Glycated hemoglobin A1c as a screening test for detecting type 2 diabetes mellitus in obese children and adolescents

2018 ◽  
Vol 31 (5) ◽  
pp. 503-506 ◽  
Author(s):  
Jong Seo Yoon ◽  
Cheol Hwan So ◽  
Hae Sang Lee ◽  
Jin Soon Hwang

Abstract Background: The diagnostic cutoff points for indicators of type 2 diabetes mellitus (T2DM) in the pediatric population have not been defined thus far. Methods: A retrospective, single-center study was conducted from April 2003 to May 2016. We enrolled 236 overweight or obese children and adolescents aged 4–17 years. Thirty-nine (26.9%) of 145 patients had T2DM according to the oral glucose tolerance test results. Results: A glycated hemoglobin (HbA1c) level of 6.5% had a sensitivity and specificity of 87.2% and 98.5%, respectively, for detecting T2DM. The optimal HbA1c cutoff level for T2DM was >6.2% (94.7% sensitivity, 95.5% specificity). Conclusions: We observed that the use of an HbA1c level of 6.5% had a lower sensitivity for detecting T2DM than an HbA1c level of >6.2%.

Author(s):  
İsmail Dündar ◽  
Ayşehan Akıncı

Abstract Objectives The aim of the study was to determine the prevalence of metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM), and other comorbidities in overweight and obese children in Malatya, Turkey. Methods Retrospective cross-sectional study. We studied 860 obese and overweight children and adolescents (obese children Body mass index (BMI) >95th percentile, overweight children BMI >85th percentile) aged between 6 and 18 years. The diagnosis of MetS, impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and T2DM were defined according to modified the World Health Organization criteria adapted for children. Other comorbidities were studied. Results Subjects (n=860) consisted of 113 overweight and 747 obese children of whom 434 (50.5%) were girls. MetS was significantly more prevalent in obese than overweight children (43.8 vs. 2.7%, p<0.001), and in pubertal than prepubertal children (41.1 vs. 31.7%, p<0.001). Mean homeostasis model assessment for insulin ratio (HOMA-IR) was 3.6 ± 2.0 in the prepubertal and 4.9 ± 2.4 in pubertal children (p<0.001). All cases underwent oral glucose tolerance test and IGT, IFG, and T2DM were diagnosed in 124 (14.4%), 19 (2.2%), and 32 (3.7%) cases, respectively. Insulin resistance (IR) was present in 606 cases (70.5%). Conclusions Puberty and obesity are important risk factors for MetS, T2DM, and IR. The prevalence of MetS, T2DM, and other morbidities was high in the study cohort. Obese children and adolescents should be carefully screened for T2DM, insulin resistance, hyperinsulinism, dyslipidemia, hypertension, IGT, and IFG. The prevention, early recognition, and treatment of obesity are essential to avoid associated morbidities.


2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Leticia Elizondo-Montemayor ◽  
Adrian M. Gonzalez-Gil ◽  
Oscar Tamez-Rivera ◽  
Carla Toledo-Salinas ◽  
Mariana Peschard-Franco ◽  
...  

Proinflammatory cytokines and the novel myokine irisin, a cleavage product of FNDC5, have been found to play a role in obesity and type 2 diabetes mellitus (T2DM). Irisin has been shown to increase browning of adipose tissue, thermogenesis, energy expenditure, and insulin sensitivity, yet its association with inflammatory markers is still limited. Circulating irisin has been found to be increased in obesity, while in adult subjects with T2DM decreased levels have been found. However, data establishing the association of circulating irisin in children and adolescents with T2DM has not been described in the literature. The objective of this study was to determine irisin plasma concentration and its association with metabolic and adiposity markers and with hs-CRP, a surrogate marker of inflammation used in clinical practice, in a pediatric population with T2DM. A cross-sample of 40 Mexican children and adolescents aged 7-17 were recruited, 20 diagnosed with T2DM and 20 healthy controls. Plasma irisin levels were found to be lower in the T2DM group compared with controls, which could be attributed to a reduced PGC-1α activity in muscle tissue with a consequent decrease in FNDC5 and irisin expression. Irisin concentration was found to be positively correlated with HDL-c, LDL-c, and total cholesterol, while negatively correlated with BMI, waist circumference, and triglycerides. However, after multiple regression analysis, only HDL-c correlation remained significant. hs-CRP was higher in the T2DM group and positively associated with adiposity markers, unfavorable lipid profile, insulin levels, and HOMA-IR, but no association with irisin was found. Given the favorable metabolic effects attributed to irisin, the low plasma levels found in children and adolescents with T2DM could exacerbate the inflammatory and metabolic imbalances and the intrinsic cardiovascular risk of this disease. We propose an “irisin-proinflammatory/anti-inflammatory axis” to explain the role of irisin as a metabolic regulator in obesity and T2DM.


