Glycated hemoglobin a valuable predictor in children and adolescents
medwireNews: Glycated hemoglobin (HbA1c) is as good as blood glucose measures for predicting type 2 diabetes in children and adolescents, research suggests.
Among all 2095 study participants aged 10–19 years, HbA1c was 70% accurate for predicting diabetes onset within 10 years, while 2-hour post-load plasma glucose (2hPG) was 73% accurate and fasting plasma glucose (FPG) was 63% accurate.
Madhumita Sinha (National Institutes of Health, Phoenix, Arizona, USA) and co-researchers note that measuring HbA1c “is convenient in children because it does not require fasting”, and that it “reflects chronic glycemia and has less preanalytical and analytical variability than FPG and 2hPG.”
HbA1c also performed as well as the other two measures in children considered high risk and eligible for screening according to American Diabetes Association criteria – overweight or obese with two additional risk factors. All the study participants were Native Americans, giving all children ethnicity as a diabetes risk factor, and 72% were overweight or obese.
In this high-risk subgroup, 78% of those with HbA1c of at least 5.7% (ie, with prediabetes) developed diabetes over the subsequent 10 years, compared with 23% of those with lower levels.
There were also 2005 adults in the study, among whom diabetes risk also rose with higher HbA1c level. In men, as in children, the three tests had broadly equivalent predictive ability, but in women the accuracy of HbA1c was significantly lower than that of 2hPG.
The researchers note in Diabetes Care that their study supports using the same prediabetes HbA1c threshold in children as in adults, despite previous cross-sectional studies showing poor correlation between this and the better established FPG and 2hPG thresholds in children.
But they say: “We suggest the goal of screening is to identify those at high risk of developing diabetes (or who already have it) rather than detecting those who have prediabetes by different criteria. In this respect, the HbA1c performs as well as the other tests.”
The team concludes: “HbA1c can be used to assess risk for diabetes in children or to identify children with prediabetes with the same confidence as FPG or 2hPG.”
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