Abstract
Objective: Long-term data validating glycated hemoglobin (HbA^sub 1c^) in assessing the risk of type 2 diabetes in children are limited. HbA^sub 1c^, fasting plasma glucose (FPG), and 2-h postload plasma glucose (2hPG) concentrations were measured in a longitudinal study of American Indians to determine their utility in predicting incident diabetes, all of which is thought to be type 2 in this population. Research design and methods: Incident diabetes (FPG ≥126 mg/dL [7.0 mmol/L], 2hPG ≥200 mg/dL [11.1 mmol/L], HbA^sub 1c^ ≥6.5% [8 mmol/mol], or clinical diagnosis) was determined in 2,095 children without diabetes ages 10-19 years monitored through age 39, and in 2,005 adults ages 20-39 monitored through age 59. Areas under the receiver operating characteristic (ROC) curve for HbA^sub 1c^, FPG, and 2hPG in predicting diabetes within 10 years were compared. Results: During long-term follow-up of children and adolescents who did not initially have diabetes, the incidence rate of subsequent diabetes was fourfold (in boys) as high and more than sevenfold (in girls) as high in those with HbA^sub 1c^ ≥5.7% as in those with HbA1c ≤5.3% -- greater rate ratios than experienced by adults in the same HbA^sub 1c^ categories. Analyses of ROCs revealed no significant differences between HbA^sub 1c^, FPG, and 2hPG in sensitivity and specificity for identifying children and adolescents who later developed diabetes. Conclusions: HbA^sub 1c^ is a useful predictor of diabetes risk in children and can be used to identify prediabetes in children with other type 2 diabetes risk factors with the same predictive value as FPG and 2hPG.