Shah Shuchi, Kublaoui Bassil M, Oden Jon D, White Perrin C
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA.
Pediatrics. 2009 Aug;124(2):573-9. doi: 10.1542/peds.2008-2949. Epub 2009 Jul 20.
To assess available blood tests as potential screening tools for impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM).
We studied 468 obese (BMI mean: 34.4 kg/m(2)) children, including a subgroup with serum fasting insulin levels of >15 microIU/mL. Fasting laboratory tests included measurements of serum glucose and insulin, hemoglobin A1c (HbA1c), and 1,5-anhydroglucitol (insulin-resistant subgroup only) levels. An oral glucose-tolerance test was performed on each patient, and 2-hour postload serum glucose and insulin levels were obtained. Fasting blood glucose (BG), Homeostasis Model of Assessment for Insulin Resistance (HOMA-IR), HbA1c, and 1,5-anhydroglucitol values were used as predictors for exceeding various 2-hour BG cut-offs. Receiver operator characteristic curves were fitted to determine area-under-the-curve values as measures of screening efficacy.
In the insulin-resistant subgroup, 3 (2%) patients had T2DM and 23 (12%) had IGT. Optimal sensitivity and specificity to detect T2DM were, respectively, 99% and 96% at HbA1c >or= 6.0%, and 96% and 88% at 1,5-anhydroglucitol < 17.0 microg/mL, with lower values for fasting BG and the HOMA-IR. In the entire study group, 9 (2%) patients had T2DM and 44 (9%) had IGT. Optimal sensitivity and specificity to detect T2DM were, respectively, 86% and 85% at HbA1c levels of 5.7%, 88%, and 93% at a fasting BG level of 104 mg/dL, and 62% and 70% at an HOMA-IR of 7.9.
HbA1c, 1,5-anhydroglucitol, and fasting BG levels are good predictors of T2DM in obese children, whereas HOMA-IR values are not. HbA1c and 1,5-anhydroglucitol are excellent predictors of T2DM in insulin-resistant obese children.
评估现有血液检测作为糖耐量受损（IGT）和2型糖尿病（T2DM）潜在筛查工具的可行性。
我们研究了468名肥胖儿童（体重指数平均为34.4 kg/m²），其中包括一个血清空腹胰岛素水平>15微国际单位/毫升的亚组。空腹实验室检测包括测量血清葡萄糖和胰岛素、糖化血红蛋白（HbA1c）以及1,5-脱水葡萄糖醇（仅胰岛素抵抗亚组）水平。对每位患者进行口服葡萄糖耐量试验，并获取负荷后2小时的血清葡萄糖和胰岛素水平。空腹血糖（BG）、胰岛素抵抗稳态模型评估（HOMA-IR）、HbA1c和1,5-脱水葡萄糖醇值被用作预测超过各种2小时BG临界值的指标。绘制受试者工作特征曲线以确定曲线下面积值，作为筛查效能的指标。
在胰岛素抵抗亚组中，3名（2%）患者患有T2DM，23名（12%）患有IGT。检测T2DM的最佳敏感性和特异性分别为：HbA1c≥6.0%时为99%和96%，1,5-脱水葡萄糖醇<17.0微克/毫升时为96%和88%，空腹BG和HOMA-IR的相应值较低。在整个研究组中，9名（2%）患者患有T2DM，44名（9%）患有IGT。检测T2DM的最佳敏感性和特异性分别为：HbA1c水平为5.7%时为86%和85%，空腹BG水平为104毫克/分升时为88%和93%，HOMA-IR为7.9时为62%和70%。
HbA1c、1,5-脱水葡萄糖醇和空腹BG水平是肥胖儿童T2DM的良好预测指标，而HOMA-IR值则不然。HbA1c和1,5-脱水葡萄糖醇是胰岛素抵抗肥胖儿童T2DM的优秀预测指标。
