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Diabetes screening in overweight and obese children and adolescents: choosing the right test

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Abstract

Type 2 diabetes can occur without any symptoms, and health problems associated with the disease are serious. Screening tests allowing an early diagnosis are desirable. However, optimal screening tests for diabetes in obese youth are discussed controversially. We performed an observational multicenter analysis including 4848 (2668 female) overweight and obese children aged 7 to 17 years without previously known diabetes. Using HbA1c and OGTT as diagnostic criteria, 2.4% (n = 115, 55 female) could be classified as having diabetes. Within this group, 68.7% had HbA1c levels ≥48 mmol/mol (≥6.5%). FPG ≥126 mg/dl (≥7.0 mmol/l) and/or 2-h glucose levels ≥200 mg/dl (≥11.1 mmol/l) were found in 46.1%. Out of the 115 cases fulfilling the OGTT and/or HbA1c criteria for diabetes, diabetes was confirmed in 43.5%. For FPG, the ROC analysis revealed an optimal threshold of 98 mg/dl (5.4 mmol/l) (sensitivity 70%, specificity 88%). For HbA1c, the best cut-off value was 42 mmol/mol (6.0%) (sensitivity 94%, specificity 93%).

Conclusions: HbA1c seems to be more reliable than OGTT for diabetes screening in overweight and obese children and adolescents. The optimal HbA1c threshold for identifying patients with diabetes was found to be 42 mmol/mol (6.0%).

What is Known:

• The prevalence of obesity is increasing and health problems related to type 2 DM can be serious. However, an optimal screening test for diabetes in obese youth seems to be controversial in the literature.

What is New:

• In our study, the ROC analysis revealed for FPG an optimal threshold of 98 mg/dl (5.4 mmol/l, sensitivity 70%, specificity 88%) and for HbA1c a best cut-off value of 42 mmol/mol (6.0%, sensitivity 94%, specificity 93%) to detect diabetes. Thus, in overweight and obese children and adolescents, HbA1c seems to be a more reliable screening tool than OGTT.

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Abbreviations

CI:

Confidence interval

FPG:

Fasting plasma glucose

IFG:

Impaired fasting glucose

IGT:

Impaired glucose tolerance

OGTT:

Oral glucose tolerance test

SDS:

Standard deviation score

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Authors and Affiliations

  1. Public Health Department of Stuttgart, Department of Pediatrics, Dental Health Care, Health Promotion and Social Services, Schloßstraße 91, 70176, Stuttgart, Germany

    Stefan Ehehalt

  2. Department of Pediatric Endocrinology and Diabetes, Charité Children’s Hospital, Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany

    Susanna Wiegand

  3. Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Liebigstraße 20a, D-04103, Leipzig, Germany

    Antje Körner, Ulrike Spielau & Wieland Kiess

  4. Pediatric Endocrinology and Diabetes, University Children’s Hospital, University of Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany

    Stefan Ehehalt, Roland Schweizer, Michael B. Ranke, Andreas Neu & Gerhard Binder

  5. Endokrinologikum Berlin am Gendarmenmarkt, Friedrichstraße 76, Jägerstraße 61, 10117, Berlin, Germany

    Klaus-Peter Liesenkötter

  6. Endokrinologikum Hamburg, Lornsenstraße 4-6, 22767, Hamburg, Germany

    Carl-Joachim Partsch

  7. Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany

    Gunnar Blumenstock

  8. Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, Department of Pediatrics and Adolescent Medicine, Ulm University, Eythstr. 24, D-89073, Ulm, Germany

    Christian Denzer & Martin Wabitsch

  9. Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children’s Hospital, University Witten/Herdecke, Dr. F. Steiner Str. 5, D-45711, Datteln, Germany

    Thomas Reinehr

Authors
  1. Stefan Ehehalt
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  2. Susanna Wiegand
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  6. Carl-Joachim Partsch
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  7. Gunnar Blumenstock
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  8. Ulrike Spielau
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  9. Christian Denzer
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  11. Andreas Neu
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  12. Gerhard Binder
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  13. Martin Wabitsch
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  14. Wieland Kiess
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Corresponding author

Correspondence to Susanna Wiegand.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.”

Conflict of interest

The authors declare that they have no competing interests.

Funding

W.K., T.R., M.W., and S.W. were supported by grants of the German Federal Ministry of Education and Research (BMBF) (project funding reference number 01GI1120A). This part of the study is integrated in the German Competence Network on Obesity (CNO). S.W. was supported by German Research Foundation (DFG), project “Hormonal regulation of body weight maintenance” (KFO 218). G. Bi., S.E., A.N., and M.B.R. were supported by a research grant from the Tübingen University Hospital (AKF-Program, nr. 221-2-0). A.K. was supported by German Research Foundation (DFG) for the Clinical Research Center “Obesity Mechanisms” CRC1052/1 C05 and the Integrated Research and Treatment Centre (IFB) Adiposity Diseases FKZ: 01EO1001.

Additional information

Communicated by Beat Steinmann

S.E., S.W., and A.K. contributed equally to this work.

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Ehehalt, S., Wiegand, S., Körner, A. et al. Diabetes screening in overweight and obese children and adolescents: choosing the right test. Eur J Pediatr 176, 89–97 (2017). https://doi.org/10.1007/s00431-016-2807-6

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  • DOI: https://doi.org/10.1007/s00431-016-2807-6

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