Author(s):  
Наталия Александровна Полушкина ◽  
Жанна Владимировна Вечеркина ◽  
Кристина Павловна Кубышкина ◽  
Татьяна Павловна Калиниченко

Рост числа больных сахарным диабетом 2 типа в мире носит характер эпидемии. Сахарный диабет 2-го типа - это нарушение углеводного обмена, который характеризуется комбинацией резистентности к инсулину и неадекватной реакции инсулина. Степень гипергликемии при этом типе сахарного диабета достаточна, чтобы привести к функциональным и патологическим изменениям в органах-мишенях, но эта гипергликемия еще не вызывает клинических симптомов и может существовать в течение длительного периода времени до момента выявления диабета. Заболевание до определенного момента носит скрытый характер, что обусловливает позднее выявление и, соответственно, несвоевременное лечение. Это приводит к высокой частоте сосудистых осложнений, ранней инвалидизации и смертности больных. Однако, в течение этого периода, можно путём определения глюкозы плазмы натощак и после пероральной нагрузки глюкозой обнаружить нарушение углеводного обмена. Изучение гликемической изменчивости - является важным компонентом системного подхода к контролю качества и компенсации сахарного диабета. Показатели гликемии натощак и гликемии через два часа после нагрузки проводили с целью подтверждения диагноза - сахарный диабет. Уровень гликированного гемоглобина HbAIc считается золотым стандартом в оценке гликемического статуса пациентов с сахарным диабетом. Гликемический контроль - это метод диагностики сахарного диабета 2-го типа снижения риска развития осложнений диабета, с целью предотвращения, задержки, замедления или остановки развития поздних осложнений. Было доказано, что гликированный гемоглобин оказался достоверен, продемонстрировав корреляцию со средними гликемическими значениями, а также отразил среднюю концентрацию глюкозы в крови за предыдущие два-три месяца. В этой связи становится актуальным повышение качества проводимых скрининговых обследований населения по выявлению нарушений углеводного обмена. Использование теста на определение гликированного гемоглобина HbA1c представляется наиболее информативным и экономически обоснованным. Вместе с этим ключевое значение приобретает выбор способа измерения гликогемоглобина (HbA1c). Он должен быть стандартизован по референсной методике - высокоэффективной жидкостной хроматографии, в соответствии с результатами исследований DCCT и UKPDS The increase in the number of patients with type 2 diabetes in the world has the character of an epidemic. Type 2 diabetes mellitus is a violation of carbohydrate metabolism, which is characterized by a combination of insulin resistance and an inadequate insulin response. The degree of hyperglycemia in this type of diabetes mellitus is sufficient to lead to functional and pathological changes in target organs, but this hyperglycemia does not yet cause clinical symptoms and can exist for a long period of time until diabetes is detected. The disease is latent up to a certain point, which causes late detection and, accordingly, untimely treatment. This leads to a high frequency of vascular complications, early disability and mortality of patients. However, during this period, it is possible to detect a violation of carbohydrate metabolism by determining fasting plasma glucose and after oral glucose loading. The study of glycemic variability is an important component of a systematic approach to quality control and compensation of diabetes mellitus. Indicators of fasting glycemia and glycemia two hours after exercise were carried out to confirm the diagnosis - diabetes mellitus. The level of glycated hemoglobin HbAic is considered the gold standard in assessing the glycemic status of patients with diabetes mellitus. Glycemic control is a method of diagnosing type 2 diabetes mellitus, reducing the risk of developing complications of diabetes, in order to prevent, delay, slow down or stop the development of late complications. It was proved that glycated hemoglobin was reliable, demonstrating a correlation with average glycemic values, and also reflected the average concentration of glucose in the blood over the previous two to three months. In this regard, it becomes urgent to improve the quality of screening surveys of the population to identify disorders of carbohydrate metabolism. The use of a test for the determination of glycated hemoglobin HbA1c seems to be the most informative and economically justified. At the same time, the choice of the method of measuring glycohemoglobin (HbA1c) becomes of key importance. It should be standardized according to the reference method - high-performance liquid chromatography, in accordance with the results of DCCT and UKPDS studies


