S62-9.