alexa Diagnosis of diabetes using hemoglobin A1c: should recommendations in adults be extrapolated to adolescents?
Infectious Diseases

Infectious Diseases

Journal of AIDS & Clinical Research

Author(s): Lee JM, Wu EL, Tarini B, Herman WH, Yoon E, Lee JM, Wu EL, Tarini B, Herman WH, Yoon E

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Abstract OBJECTIVE: To compare test performance of hemoglobin A1c (HbA1c) for detecting diabetes mellitus/pre-diabetes for adolescents versus adults in the United States. STUDY DESIGN: Individuals were defined as having diabetes mellitus (fasting plasma glucose [FPG] ≥ 126 mg/dL; 2-hour plasma glucose (2-hr PG) ≥ 200 mg/dL) or pre-diabetes (100 ≤ FPG < 126 mg/dL; 140 ≤ 2-hr PG < 200 mg/dL. HbA1c test performance was evaluated with receiver operator characteristic (ROC) analyses. RESULTS: Few adolescents had undiagnosed diabetes mellitus (n = 4). When assessing FPG to detect diabetes, an HbA1c of 6.5\% had sensitivity rates of 75.0\% (30.1\% to 95.4\%) and 53.8\% (47.4\% to 60.0\%) and specificity rates of 99.9\% (99.5\% to 100.0\%) and 99.5\% (99.3\% to 99.6\%) for adolescents and adults, respectively. Additionally, when assessing FPG to detect diabetes mellitus, an HbA1c of 5.7\% had sensitivity rates of 5.0\% (2.6\% to 9.2\%) and 23.1\% (21.3\% to 25.0\%) and specificity rates of 98.3\% (97.2\% to 98.9\%) and 91.1\% (90.3\% to 91.9\%) for adolescents and adults, respectively. ROC analyses suggested that HbA1c is a poorer predictor of diabetes mellitus (area under the curve, 0.88 versus 0.93) and pre-diabetes (FPG area under the curve 0.61 versus 0.74) for adolescents compared with adults. Performance was poor regardless of whether FPG or 2-hr PG measurements were used. CONCLUSIONS: Use of HbA1c for diagnosis of diabetes mellitus and pre-diabetes in adolescents may be premature, until information from more definitive studies is available. Copyright © 2011 Mosby, Inc. All rights reserved.
This article was published in J Pediatr and referenced in Journal of AIDS & Clinical Research

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