2019 ◽  
Vol 18 (3) ◽  
pp. 247-255
Author(s):  
Sierra-Puente D. ◽  
Abadi-Alfie S. ◽  
Arakanchi-Altaled K. ◽  
Bogard-Brondo M. ◽  
García-Lascurain M. ◽  
...  

Spices such as cinnamon (Cinnamomum Spp.) have been of interest due to their phytochemical composition that exert hypoglycemic effects with potential for management of type 2 diabetes mellitus (T2DM). We summarize data from 27 manuscripts that include, one book chapter, 3 review articles, 10 randomized controlled trials, 4 systematic reviews with meta-analysis, and 9 preclinical studies. The most frequently used cinnamon variety was Cinnamomum cassia rather than the Cinnamomum zeylanicum, whereas outcomes were defined as fasting blood glucose, glycated hemoglobin, and oral glucose tolerance test. A great variability in methodology such as different doses (from 120 mg to 6 g), duration of intervention, data retrieved and use of different concomitant medication, were found to be key aspects of most of trials and systematic reviews with meta-analysis available to date. Low quality studies have been made in most cases with a lot of heterogeneity clouding significance of results. More research needs to be done in order to yield accurate evidence for evidence-based recommendations. Its use is not currently a reliable nor advisable option for the treatment of T2DM.


Author(s):  
Indranila KS

Diabetes Melitus (DM) memerlukan pengendalian glikemia yang dapat diketahui dengan melakukan pemeriksaan hemoglobinterglikasi (HbA1c). Semakin tinggi kadar hemoglobin terglikasi (HbA1c), semakin tidak terkendali kadar gula darah pasien DM tipe2. Hal ini dapat menyebabkan terjadinya proses hiperkoagulasi dan gangguan mikrovaskular maupun makrovaskular. PemeriksaanProtrombin Time (PT) dan Activated Partial Thromboplastin Time (APTT) diharapkan dapat mendeteksi secara dini adanya gangguankoagulasi di pasien DM tipe 2. Penelitian potong lintang terhadap 72 orang pasien DM tipe 2 yang berusia diatas 18 tahun diperiksakadar HbA1c dan dikaji koagulasi (PT dan APTT). Pasien dengan penyakit penyerta seperti anemia dan kelainan hemoglobin, keganasanatau kelainan hematologis, pasca bedah, hipertiroid, perempuan hamil, riwayat penyakit hati dan pasien yang mengkonsumsi obatobatanyang mengganggu fungsi koagulasi dikeluarkan dari penelitian ini. Uji normalitas data menggunakan Kolmogorov-Smirnovdan analisis hubungan menggunakan uji Pearson. Analisis kenasaban terdapat hubungan antara kadar hemoglobin terglikasi denganProthrombin Time negatif lemah (r= -0,179; p=0,132) dan dengan Activated Partial Thromboplastin Time positif sangat lemah (r=0,016;p=0,892). Berdasarkan telitian ini terdapat hubungan negatif lemah yang bermakna antara kadar hemoglobin terglikasi dengan PTdan hubungan positif sangat lemah yang tidak bermakna dengan Activated Partial Thomboplastin Time.


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