Pros and Cons of Current Diagnostic Tools for Risk-Based Screening of Prediabetes and Type 2 Diabetes in Children and Adolescents with Overweight or Obesity

Garonzi, Chiara; Maguolo, Alice; Maffeis, Claudio

doi:10.1159/000528342

Cited by 6 publications

(15 citation statements)

References 64 publications

(83 reference statements)

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“…Routinely testing HbA1c at the point of care should be encouraged since it allows identifying young individuals at risk of T2D that otherwise would be missed. Indeed, children with HbA1c values greater than 5.7% showed a sevenfold (girls)/fourfold (boys) increased risk of developing T2D in adulthood [ 72 ].…”

Section: Screening For Prediabetes and T2dmentioning

confidence: 99%

“…In clinical practice, we continue to use diagnostic tests and threshold values that are derived from epidemiological evidence in adult populations, while it is still debated what test is the most suitable in clinical practice. Recently, Garonzi et al have proposed a practical flow chart for the clinical use of screening tools in young individuals, taking into account pros and cons of each test [ 72 ]. They suggest starting to screen by testing FPG and HbA1c in the same fasting blood draw, as a first level examination.…”

Section: Screening For Prediabetes and T2dmentioning

confidence: 99%

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From Metabolic Syndrome to Type 2 Diabetes in Youth

et al. 2023

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In the frame of metabolic syndrome, type 2 diabetes emerges along a continuum of the risk from the clustering of all its components, namely visceral obesity, high blood pressure and lipids, and impaired glucose homeostasis. Insulin resistance is the hallmark common to all the components and, in theory, is a reversible condition. Nevertheless, the load that this condition can exert on the β-cell function at the pubertal transition is such as to determine its rapid and irreversible deterioration leading to plain diabetes. The aim of this review is to highlight, in the context of metabolic syndrome, age-specific risk factors that lead to type 2 diabetes onset in youth; resume age specific screening and diagnostic criteria; and anticipate potential for treatment. Visceral obesity and altered lipid metabolism are robust grounds for the development of the disease. Genetic differences in susceptibility to hampered β-cell function in the setting of obesity and insulin resistance largely explain why some adolescents with obesity do develop diabetes at a young age and some others do not. Lifestyle intervention with a healthy diet and physical activity remains the pillar of the type 2 diabetes treatment in youth. As to the pharmacological management, metformin and insulin have failed to rescue β-cell function and to ensure long-lasting glycemic control in youth. A new era might start with the approval for use in pediatric age of drugs largely prescribed in adults, such as dipeptidyl peptidase-4 and sodium-dependent glucose transport inhibitors, and of new weight-lowering drugs in the pipeline such as single and multiple agonists of the glucagon-like peptide 1 receptor. The latter drugs can have tremendous impact on the natural history of the disease. By treating diabetes, they will reduce the burden of all the metabolic abnormalities belonging to the syndrome while causing a tremendous weight loss hitherto never seen before.

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Section: Screening For Prediabetes and T2dmentioning

confidence: 99%

Section: Screening For Prediabetes and T2dmentioning

confidence: 99%

From Metabolic Syndrome to Type 2 Diabetes in Youth

et al. 2023

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“…Explicitly, their position is neither for nor against screening prediabetes. Pediatricians and health care providers should continue to use their clinical judgement in deciding whether or not screening is warranted[ 61 , 62 ].…”

Section: Prediabetesmentioning

confidence: 99%

“…Despite most authorities proposing risk-based screening, the optimal or the best strategy remains a matter of debate[ 43 , 62 ]. According to the latest ADA and ISPAD recommendations, fasting plasma glucose (FPG), 2-h plasma glucose level measured during oral glucose tolerance test (OGTT), and hemoglobin A1c (HbA1c) can be used to diagnose prediabetes and diabetes in childhood and adolescence[ 48 , 70 ].…”

Section: Prediabetesmentioning

confidence: 99%

Prediabetes in children and adolescents: An updated review

Ng,

Chan

2023

World J Clin Pediatr

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Prediabetes, the precursor of type 2 diabetes mellitus, is an intermediate stage between normal glucose homeostasis and overt diabetes. This asymptomatic metabolic state is increasingly prevalent in pediatric population and is very difficult to detect without appropriate screening. Studies have shown that a certain proportion of children with prediabetes will develop diabetes in a few years. Even more alarming is the evidence that youth-onset diabetes has a more aggressive clinical course with progressive beta-cell decline and accelerated end-organ damage. Despite its importance, several aspects involving prediabetes in childhood are disputed or unknown. This review presents the latest insights into this challenging entity and outlines a simplified screening approach to aid clinical practice. In summary, childhood prediabetes is an important clinical condition indicating the need for proper screening and timely intervention.

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“…The utilization of the HbA1c test has gone beyond determination of diabetes control to include diagnosis of type 2 diabetes mellitus (T2DM) [ 3 - 5 ]. However, there is still some clarity required on the superiority of HbA1c in the screening for diabetes and prediabetes [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Anaemia on HbA1c Interpretation Among Normogylcaemic Individuals With Diabetes Mellitus: A Clinical Laboratory Observational Study

Bwititi,

Wang,

Butkowski

et al. 2023

Cureus

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Background and aim: Over the past decades, glycosylated haemoglobin (HbA1c) has been a gold standard for monitoring diabetes control over a long period, relative to blood glucose level (BGL) which measures short-term results. It is speculated that anaemia and factors that induce haemolysis may cause falsely elevated HbA1c leading to ‘false positive’ interpretations. This study aimed to investigate how anaemia impacts HbA1c. Methods: This was a pathology-based observational pilot study using archived data of diabetic subjects monitored with both BGL and HbA1c in regional New South Wales (NSW), Australia. A total of 28,487 cases of blood glucose results were pooled and those with HbA1c and anaemia results were evaluated for correlation with the BGL results. Data collection was limited to de-identified information from the laboratory information system, hence details on the ethnicity and medical history were unavailable. Descriptive frequencies and Pearson correlations were performed. Results: In the pooled data, 53.36% of individuals were females, and 50.54% had BGL ≥5.6 mmol/L. In the pilot dataset, the majority (64.86%) were males, 18.92% with BGL ≤5.6 mmol/L and 67.57% had HbA1c (≥6.5%). In the entire dataset, BGL was moderately and positively correlated with HbA1c (r = 0.6), whereas in the subset of individuals with normo-BGL and anaemia, the correlation was negative (r = -0.2). Discussion: This pilot investigation observed a pertinent issue, which is a negative correlation between glycaemia and HbA1c in patients with anaemia. HbA1c was falsely increased despite normal blood glucose levels in individuals with anaemia. This advances the speculation that anaemia falsely increases HbA1c. Therefore, caution is necessary while interpreting HbA1c results for patients with anaemia, and new methods for interpretation are required.

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Pros and Cons of Current Diagnostic Tools for Risk-Based Screening of Prediabetes and Type 2 Diabetes in Children and Adolescents with Overweight or Obesity

Cited by 6 publications

References 64 publications

From Metabolic Syndrome to Type 2 Diabetes in Youth

From Metabolic Syndrome to Type 2 Diabetes in Youth

Prediabetes in children and adolescents: An updated review

Impact of Anaemia on HbA1c Interpretation Among Normogylcaemic Individuals With Diabetes Mellitus: A Clinical Laboratory Observational Study

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