Screening for type 2 diabetes and prediabetes in obese youth: evaluating alternate markers of glycemia – 1,5‐anhydroglucitol, fructosamine, and glycated albumin

Hemoglobin A1c ( HbA1c ) is increasingly performed over the oral glucose tolerance test ( OGTT ) as the initial screening test for type 2 diabetes in youth. However, the optimal strategy for identifying type 2 diabetes in youth remains controversial. Alternate glycemic markers have been proposed as potentially useful tools for diabetes screening. We examined the relationships among fructosamine ( FA ), glycated albumin ( GA ), and 1,5‐anhydroglucitol (1,5‐ AG ) with traditional screening tests, HbA1c and OGTT . Youth 10–18 yrs, BMI ≥85th‰, and HbA1c <7.5% had a single visit with measurement of HbA1c , 1,5‐ AG , FA , GA , and a standard OGTT . Distributions of FA , GA , and 1,5‐ AG by HbA1c and 2‐hour glucose ( 2hG ) categories were compared. Receiver operating characteristic ( ROC )‐curves were generated to determine the cut points at which alternate markers maximized sensitivity and specificity for predicting prediabetes and diabetes. One hundred and seventeen, 62% female, 59% Hispanic, 22% White, 17% black, median 14.1 yr, and body mass index ( BMI ) z‐score 2.3 participated. Median values of each alternate marker differed significantly between prediabetes and diabetes HbA1c and 2hG categories (p < 0.017). Only GA medians differed (p = 0.006) between normal and prediabetes HbA1c . Area under the receiver operating characteristic curves ( ROC‐AUCs ) for alternate markers as predictors of prediabetes (0.5–0.66) were low; however, alternate marker ROC‐AUCs for identifying diabetes (0.82–0.98) were excellent. Although the alternate markers were poor predictors of prediabetes, they all performed well predicting diabetes by 2hG and HbA1c . Whereas the usefulness of these markers for identifying prediabetes is limited, they may be useful in certain scenarios as second line screening tools for diabetes in overweight/obese youth.