Oral Glucose Tolerance Testing In Children Research Articles

Is A1C Less Concordant with OGTT in Children as Compared in Adults? Data from a Hispanic Community in Arizona

Early efforts to identify hyperglycemia and those at risk for developing type 2 diabetes (T2DM) are warranted. For decades, the diagnosis of T2DM has been based on plasma glucose (PG) criteria but recent recommendations include the use of A1C for identifying hyperglycemia. These recommendations are based upon adult studies and data suggests that A1C may be less concordant in children, as compared to adults. The purpose of our study was to compare A1C, fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) between adolescents and adults in Hispanic population at disproportionate risk for developing T2DM. Methods: Data from self-identified as Latino, 91 overweight adolescents, and 406 overweight adults were assessed after an overnight fast for A1C, FPG and OGTT results. Receiver Operator Characteristics Curves for A1C vs. any hyperglycemia (prediabetes or diabetes) were then developed. Result: 26 (28.6%) of the adolescents and 209 (51.5%) of adults exhibited hyperglycemia according to FPG and/OGTT. The prevalence of hyperglycemia as defined by an A1C>5.7% was 30.8% in adolescents and 55.6% in adults. Of the 26 adolescents, hyperglycemic on FPG and /or OGTT only 9 had A1C>5.7% for a sensitivity of 34.6%. This in contrast to adults, where the sensitivity of A1C>5.7% was 74.2%. Positive predictive value (PPV) for the A1C threshold of 5.7% was 32.1% in adolescents vs. 73.7% in adults. Conclusion: Concordance of A1C with other measures of hyperglycemia is lower in overweight Hispanic adolescents, as compared to overweight Hispanic adults.

Chemical diabetes in childhood

The recognition of chemical diabetes mellitus in children has led to questions of diagnostic criteria, methodology of testing, choice of populations to study, and possible therapeutic approaches to the prevention of progression to overt (insulin-dependent) diabetes. Since the natural history of chemical diabetes in children includes spontaneous improvement as well as stability or progression of glucose intolerance, evaluation of the significance of abnormality and the effect of potential therapy is difficult. The oral glucose tolerance test (OGTT), despite problems in interpretation and methodology, remains the only generally accepted test for chemical diabetes in children. Criteria for interpretation of the OGTT in children used by pediatric investigators are similar to the Fajans and Conn standards for adults. Application of this test to certain high-risk groups, including obese children, children with mild symptoms suggestive of hypoglycemia, and siblings of those with overt diabetes, has permitted the identification of over 200 children with this stage of diabetes. Approximately 10% have progressed to insulin dependence during 1–17 yr of observation. Data on treatment of these patients is limited to anecdotal reports or summaries of small groups of patients treated for variable periods with sulfonylurea drugs. It is not possible to recommend a therapeutic program for children with chemical diabetes, except in the case of the overweight child, where diet restriction may be as efficacious as in adults. Thus, testing of high-risk persons and attempts at treatment should only be undertaken In an investigational setting.

Chemical diabetes mellitus in childhood. Report of a conference.

The recognition of chemical diabetes mellitus in children has led to questions of diagnostic criteria, methodology of testing, choice of populations to study and possible therapeutic approaches to the prevention of progression to overt (insulin-dependent) diabetes. Since the natural history of chemical diabetes in children includes spontaneous improvement as well as stability or progression of glucose intolerance, evaluation of the significance of abnormality and the effect of potential therapy is difficult. The oral glucose tolerance test (OGTT), despite problems in interpretation and methodology, remains the only generally accepted test for chemical diabetes in children. Criteria for interpretation of the OGTT in children used by pediatric investigators are similar to the Fajans and Conn standards for adults. Application of these criteria to certain high risk groups, including obese children, children with mild symptoms suggestive of hypoglycemia, and siblings of those with overt diabetes, has permitted the identification of 200 children with this stage of diabetes. Approximately 11 per cent have progressed to insulin dependency during one to seventeen years of observation. Data on treatment of these patients is limited to anecdotal reports or summaries of small groups of patients treated for variable periods with sulfonylurea drugs. It is not possible to recommend a therapeutic program for children with chemical diabetes, except in the case of the overweight child, where diet restriction may be as efficacious as in adults. Thus, testing of high risk persons and attempts at treatment should only be undertaken in an investigational setting.