Jump to ContentJump to Main Navigation
Show Summary Details
In This Section

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

12 Issues per year


IMPACT FACTOR 2016: 1.233

CiteScore 2016: 1.09

SCImago Journal Rank (SJR) 2015: 0.493
Source Normalized Impact per Paper (SNIP) 2015: 0.600

Online
ISSN
2191-0251
See all formats and pricing
In This Section
Volume 26, Issue 5-6 (May 2013)

Issues

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

Joyce M. Lee
  • Corresponding author
  • 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
  • Email:
/ 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

References

  • 1.

    Pinhas-Hamiel O, Dolan LM, Daniels SR, Standiford D, Khoury PR, et al. Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr 1996;128:608–15. [Crossref]

  • 2.

    de Vegt F, Dekker JM, Jager A, Hienkens E, Kostense PJ, et al. Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: the Hoorn study. J Am Med Assoc 2001;285:2109–13. [Crossref]

  • 3.

    Barr EL, Zimmet PZ, Welborn TA, Jolley D, Magliano DJ, et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation 2007;116:151–7. [PubMed] [Crossref] [Web of Science]

  • 4.

    Lee JM, Gebremariam A, Wu EL, Larose J, Gurney JG. Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia. Diabetes Care 2011;34:2597–602. [Crossref] [PubMed] [Web of Science]

  • 5.

    Lipton RB, Drum M, Burnet D, Rich B, Cooper A, et al. Obesity at the onset of diabetes in an ethnically diverse population of children: what does it mean for epidemiologists and clinicians? Pediatrics 2005;115:e553–60. [Crossref]

  • 6.

    Lipton R, Keenan H, Onyemere KU, Freels S. Incidence and onset features of diabetes in African-American and Latino children in Chicago, 1985–1994. Diabetes Metab Res Rev 2002;18:135–42.

  • 7.

    Dolan LM, Bean J, D’Alessio D, Cohen RM, Morrison JA, et al. Frequency of abnormal carbohydrate metabolism and diabetes in a population-based screening of adolescents. J Pediatr 2005;146:751–8. [Crossref]

  • 8.

    Lee JM. Why young adults hold the key to assessing the obesity epidemic in children. Arch Pediatr Adolesc Med 2008;162:682–7. [Crossref] [PubMed] [Web of Science]

  • 9.

    Li C, Ford ES, Zhao G, Mokdad AH. Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among U.S. adolescents: National Health and Nutrition Examination Survey 2005–2006. Diabetes Care 2009;32:342–7. [Web of Science]

  • 10.

    American Diabetes Association. Type 2 diabetes in children and adolescents. Pediatrics 2000;105:671–80.

  • 11.

    Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346: 393–403. [PubMed]

  • 12.

    Izzo R, de Simone G, Chinali M, Iaccarino G, Trimarco V, et al. Insufficient control of blood pressure and incident diabetes. Diabetes Care 2009;32:845–50. [Crossref] [PubMed]

  • 13.

    Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11 2002;246:1–190.

  • 14.

    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114: 555–76.

  • 15.

    Kaelber DC, Pickett F. Simple table to identify children and adolescents needing further evaluation of blood pressure. Pediatrics 2009;123:e972–4. [Crossref] [Web of Science]

  • 16.

    Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 2004;113:475–82. [Crossref] [PubMed]

  • 17.

    Lee JM, Wu EL, Tarini B, Herman WH, Yoon E. Diagnosis of diabetes using hemoglobin A1c: should recommendations in adults be extrapolated to adolescents? J Pediatr 2011;158:947–52, e1–3. [Crossref] [Web of Science]

  • 18.

    Glümer C, Vistisen D, Borch-Johnsen K, Colagiuri S. Risk scores for type 2 diabetes can be applied in some populations but not all. Diabetes Care 2006;29:410–4. [Crossref] [PubMed]

  • 19.

    Reinehr T, Wabitsch M, Kleber M, De Sousa G, Denzer C, et al. Parental diabetes, pubertal stage, and extreme obesity are the main risk factors for prediabetes in children and adolescents: a simple risk score to identify children at risk for prediabetes. Pediatr Diabetes 2009;10:395–400. [Crossref] [PubMed] [Web of Science]

  • 20.

    Puri M, Freeman K, Garcia M, Nussbaum H, DiMartino-Nardi JR. Criteria for oral glucose tolerance testing of obese minority youth. J Pediatr Endocrinol Metab 2007;20:703–10. [PubMed]

  • 21.

    Fagot-Campagna A, Saaddine JB, Engelgau MM. Is testing children for type 2 diabetes a lost battle? Diabetes Care 2000;23:1442–3. [Crossref]

  • 22.

    Rhodes ET, Finkelstein JA, Marshall R, Allen C, Gillman MW, et al. Screening for type 2 diabetes mellitus in children and adolescents: attitudes, barriers, and practices among pediatric clinicians. Ambul Pediatr 2006;6:110–4. [PubMed] [Crossref]

  • 23.

    Robbins DC, Andersen L, Bowsher R, Chance R, Dinesen B, et al. Report of the American Diabetes Association’s Task Force on standardization of the insulin assay. Diabetes 1996;45:242–56. [Crossref]

  • 24.

    Palmert MR, Gordon CM, Kartashov AI, Legro RS, Emans SJ, et al. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab 2002;87:1017–23. [PubMed] [Crossref] [Web of Science]

  • 25.

    Dabelea D, Pettitt DJ. Intrauterine diabetic environment confers risks for type 2 diabetes mellitus and obesity in the offspring, in addition to genetic susceptibility. J Pediatr Endocrinol Metab 2001;14:1085–91. [PubMed]

  • 26.

    Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393–403. [PubMed]

  • 27.

    Phillips L, Ziemer D, Kolm P, Weintraub W, Vaccarino V, et al. Glucose challenge test screening for prediabetes and undiagnosed diabetes. Diabetologia 2009;52:1798–807. [PubMed] [Crossref] [Web of Science]

  • 28.

    Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346: 802–10. [Crossref] [PubMed]

  • 29.

    Libman IM, Barinas-Mitchell E, Bartucci A, Robertson R, Arslanian S. Reproducibility of the oral glucose tolerance test in overweight children. J Clin Endocrinol Metab 2008;93:4231–7. [PubMed] [Crossref] [Web of Science]

  • 30.

    Freedman DS, Wang J, Thornton JC, Mei Z, Pierson RN Jr., et al. Racial/ethnic differences in body fatness among children and adolescents. Obesity (Silver Spring) 2008;16:1105–11. [PubMed]

About the article

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


Grant support: This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (K08-DK-082386), Clinical Sciences Scholars Program, Michigan Clinical Research Unit (UL1RR024986), Michigan Institute for Clinical and Health Research (UL1RR024986), Michigan Diabetes Research and Training Center (5P60-DK-20572), Blue Cross Blue Shield Foundation of Michigan, and Elizabeth Kennedy Award/Elizabeth Crosby Funds/Office of the Vice President for Research from the University of Michigan.


Citation Information: Journal of Pediatric Endocrinology and Metabolism, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2012-0259. Export Citation

Comments (0)

Please log in or register to comment.
Log in