Use of HbA1C testing to diagnose pre-diabetes in high risk African American children: A comparison with fasting glucose and HOMA-IR

ObjectiveThis study aimed to compare the discriminating power of HbA1C with other pre-diabetes diagnostic tests specifically in high-risk African American children.Research design and methodsA cross-sectional analysis was performed on a sample of 172 children (70 boys and 102 girls) aged 9–11 years with BMI's above the 85th percentile. Fasting glucose, insulin and HbA1C were analyzed from the plasma samples.ResultsOf the 172 participants included in this analysis, 21 (12.2%) had HbA1C concentrations above the cutoff of 5.7 used to identify pre-diabetes. None (0%) of these 21 participants, however, were observed to have a glucose concentration above the pre-diabetes cutoff of 110 mg/dl, and only 13 of 21 participants had HOMA-IR above the pre-diabetes cutoff of 2.5. When compared to the previously identified glucose cutoff of 110 mg/dl and HOMA-IR cutoff of 2.5 for pre-diabetes, HbA1C showed high specificity (88 and 93%, respectively) but very low sensitivity (0 and 21%, respectively). Glucose, insulin and HOMA-IR were significantly interrelated, but HbA1C was not significantly correlated with these biochemical prediabetes assessment variables, nor with anthropometric (BMIz, WC) risk factors.ConclusionOur results suggest that HbA1C had poor discrimination power to identify prediabetes in overweight and obese 9- to 11-year-old African American children. Future studies are recommended to compare the feasibility, sensitivity and predictive power of different screening tests currently recommended to avoid inadequacy when screening for prediabetes and diabetes.