Yeşiltepe Mutlu Gül, Özsu Elif, Çizmecioğlu Filiz Mine, Hatun Şükrü
Kocaeli University Medical Faculty, Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Kocaeli, Turkey.
J Clin Res Pediatr Endocrinol. 2013;5(2):80-4. doi: 10.4274/Jcrpe.889.
To investigate whether glycosylated hemoglobin (HbA1c) and 1-hour glucose level in oral glucose tolerance test (OGTT) are useful parameters for evaluation of glucose homeostasis in childhood.
The medical records of 106 obese/overweight children aged from 7 to 18 years who underwent OGTT were evaluated retrospectively. The subjects were divided into 2 groups according to their one-hour glucose concentration. Group 1 consisted of subjects whose one-hour glucose level was <155 mg/dL, and Group 2 consisted of subjects whose one-hour glucose level was ≥155 mg/dL. The fasting and 2-hour glucose concentrations of the groups were compared. The sensitivity and specificity levels were determined using the ROC curve to assess the predictive value of HbA1c for impaired glucose tolerance (IGT).
The mean 2-hour glucose concentration of the subjects in Group 2 was significantly higher than that of the subjects in Group 1 (137.8±35.5 mg/dL versus 113.1±21.2 mg/dL, p<0.05). If a 5.5% cut-off value for HbA1c was accepted as predictor of IGT, the sensitivity was 63% and specificity was 70%. 31% of the subjects with HbA1c levels at or above 5.5% had IGT. This rate was significantly lower in subjects who had HbA1c levels below 5.5% (p<0.05).
Obese/overweight children and adolescents whose 1-hour glucose level is ≥155 mg/dL in the standard OGTT carry a high risk for IGT. Obese/overweight children and adolescents whose HbA1c level is at or above 5.5% may have IGT even though their fasting glucose level is normal, thus, OGTT is necessary to evaluate the glucose tolerance.
探讨糖化血红蛋白（HbA1c）和口服葡萄糖耐量试验（OGTT）中的1小时血糖水平是否为评估儿童葡萄糖稳态的有用参数。
回顾性评估106例7至18岁接受OGTT的肥胖/超重儿童的病历。根据1小时血糖浓度将受试者分为2组。第1组由1小时血糖水平<155 mg/dL的受试者组成，第2组由1小时血糖水平≥155 mg/dL的受试者组成。比较两组的空腹和2小时血糖浓度。使用ROC曲线确定敏感性和特异性水平，以评估HbA1c对糖耐量受损（IGT）的预测价值。
第2组受试者的平均2小时血糖浓度显著高于第1组受试者（137.8±35.5 mg/dL对113.1±21.2 mg/dL，p<0.05）。如果将HbA1c的5.5%临界值作为IGT的预测指标，敏感性为63%，特异性为70%。HbA1c水平在5.5%及以上的受试者中有31%患有IGT。HbA1c水平低于5.5%的受试者中这一比例显著更低（p<0.05）。
在标准OGTT中1小时血糖水平≥155 mg/dL的肥胖/超重儿童和青少年患IGT的风险很高。HbA1c水平在5.5%及以上的肥胖/超重儿童和青少年即使空腹血糖水平正常也可能患有IGT，因此，需要进行OGTT来评估糖耐量。
