Dataset Information

HbA1c and the Prediction of Type 2 Diabetes in Children and Adults.

ABSTRACT:

Objective

Long-term data validating glycated hemoglobin (HbA_1c) in assessing the risk of type 2 diabetes in children are limited. HbA_1c, fasting plasma glucose (FPG), and 2-h postload plasma glucose (2hPG) concentrations were measured in a longitudinal study of American Indians to determine their utility in predicting incident diabetes, all of which is thought to be type 2 in this population.

Research design and methods

Incident diabetes (FPG ?126 mg/dL [7.0 mmol/L], 2hPG ?200 mg/dL [11.1 mmol/L], HbA_1c ?6.5% [8 mmol/mol], or clinical diagnosis) was determined in 2,095 children without diabetes ages 10-19 years monitored through age 39, and in 2,005 adults ages 20-39 monitored through age 59. Areas under the receiver operating characteristic (ROC) curve for HbA_1c, FPG, and 2hPG in predicting diabetes within 10 years were compared.

Results

During long-term follow-up of children and adolescents who did not initially have diabetes, the incidence rate of subsequent diabetes was fourfold (in boys) as high and more than sevenfold (in girls) as high in those with HbA_1c ?5.7% as in those with HbA_1c ?5.3%-greater rate ratios than experienced by adults in the same HbA_1c categories. Analyses of ROCs revealed no significant differences between HbA_1c, FPG, and 2hPG in sensitivity and specificity for identifying children and adolescents who later developed diabetes.

Conclusions

HbA_1c is a useful predictor of diabetes risk in children and can be used to identify prediabetes in children with other type 2 diabetes risk factors with the same predictive value as FPG and 2hPG.

SUBMITTER: Vijayakumar P

PROVIDER: S-EPMC5180461 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Publications

HbA1c and the Prediction of Type 2 Diabetes in Children and Adults.

Vijayakumar Pavithra P Nelson Robert G RG Hanson Robert L RL Knowler William C WC Sinha Madhumita M

Diabetes care 20161103 1

<h4>Objective</h4>Long-term data validating glycated hemoglobin (HbA<sub>1c</sub>) in assessing the risk of type 2 diabetes in children are limited. HbA<sub>1c</sub>, fasting plasma glucose (FPG), and 2-h postload plasma glucose (2hPG) concentrations were measured in a longitudinal study of American Indians to determine their utility in predicting incident diabetes, all of which is thought to be type 2 in this population.<h4>Research design and methods</h4>Incident diabetes (FPG ≥126 mg/dL [7.0 ...[more]

PMID: 27810987

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Project description:Study questionWhat is the extent and effect of excessive testing for glycated hemoglobin (HbA1c) among adults with controlled type 2 diabetes?MethodsA retrospective analysis of data from a national administrative claims database included commercially insured individuals in the USA, 2001-13. Study patients were aged 18 years or older, had type 2 diabetes with stable glycemic control (two consecutive tests showing HbA1c<7.0% within 24 months), did not use insulin, had no history of severe hypoglycemia or hyperglycemia, and were not pregnant. HbA1c testing frequency was measured within 24 months after the second (index) HbA1c test, and classified as guideline recommended (≤ 2 times/year), frequent (3-4 times/year), and excessive (≥ 5 times/year). Changes in treatment regimen were ascertained within three months of the index test.Study answer and limitationsOf 31,545 patients in the study cohort (mean age 58 years; mean index HbA1c 6.2%), HbA1c testing frequency was excessive in 6% and frequent in 55%. Despite good glycemic control at baseline, treatment was further intensified by addition of glucose lowering drugs or insulin in 8.4% of patients (comprising 13%, 9%, and 7% of those tested excessively, frequently, and per guidelines, respectively; P<0.001). Compared with guideline recommended testing, excessive testing was associated with treatment intensification (odds ratio 1.35 (95% confidence interval 1.22 to 1.50)). Excessive testing rates remained unchanged in 2001-08, but fell significantly after 2009. The odds of excessive testing was 46% lower in 2011 than in 2001-02. The study population is not representative of all US patients with type 2 diabetes because it was restricted to commercially insured adults with stable and controlled diabetes not receiving insulin treatment. The study design did not capture the underuse of HbA1c testing.What this study addsIn this US cohort of adults with stable and controlled type 2 diabetes, more than 60% received too many HbA1c tests, a practice associated with potential overtreatment with hypoglycemic drugs. Excessive testing contributes to the growing problem of waste in healthcare and increased patient burden in diabetes management.Funding, competing interests, data sharingNDS and RGM are funded partly by the Agency for Healthcare Research and Quality (R18HS18339) and AcademyHealth Delivery System Science Fellowship (2013), respectively. No competing interests declared. Additional data are available from mccoy.rozalina@mayo.edu.

Dataset Information

HbA1c and the Prediction of Type 2 Diabetes in Children and Adults.

Objective

Research design and methods

Results

Conclusions

Publications

HbA1c and the Prediction of Type 2 Diabetes in Children and Adults.

Similar Datasets

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