ESPE Abstracts

Background: The incidence of Type 2 Diabetes Mellitus (T2DM) among children is escalating at an alarming rate, presenting a significant public health concern. This increase is intrinsically linked to the obesity epidemic, with most children diagnosed with T2DM being overweight or obese. While the oral glucose tolerance test (OGTT) remains the gold standard for diagnosing T2DM (and the preceding dysglycaemia), its accessibility and practicality in community settings are limited. HbA1c is thus used as a surrogate screening tool due to ease. However, the efficacy of HbA1c as a screening tool in paediatric populations is unproven, with cut-off values derived from adult data.

Aims: This study aimed to assess the utility of HbA1c, and other accessible markers, as a screening tools for dysglycaemia, prediabetes and T2DM in children.

Methods: A retrospective analysis of 451 children underwent OGTT between 2017 and 2023 included demographics, clinical history, examination findings and laboratory tests. HbA1c and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were evaluated against OGTT to ascertain sensitivity in predicting dysglycaemia and T2DM.

Results: Of the 451 patients analysed, 346 had an HbA1c within three months of OGTT. HbA1c had a sensitivity of 44.1% for dysglycaemia when using a cut-off of ≥39 mmol/mol, and 46.2% for T2DM at ≥48 mmol/mol. We used logistic regression analysis to assess the association of dysglycaemia with factors including HbA1c, HOMA-IR, abnormal liver function, sex, BMI SDS, ethnicity, deprivation, family history and acanthosis nigricans. Only HbA1c and HOMA-IR offered a statistically significant association with dysglycaemia. Combining HbA1c with HOMA-IR increased sensitivity to 76.7% for detecting dysglycaemia (specificity 66.7%) and 92.3% for T2DM (specificity 60%).

Discussion/Conclusions: These findings highlight the insensitivity of HbA1c using adult cut-offs as a standalone screening tool for dysglycaemia in paediatric populations and the risk of missing dysglycaemia without OGTT. OGTT thus remains the gold standard for accurately diagnosing dysglycaemia in at-risk paediatric patients but is limited by practicality issues in the community setting. Increased sensitivity utilising combined HbA1c and HOMA-IR, and with revised cutoffs from large paediatric datasets, this could form an effective screening tool in primary care to identify patients of concern for further investigation.