Chan Christine L, McFann Kim, Newnes Lindsey, Nadeau Kristen J, Zeitler Philip S, Kelsey Megan
Children's Hospital Colorado, Aurora, CO, USA.
Pediatr Diabetes. 2014 Dec;15(8):557-63. doi: 10.1111/pedi.12132. Epub 2014 Mar 17.
Standardization of the hemoglobin A1c (A1c) assay has led to its increasing utilization as a screening tool for the diagnosis of prediabetes and type 2 diabetes in youth. However, significant A1c assay variability remains and has implications for clinical management.
To describe our center's experiences with A1c results in youth and to evaluate inter-method differences and their clinical implications.
Seventy-five youth (aged 10-18 yr old), body mass index (BMI) ≥85th‰ participated.
Seventy-two participants had two A1c values performed on the same sample, one via immunoassay (DCA Vantage Analyzer, A1c1 ) and the other via high performance liquid chromatography (Bio-Rad Variant II, A1c2 ). Nineteen had A1c run on two immunoassay devices (A1c1 and Dimensions Vista, A1c3 ).
Mean age of participants was 13.9 years, BMI% 97.89%, 33% male, 16% white, 21% black, and 61% Hispanic (H). Mean A1c1 was 5.68% ± 0.38 vs. a mean A1c2 of 5.73% ± 0.39, p = 0.049. Concordance in diabetes status between methods was achieved in 79% of subjects. Nineteen subjects with A1c3 results had testing performed an average of 22 ± 9 days prior to A1c1 . Mean A1c3 was 6.24% ± 0.4, compared to a mean A1c1 of 5.74% ± 0.31, (p < 0.0001). A1c1 was on average systematically -0.5 ± 0.28 lower compared to A1c3 . There was poor agreement in diabetes classification between A1c1 and A1c3 , with a concordance in classification between methods of only 36.8%.
Clinically significant inter-method A1c variability exists that impacts patient classification and treatment recommendations. In the screening of obese youth for diabetes, A1c results should be interpreted with caution.
糖化血红蛋白（A1c）检测的标准化使得其越来越多地被用作青少年糖尿病前期和2型糖尿病诊断的筛查工具。然而，A1c检测仍存在显著差异，这对临床管理有影响。
描述我们中心在青少年A1c检测结果方面的经验，并评估不同检测方法之间的差异及其临床意义。
75名青少年（年龄10 - 18岁）参与，体重指数（BMI）≥第85百分位数。
72名参与者对同一样本进行了两次A1c检测，一次通过免疫测定法（DCA Vantage分析仪，A1c1），另一次通过高效液相色谱法（伯乐Variant II，A1c2）。19名参与者在两种免疫测定设备上进行了A1c检测（A1c1和Dimension Vista，A1c3）。
参与者的平均年龄为13.9岁，BMI%为97.89%，33%为男性，16%为白人，21%为黑人，61%为西班牙裔（H）。平均A1c1为5.68%±0.38，而平均A1c2为5.73%±0.39，p = 0.049。79%的受试者在糖尿病状态的检测方法之间达成了一致性。19名有A1c3检测结果的受试者在进行A1c1检测前平均22±9天进行了该项检测。平均A1c3为6.24%±0.4，相比之下平均A1c1为5.74%±0.31，（p < 0.0001）。与A1c3相比，A1c1平均系统性地低0.5±0.28。A1c1和A1c3在糖尿病分类方面的一致性较差，检测方法之间的分类一致性仅为36.8%。
存在具有临床意义的不同A1c检测方法间的差异，这会影响患者分类和治疗建议。在筛查肥胖青少年糖尿病时，应谨慎解读A1c检测结果。
