Rodriguez Gonzalez Adriana, Harrison Caleb, Hewitt Brianna, Mejier Jennifer L, Vajravelu Mary Ellen
Center for Pediatric Research in Obesity and Metabolism and Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA.
UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
J Clin Endocrinol Metab. 2025 Jul 15;110(8):e2510-e2516. doi: 10.1210/clinem/dgae845.
Home-based approaches to type 2 diabetes (T2D) screening in youth may facilitate early diagnosis.
This work aimed to evaluate feasibility, acceptability, and validity of a continuous glucose monitoring (CGM)-based oral glucose tolerance test (OGTT).
A prospective observational study was conducted at a pediatric clinical and translational research center. Participants were youth aged 8 to 18 years with overweight/obesity and prediabetes-range glycated hemoglobin A1c (HbA1c), fasting glucose, or 2-hour glucose on OGTT, and/or one or more guideline-based T2D risk factors. Participants completed two 75 g 2-hour OGTT 1) at the research center using serum samples (research-OGTT), and 2) at home using blinded CGM (home-OGTT). Feasibility: Percentage with valid home-OGTT data (date/time reported, transmitter returned). Acceptability: Survey and interview responses. Validity: Sensitivity, specificity, positive- and negative predictive value (PPV, NPV) of home- vs research-OGTT dysglycemia (fasting ≥100 mg/dL; 2-hour ≥140 mg/dL).
Thirty-nine youth (54% female; 33% Black, 8% Hispanic/Latinx, 13% multiracial, 46% non-Hispanic White; age 14.6 ± 2.0 years; mean body mass index 37.0 ± 6.7 kg/m2) participated. HbA1c was 5.7% ± 0.4%, fasting glucose 85.7 ± 8.0 mg/dL, and 2-hour glucose 115.9 ± 25.9 mg/dL. Thirty (77%) had valid home-OGTT data. Acceptability was high (92% excellent/great, 8% neutral). Due to higher average values on home-OGTT, sensitivity and NPV were high (≥80%), while specificity (fasting: 10%; 2-hour: 25%) and PPV (fasting: 3.6%, 2-hour: 18.2%) were low.
Home-OGTT was acceptable, but strategies to precisely capture glucose ingestion timing could improve feasibility. Alternate dysglycemia thresholds may need to be defined prior to using CGM as a method for T2D screening in youth.
基于家庭的青少年2型糖尿病（T2D）筛查方法可能有助于早期诊断。
本研究旨在评估基于连续血糖监测（CGM）的口服葡萄糖耐量试验（OGTT）的可行性、可接受性和有效性。
在一家儿科临床与转化研究中心进行了一项前瞻性观察研究。参与者为年龄在8至18岁之间、超重/肥胖且糖化血红蛋白A1c（HbA1c）、空腹血糖或OGTT 2小时血糖处于糖尿病前期范围，和/或有一项或多项基于指南的T2D危险因素的青少年。参与者完成两项75g 2小时OGTT：1）在研究中心使用血清样本（研究性OGTT）；2）在家中使用盲法CGM（家庭OGTT）。可行性：有有效家庭OGTT数据（报告的日期/时间、发射器归还）的百分比。可接受性：调查和访谈的反馈。有效性：家庭OGTT与研究性OGTT血糖异常（空腹≥100mg/dL；2小时≥140mg/dL）的敏感性、特异性、阳性和阴性预测值（PPV、NPV）。
39名青少年（54%为女性；33%为黑人，8%为西班牙裔/拉丁裔，13%为多种族，46%为非西班牙裔白人；年龄14.6±2.0岁；平均体重指数37.0±6.7kg/m²）参与研究。HbA1c为5.7%±0.4%，空腹血糖85.7±8.0mg/dL，2小时血糖115.9±25.9mg/dL。30名（77%）有有效的家庭OGTT数据。可接受性较高（92%为优秀/良好，8%为中性）。由于家庭OGTT的平均值较高，敏感性和NPV较高（≥80%），而特异性（空腹：10%；2小时：25%）和PPV（空腹：3.6%，2小时：18.2%）较低。
家庭OGTT是可接受的，但精确捕捉葡萄糖摄入时间的策略可能会提高可行性。在将CGM用作青少年T2D筛查方法之前，可能需要定义其他血糖异常阈值。
