Endocrine Abstracts

JOINT2648

Background-: Dysglycemia is a significant cause of concern in children and adolescents with obesity. The beneficial impact of early intervention makes timely identification desirable. The current diagnostic cutoffs for dysglycemia based on adult recommendations have not been validated in Indian children and adolescents. In particular, the validity of hemoglobin A1C (HbA1C) cutoffs has been questioned.

Aim: To compare the diagnostic accuracy of glycemic parameters (glucose tolerance test, HBA1C, and continuous glucose monitoring measures) in identifying dysglycemia in obese Indian children and adolescents.

Methodology: An oral glucose tolerance test and HbA1C were performed in 170 obese children and adolescents (110 boys; age 12.8 + 3.2 and BMI SDS 2.3 + 0.6). Twenty subjects also underwent 14-day ambulatory blood glucose monitoring. The prevalence of dysglycemia according to different measures and the correlation between different parameters were compared. A ROC curve was generated to determine the diagnostic cutoff of HbA1C to identify glucose tolerance test-detected dysglycemia.

Results: Dysglycemia was identified by eight subjects according to fasting glucose (all pre-diabetes, 4.7%), fifteen as per 2-hour value (13 with prediabetes, 2 with diabetes; 8.8%), and 37 by to HbA1C (36 with pre-diabetes and 1 with diabetes, 21.8%). Twenty-eight subjects (77.8%) identified as pre-diabetes by HbA1C had normal glucose tolerance tests. Both the subjects with abnormal glucose profiles on continuous glucose monitoring (16.2%) had glucose tolerance tests determined dysglycemia. Average blood glucose in CGM data correlated with fasting (r = 0.9, P = 0.001) and 2-hour blood glucose (r = 0.8, p=<0.001) with no correlation with HBA1c (r = 0.5, P = 0.09). The ROC curve for diagnostic efficacy of HbA1C in identifying dysglycemia had an area under the curve of 0.730 (P = 0.02). An increase in HBA1C cutoff to 6% would have avoided the diagnosis of dysglycemia in 8 subjects with normal glucose tolerance tests.

Conclusion: Dysglycemia is common in Indian children and adolescents, highlighting the need for early identification. HbA1C tends to overestimate dysglycemia, suggesting the need for higher cutoffs. ABGM is a promising tool for screening dysglycemia but needs further exploration before widespread use.