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. 2011 Dec;34(12):2597-602.
doi: 10.2337/dc11-0827. Epub 2011 Sep 27.

Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia

Joyce M Lee  1 , Achamyeleh Gebremariam, En-Ling Wu, Jennifer LaRose, James G Gurney
Affiliations

Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia

Joyce M Lee et al. Diabetes Care. 2011 Dec.

Abstract

Objective: To assess performance of nonfasting tests to screen children for dysglycemia (prediabetes or diabetes).

Research design and methods: This was a cross-sectional study of 254 overweight or obese (BMI ≥85th percentile) children aged 10-17 years. Subjects came for two visits to a clinical research unit. For visit one, they arrived fasting and a 2-h glucose tolerance test and HbA(1c) and fructosamine testing were performed. For visit two, they arrived nonfasting and had a random plasma glucose, a 1-h 50-g nonfasting glucose challenge test (1-h GCT), and urine dipstick performed. The primary end point was dysglycemia (fasting plasma glucose ≥100 mg/dL or a 2-h postglucose ≥140 mg/dL). Test performance was assessed using receiver operating characteristic (ROC) curves and calculations of area under the ROC curve.

Results: Approximately one-half of children were female, 59% were white, and 30% were black. There were 99 (39%) cases of prediabetes and 3 (1.2%) cases of diabetes. Urine dipstick, HbA(1c) (area under the curve [AUC] 0.54 [95% CI 0.47-0.61]), and fructosamine (AUC 0.55 [0.47-0.63]) displayed poor discrimination for identifying children with dysglycemia. Both random glucose (AUC 0.66 [0.60-0.73]) and 1-h GCT (AUC 0.68 [0.61-0.74]) had better levels of test discrimination than HbA(1c) or fructosamine.

Conclusions: HbA(1c) had poor discrimination, which could lead to missed cases of dysglycemia in children. Random glucose or 1-h GCT may potentially be incorporated into clinical practice as initial screening tests for prediabetes or diabetes and for determining which children should undergo further definitive testing.

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Figures

Figure 1
Figure 1
ROC curve for predicting dysglycemia (prediabetes or diabetes) at various thresholds of nonfasting tests. A: HbA1c (AUC 0.54 [95% CI 0.47–0.61]; n = 254). B: Fructosamine (AUC 0.55 [0.47–0.63]; n = 222). C: Random glucose (AUC 0.66 [0.60–0.73]; n = 243). D: 1-h GCT (AUC 0.68 [0.61–0.74]; n = 241).
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