Elevated Glycolated Hemoglobin in Young People Predicts Likelihood of Diabetes or Cardiovascular Disease in Adulthood

A review of blood test results from more than 14,000 young people suggested that measurement of glycated hemoglobin (HbA1c) was a specific and useful nonfasting marker for identify high-risk youth who could benefit from lifestyle interventions to prevent diabetes and cardiovascular risk in adulthood.

The American Diabetes Association (ADA) has estimated that more than 34 million or roughly 10% of Americans have diabetes, and many of these cases are undiagnosed. Furthermore, obesity-associated type II diabetes is rapidly becoming more prevalent in children, due to the rise in obesity, poor diet, and sedentary lifestyles.

In this light, investigators at Johns Hopkins University (Baltimore, MD, USA) evaluated the performance of current clinical definitions of prediabetes and diabetes based on glycolated hemoglobin (HbA1c), fasting plasma glucose (FPG), either HbA1c or FPG, or both HbA1c and FPG (confirmatory definition) to identify youth at high cardiometabolic risk. For this study, the investigators reveiwed blood test data on 14,119 young people aged 10 to 19 from the U.S. National Health and Nutrition Examination Surveys ( NHANES) conducted between 1999 and 2016.

Results revealed that associations with cardiometabolic risk were consistently stronger and more specific for HbA1c-defined hyperglycemia (specificity = 98.6%; sensitivity = 4.0%) than FPG-defined hyperglycemia (specificity = 90.1%; sensitivity = 19.4%). Furthermore, 51% of subjects with HbA1c-defined hyperglycemia were obese compared to just 29% with hyperglycemia defined by the fasting glucose test.

"Our study demonstrates that HbA1c is a useful non-fasting test for identifying high-risk youth who could benefit from lifestyle interventions to prevent diabetes and cardiovascular disease later in life," said senior author Dr. Elizabeth Selvin, professor of epidemiology, at Johns Hopkins University. "Some pediatricians have already been using HbA1c, but there has not been sufficient guidance from pediatric organizations. I am hoping that these results will help inform and guide the use of this important screening tool in clinical practice."

The study was published in the August 10, 2020, online edition of the journal Pediatrics.

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