Factors Affecting Hemoglobin A1C in the Diagnosis of Diabetes and Prediabetes in Youth

•Statistical analysis did not show a strong relationship between the variables tested and the A1C.•Results indicate A1C is correlated with all beta cell function proxy measurements and correlated to the corrected insulin level at 30 minutes but not the fasting insulin or insulinogenic index.•Clinicians should continue to examine a variety of variables prior to determining the need for diabetes diagnostic testing.

PurposeWe sought to examine the correlation between variables and A1C levels to determine if prediction modeling could be used in the screening and diagnosis of diabetes and prediabetes in youth. We also sought to test relationships between A1C levels to insulin sensitivity indices and β-cell function indices.Design and methodsWe performed a retrospective review of 904 medical records from youth deemed at-risk for the disease. We performed Pearson correlation, multiple regression, and simple regression testing to determine the relationship between variables and A1C levels. In addition, we performed Pearson correlation testing on insulin sensitivity indices and β-cell function indices to determine the strength of correlation to A1C levels.ResultsStatistical analysis did not show a strong relationship between the variables tested and the A1C. When racial and ethnic groups were tested together, the results from African American participants resulted in bias estimates, and as a result, a statistical model for the entire sample could not be performed. Results indicate that A1C is correlated with all β-cell function proxy measurements and correlated to the corrected insulin level at 30 minutes, but not the fasting insulin or insulinogenic index.DiscussionThe results from this study underline the multi-dimensional causes of diabetes and prediabetes and further stress the difficulties in predicting the diseases. The causes of diabetes and prediabetes are multifaceted, often individualized, and often difficult to ascertain.Practice implicationsClinicians should continue to examine a variety of variables prior to determining the need for diabetes diagnostic testing.