Search

Type 2 diabetes can occur without any symptoms, and health problems associated with the disease are serious. Screening tests allowing an early diagnosis are desirable. However, optimal screening tests for diabetes in obese youth are discussed controversially. We performed an observational multicenter analysis including 4848 (2668 female) overweight and obese children aged 7 to 17 years without previously known diabetes. Using HbA1c and OGTT as diagnostic criteria, 2.4% (n = 115, 55 female) could be classified as having diabetes. Within this group, 68.7% had HbA1c levels ≥48 mmol/mol (≥6.5%). FPG ≥126 mg/dl (≥7.0 mmol/l) and/or 2-h glucose levels ≥200 mg/dl (≥11.1 mmol/l) were found in 46.1%. Out of the 115 cases fulfilling the OGTT and/or HbA1c criteria for diabetes, diabetes was confirmed in 43.5%. For FPG, the ROC analysis revealed an optimal threshold of 98 mg/dl (5.4 mmol/l) (sensitivity 70%, specificity 88%). For HbA1c, the best cut-off value was 42 mmol/mol (6.0%) (sensitivity 94%, specificity 93%)., Conclusions: HbA1c seems to be more reliable than OGTT for diabetes screening in overweight and obese children and adolescents. The optimal HbA1c threshold for identifying patients with diabetes was found to be 42 mmol/mol (6.0%). What is Known: • The prevalence of obesity is increasing and health problems related to type 2 DM can be serious. However, an optimal screening test for diabetes in obese youth seems to be controversial in the literature. What is New: • In our study, the ROC analysis revealed for FPG an optimal threshold of 98 mg/dl (5.4 mmol/l, sensitivity 70%, specificity 88%) and for HbA1c a best cut-off value of 42 mmol/mol (6.0%, sensitivity 94%, specificity 93%) to detect diabetes. Thus, in overweight and obese children and adolescents, HbA1c seems to be a more reliable screening tool than OGTT.

Unlabelled: Over the last 20 years, obesity in childhood and adolescence has become a major public health concern due to dramatically increasing prevalence rates. We evaluated the outcome of 294 children (135 girls, 159 boys) aged 6-16 years (median 10.9 years) enrolled in a single centre outpatient obesity intervention programme consisting of periodical visits to the outpatient unit with regular medical and dietetic counselling aiming at a modification of dietary and activity patterns of patients and parents. The average number of visits to the outpatient unit was 3.6 (SD 2.7) with a mean visit interval of 62.1 days. A mean drop-out rate of 27.5% between each scheduled appointment occurred. In a stepwise regression model, neither reduction of the standard deviation score of patients' body mass index (BMI-SDS) nor dietary counselling contributed to the total number of visits. The only significant contributor was the patients' initial BMI-SDS explaining 4.6% of the variance of attended visits adjusted for age and sex. Segregation of the patients into an "obesity" (initial BMI-SDS >/=90th percentile, at least three visits attended, n=59) and an "excessive obesity" (initial BMI-SDS >/=99th percentile, at least four visits attended, n=75) subgroup showed a mean reduction of BMI-SDS in the "obesity" group at visit three of 0.14 (SD 0.21, P<0.0001), and in the "excessive obese" group at visit four of 0.17 (SD 0.22, P<0.001). In a stepwise regression model, the mean interval between visits and regular dietary counselling explained 11.7% of the variance of BMI-SDS reduction at visit three in both subgroups., Conclusion: there is an urgent need for efficient strategies to improve adherence of outpatients to obesity treatment since, in terms of reduction in body mass index standard deviation score, a beneficial outcome can be achieved for compliant obese children and adolescents.