ESPE Abstracts

Background: HbA1c was recommended as diagnostic tool in adults at risk for diabetes. In obese patients, HbA1c shows an association even with other features of metabolic syndrome. However, its value in pediatric population for this purpose has yet to be established.

Material and methods: We determined HbA1c (IFCC method) in 307 overweight/obese children and adolescents (age 11.4±3.2; range 3.0–17.9 and BMI 27.9±4.7; range 20.4–47.6) valuated in our Pediatric Endocrinology Unit from July 2011 to March 2013. Considering ADA guidelines, HbA1c between 39–47 mmol/mol would indicate the presence of impaired hyperglycaemia, responsible for an increased risk of diabetes, while levels above 47 mmol/mol would indicate diabetes. The aim of this study is to analyze the diagnostic power of HbA1c in detecting prediabetes and to establish the relationship between HbA1c and other features or co-morbidity of metabolic syndrome (BMI, lipid values, hypertension, insulinemia, liver steatosis).

Results: Sensibility and specificity in detecting prediabetes for HbA1c cutoff of 39 mmol/mol were respectively 52.6 and 67.0%. In multivariate analysis, HbA1c showed a significant relationship with BMI (r=0.173, P=0.002), triglycerides (r=0.133, P=0.02), glycemia after OGTT (r=0.111, P=0.05), insulin levels after OGTT (r=0.157, P=0.007). No relationship was found regarding hypertension and steatosis.

Conclusion: Using 39 mmol/mol as cutoff value, HbA1c showed a poor diagnostic power for prediabetes in a pediatric overweight and obese population. Given its continuous association with glycemic values after OGTT and with metabolic syndrome features (triglycerides, BMI, insulinemia), HbA1c could be a useful and rapid tool in layering risk for metabolic syndrome in overweight/obese children, although the threshold levels and the prognostic value for HbA1c in this population have yet to be confirmed.