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Roth, Christian

Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Cohen, Pinhas / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Feihong / Mericq, Veronica / Toppari, Jorma

Editorial Board Member: Battelino, Tadej / Buyukgebiz, Atilla / Cassorla, Fernando / Chrousos, George P. / Cutfield, Wayne / Fideleff, Hugo L. / Hershkovitz, Eli / Hiort, Olaf / LaFranchi, Stephen H. / Lanes M. D., Roberto / Mohn, Angelika / Root, Allen W. / Rosenfeld, Ron G. / Werther, George / Zadik, Zvi

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A risk score for identifying overweight adolescents with dysglycemia in primary care settings1)

Joyce M. Lee
  • Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI
  • Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI
  • Pediatric Endocrinology and Health Services Research, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, 300 NIB, Room 6E18, Campus Box 5456, Ann Arbor, 48109-5456 MI
  • :
/ Achamyeleh Gebremariam
  • Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI
/ Susan J. Woolford
  • Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI
/ Beth A. Tarini
  • Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI
/ Melissa A. Valerio
  • Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
/ Surair Bashir
  • Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI
/ Ashley J. Eason
  • Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI
/ Preciosa Y. Choi
  • Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI
/ James G. Gurney
  • Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
Published Online: 2013-02-25 | DOI: https://doi.org/10.1515/jpem-2012-0259

Abstract

Objective: To develop a clinical risk scoring system for identifying adolescents with dysglycemia (prediabetes or diabetes) who need further confirmatory testing and to determine whether the addition of non-fasting tests would improve the prediction of dysglycemia.

Study Design: A sample of 176 overweight and obese adolescents (10–17 years) had a history/physical exam, a 2-h oral glucose tolerance test, and non-fasting tests [hemoglobin A1c, 1-h glucose challenge test (GCT), and random glucose test] performed. Given the low number of children with diabetes, we created several risk scoring systems combining the clinical characteristics with non-fasting tests for identifying adolescents with dysglycemia and compared the test performance.

Results: Sixty percent of participants were white and 32% were black; 39.2% had prediabetes and 1.1% had diabetes. A basic model including demographics, body mass index percentile, family history of diabetes, and acanthosis nigricans had reasonable test performance [area under the curve (AUC), 0.75; 95% confidence interval (95% CI), 0.68–0.82]. The addition of random glucose (AUC, 0.81; 95% CI, 0.75–0.87) or 1-h GCT (AUC, 0.82; 95% CI, 0.75–0.88) to the basic model significantly improved the predictive capacity, but the addition of hemoglobin A1c did not (AUC, 0.76; 95% CI, 0.68–0.83). The clinical score thresholds to consider for the basic plus random glucose model are total score cutoffs of 60 or 65 (sensitivity 86% and 65% and specificity 60% and 78%, respectively) and for the basic plus 1-h GCT model are total score cutoffs of 50 or 55 (sensitivity 87% and 73% and specificity 59% and 76%, respectively).

Conclusions: Pending a validation in additional populations, a risk score combining the clinical characteristics with non-fasting test results may be a useful tool for identifying children with dysglycemia in the primary care setting.

Keywords: adolescents; prediabetes; risk score

Corresponding author: Joyce M. Lee, Pediatric Endocrinology and Health Services Research, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, 300 NIB, Room 6E18, Campus Box 5456, Ann Arbor, 48109-5456 MI, Phone: +1-734-615-3139, Fax: +1-734-615-5153


Received: 2012-08-07

Accepted: 2013-01-18

Published Online: 2013-02-25

Published in Print: 2013-05-01


Citation Information: Journal of Pediatric Endocrinology and Metabolism. Volume 26, Issue 5-6, Pages 477–488, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2012-0259, February 2013

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