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Endocrine Abstracts (2021) 78 OC7.1 | DOI: 10.1530/endoabs.78.OC7.1

BSPED2021 Oral Communications Oral Communications 7 (5 abstracts)

Utility of glycated haemoglobin in assessing abnormal glucose homeostasis in children and adolescents with obesity undergoing oral glucose tolerance test

Ayaan Matan 1,2 , Katherine Hawton 1 , Kulsoom Riaz 1 , Julian P H Shield 1,3 , Toby Candler 1 & Dinesh Giri 1,4

1Department of Paediatric Endocrinology, Bristol Royal Hospital for Children, Bristol, United Kingdom; 2Bristol Medical School, University of Bristol, Bristol, United Kingdom; 3National Institute for Health Research Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, United Kingdom; 4Department of Translational Health Sciences, University of Bristol, Bristol, United Kingdom

Background: Childhood obesity and type 2 diabetes mellitus (T2DM) have increased proportionately in the last decade. Oral glucose tolerance test (OGTT) is recommended for paediatric patients with a BMI >98th centile (NICE, 2014) to identify T2DM or abnormal glucose homeostasis (AGH).

Aim: To estimate the proportion of patients with AGH/T2DM seen in a tier 3 obesity service and evaluate the utility of the glycated haemoglobin (HbA1C) in detecting AGH.

Methods: Retrospective data were collected from children and young people (CYP) with obesity undergoing an OGTT between 2015-2020. Fasting blood glucose (FBG), 2 h post-prandial glucose (PPG), fasting insulin and HbA1C were recorded. Any clinical features of insulin resistance were documented. OGTT results were interpreted using WHO (2006) criteria.

Results: Of 113 CYP (mean age 13.2 years), 52 were male and mean body mass index (BMI) was 32.1 kg/m2 (+2.77SDS). 6 patients (5.3%, 5 Caucasian, 1 Black African ethnicity) were diagnosed with T2DM. 5 (4.5%) had impaired glucose tolerance (IGT) (2-hour PPG 7.8-11 mmol/l) and 1 (1%) had both impaired fasting glycaemia (IFG) (FBG 6.1-6.9 mmol/l) and IGT. 101 patients (90%) had a normal OGTT. Median HbA1C at diagnosis was 53.5 mmol/mol (49-94) for those with T2DM and 40 mmol/mol (33-45 mmol/mol) for those with for those with IFG/IGT. HbA1c ≥ 48 mmol/l was predictive of T2DM with sensitivity 100% (95% CI 54.1 - 100), specificity 100% (95% CI 96.6 - 100) and positive predictive value (PPV) of 85.7% (95% CI 46.0 -97.7). HbA1c > 43 mmol/mol was predictive of detecting AGH with sensitivity 66.7% (95% CI 34 - 90), and specificity 97.0% (95% CI 93.03 - 99.76). In patients with normal OGTT average HbA1C was 37 mmol/mol (range = 29-44 mmol/mol). HbA1c ≤39 was predictive of normal OGTT with sensitivity 85.3% (95% CI 76.5 – 91.7) and specificity 83.3% (95% CI 58.6 – 96.4).The number-needed-to-screen for one patient to be diagnosed with T2DM or AGH was 28 and 10 respectively.

Conclusion: HbA1C could be considered as a screening tool in CYP with obesity to indicate the requirement for OGTT to detect AGH, potentially avoiding the clinical and cost burden of an invasive test.

Volume 78

48th Meeting of the British Society for Paediatric Endocrinology and Diabetes

Online, Virtual
24 Nov 2021 - 26 Nov 2021

British Society for Paediatric Endocrinology and Diabetes 

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