Brar Preneet C, Mengwall Lisa, Franklin Bonita H, Fierman Arthur H
New York University School of Medicine, New York, NY, USA
New York University School of Medicine, New York, NY, USA.
Clin Pediatr (Phila). 2014 Jul;53(8):771-6. doi: 10.1177/0009922814528571. Epub 2014 Mar 25.
Increased prevalence of type 2 diabetes mellitus (T2DM) makes it important for pediatricians to use effective screening tools for risk assessment of prediabetes/T2DM in children.
Children (n = 149) who had an oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) were studied. American Diabetes Association recommended screening criteria-HbA1c ≥5.7% and fasting plasma glucose (FPG) ≥100 mg/dL-were compared against OGTT. The homeostatic model assessment of insulin resistance (HOMA-IR), a mathematical index derived from fasting insulin and glucose, was compared with OGTT. We studied whether combining screening tests (HbA1c and fasting glucose or HbA1c and HOMA-IR) improved accuracy of prediction of the OGTT.
HbA1c of ≥5.7% had a sensitivity of 75% and specificity of 57% when compared with the OGTT. Combining screening tests (HbA1c ≥5.7% and FPG ≥100 mg/dL; HbA1c ≥5.7% and HOMA-IR ≥3.4) resulted in improved sensitivity (95.5% for each), with the HbA1c-FPG doing better than the HbA1c-HOMA-IR combination in terms of ability to rule out prediabetes (likelihood ratio [LR]) negative. 0.07 vs 0.14).
HbA1c of ≥5.7% provided fair discrimination of glucose tolerance compared with the OGTT. The combination of HbA1c and FPG is a useful method for identifying children who require an OGTT.
2型糖尿病（T2DM）患病率的上升使得儿科医生使用有效的筛查工具对儿童糖尿病前期/T2DM进行风险评估变得很重要。
对进行口服葡萄糖耐量试验（OGTT）和糖化血红蛋白（HbA1c）检测的149名儿童进行研究。将美国糖尿病协会推荐的筛查标准——HbA1c≥5.7%和空腹血糖（FPG）≥100mg/dL——与OGTT结果进行比较。将基于空腹胰岛素和血糖得出的数学指标胰岛素抵抗稳态模型评估（HOMA-IR）与OGTT进行比较。我们研究了联合筛查试验（HbA1c和空腹血糖或HbA1c和HOMA-IR）是否能提高OGTT预测的准确性。
与OGTT相比，HbA1c≥5.7%的敏感性为75%，特异性为57%。联合筛查试验（HbA1c≥5.7%且FPG≥100mg/dL；HbA1c≥5.7%且HOMA-IR≥3.4）可提高敏感性（每种组合的敏感性均为95.5%），就排除糖尿病前期的能力（似然比[LR]）而言，HbA1c-FPG组合比HbA1c-HOMA-IR组合表现更好（阴性似然比分别为0.07和0.14）。
与OGTT相比，HbA1c≥5.7%对葡萄糖耐量有较好的鉴别能力。HbA1c和FPG联合是识别需要进行OGTT检查儿童的有用方法。
