Kumar Seema, King Eileen, Binns Helen J, Christison Amy, Cuda Suzanne E, Yee Jennifer K, Joseph Madeline, Kirk Shelley
Division of Pediatric Endocrinology and Metabolism, Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Division of Biostatistics and Epidemiology, Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Pediatr Obes. 2024 Apr;19(4):e13102. doi: 10.1111/ijpo.13102. Epub 2024 Jan 31.
Rising prevalence of obesity has led to increased rates of prediabetes and diabetes mellitus (DM) in children. This study compares rates of prediabetes and diabetes using two recommended screening tests (fasting plasma glucose [FPG] and haemoglobin A1c [HbA1c]).
Data were collected prospectively from 37 multi-component paediatric weight management programs in POWER (Paediatric Obesity Weight Evaluation Registry).
For this study, 3962 children with obesity without a known diagnosis of DM at presentation and for whom concurrent measurement of FPG and HbA1c were available were evaluated (median age 12.0 years [interquartile range, IQR 9.8, 14.6]; 48% males; median body mass index 95th percentile [%BMIp95] 134% [IQR 120, 151]). Notably, 10.7% had prediabetes based on FPG criteria (100-125 mg/dL), 18.6% had prediabetes based on HbA1c criteria (5.7%-6.4%), 0.9% had DM by FPG abnormality (≥126 mg/dL) and 1.1% had DM by HbA1c abnormality (≥6.5%). Discordance between the tests was observed for youth in both age groups (10-18 years [n = 2915] and age 2-9 years [n = 1047]).
There is discordance between FPG and HbA1c for the diagnosis of prediabetes and DM in youth with obesity. Further studies are needed to understand the predictive capability of these tests for development of DM (in those diagnosed with prediabetes) and cardiometabolic risk.
肥胖患病率的上升导致儿童糖尿病前期和糖尿病（DM）的发病率增加。本研究使用两种推荐的筛查试验（空腹血糖[FPG]和糖化血红蛋白[HbA1c]）比较糖尿病前期和糖尿病的发病率。
前瞻性收集了来自POWER（儿科肥胖体重评估登记处）37个多成分儿科体重管理项目的数据。
在本研究中，对3962名肥胖儿童进行了评估，这些儿童在就诊时未被诊断出患有DM，且同时进行了FPG和HbA1c测量（中位年龄12.0岁[四分位间距，IQR 9.8，14.6]；48%为男性；中位体重指数第95百分位[%BMIp95]为134%[IQR 120，151]）。值得注意的是，根据FPG标准（100 - 125mg/dL），10.7%的儿童患有糖尿病前期；根据HbA1c标准（5.7% - 6.4%），18.6%的儿童患有糖尿病前期；FPG异常（≥126mg/dL）的儿童中有0.9%患有DM，HbA1c异常（≥6.5%）的儿童中有1.1%患有DM。在两个年龄组（10 - 18岁[n = 2915]和2 - 9岁[n = 1047]）的青少年中均观察到了两种检测方法之间的不一致性。
在肥胖青少年中，FPG和HbA1c在糖尿病前期和DM的诊断上存在不一致性。需要进一步研究以了解这些检测方法对DM发生（在被诊断为糖尿病前期的患者中）和心脏代谢风险的预测能力。
