Background: Screening for glucose intolerance (GI) or type 2 diabetes (T2D) is recommended for obese children over 10 years of age (or onset of puberty) in the presence of ≧2 of the following risk factors: family history of T2D in a first- or second-degree relative, high risk ethnicity, signs of insulin resistance (IR) or associated conditions, or maternal gestational diabetes. The diagnostic importance of HbA1C levels is still controversial in children and adolescents.
Aims and objectives: To evaluate the prevalence GI and T2D among a cohort of obese paediatric patients in Switzerland using Oral Glucose Tolerance Test (OGTT), and to assess the utility of alternative tests (i.e. single fasting blood sample for glucose, insulin, HOMA-IR and HbA1C) as compared to the OGTT.
Methods: All the patients with a BMI z-Score above +2 S.D.s (WHO references) had OGTT and HbA1C measurement performed. Risk factors for diabetes were evaluated.
Results: 148 patients included: mean age was 12 (range 3.218) and mean BMI z-score was +2.92 S.D.s (range 2.012.9). 34 patients (23%) had normal OGTT, 84 (57%) had IR, 28 (19%) had GI and 2 (1.4%) had T2D. 19 patients (68%) of the GI group and both T2D patients had normal fasting glucose levels. Ten patients (7%) had HbA1C ≧7.5% and poor correlation with OGTT diagnosis of GI or T2D. Among the patients diagnosed with GI, 13 (46%) did not belong to the risk-group according to the ADA guidelines, nor did the two patients diagnosed with T2D.
Conclusions: 20% of this large cohort of obese Swiss children had either GI or T2D when tested with OGTT. Remarkably, more than half would have been missed using fasting glucose measurements alone. Further, HbA1C level in children does not seem to correlate well with the diagnosis obtain with OGTT. Additional statistical analysis is ongoing to further elucidate these results.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology