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. 2023;96(3):316-324.
doi: 10.1159/000528043. Epub 2022 Nov 15.

Prospective Test Performance of Nonfasting Biomarkers to Identify Dysglycemia in Children and Adolescents

Mary Ellen Vajravelu  1   2 , Emily Hirschfeld  3 , Acham Gebremariam  3 , Charles F Burant  4   5 , William H Herman  4   6 , Karen E Peterson  5 , Jennifer L Meijer  4   7 , Joyce M Lee  3   8
Affiliations

Prospective Test Performance of Nonfasting Biomarkers to Identify Dysglycemia in Children and Adolescents

Mary Ellen Vajravelu et al. Horm Res Paediatr. 2023.

Abstract

Introduction: Test performance screening measures for dysglycemia have not been evaluated prospectively in youth. This study evaluated the prospective test performance of random glucose (RG), 1-h nonfasting glucose challenge test (1-h GCT), hemoglobin A1c (HbA1c), fructosamine (FA), and 1,5-anhydroglucitol (1,5-AG) for identifying dysglycemia.

Methods: Youth ages 8-17 years with overweight or obesity (body mass index, BMI, ≥85th percentile) without known diabetes completed nonfasting tests at baseline (n = 176) and returned an average of 1.1 years later for two formal fasting 2-h oral glucose tolerance tests. Outcomes included glucose-defined dysglycemia (fasting plasma glucose ≥100 mg/dL or 2-h plasma glucose ≥140 mg/dL) or elevated HbA1c (≥5.7%). Longitudinal test performance was evaluated using receiver-operating characteristic (ROC) curves and calculation of area under the curve (AUC).

Results: Glucose-defined dysglycemia, elevated HbA1c, and either dysglycemia or elevated HbA1c were present in 15 (8.5%), 11 (6.3%), and 23 (13.1%) participants at baseline, and 16 (9.1%), 18 (10.3%), and 28 (15.9%) participants at follow-up. For prediction of glucose-defined dysglycemia at follow-up, RG, 1-h GCT, and HbA1c had similar performance (0.68 (95% CI: 0.55-0.80), 0.76 (95% CI: 0.64-0.89), and 0.70 (95% CI: 0.56-0.84)), while FA and 1,5-AG performed poorly. For prediction of HbA1c at follow-up, baseline HbA1c had strong performance (AUC 0.93 [95% CI: 0.88-0.98]), RG had moderate performance (AUC 0.67 [95% CI: 0.54-0.79]), while 1-h GCT, FA, and 1,5-AG performed poorly.

Conclusion: HbA1c and nonfasting glucose tests had reasonable longitudinal discrimination identifying adolescents at risk for dysglycemia, but performance depended on outcome definition.

Keywords: Adolescent; Glycated hemoglobin A; Insulin; Type 2 diabetes mellitus.

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Conflict of interest statement

Conflict of Interest Statement: Joyce M. Lee serves as a consultant to T1D Exchange, has received grant funding from Lenovo, and is on the medical advisory board for GoodRx. All other authors have no relevant conflicts of interest to disclose.

Figures

Fig. 1.
Fig. 1.
Receiver Operating Characteristic (ROC) curves by glycemic outcome (a) glucose-defined dysglycemia (Fasting Plasma Glucose ≥100 mg/dL or 2-h Plasma Glucose ≥140 mg/dL); (b) elevated HbA1c (HbA1c ≥5.7%); (c) any dysglycemia (Fasting Plasma Glucose ≥100 mg/dL, 2-h Plasma Glucose ≥140 mg/dL, or HbA1c ≥5.7%)
See this image and copyright information in PMC

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