Diabetes Screening With A1C Versus Fasting Plasma Glucose in a Multiethnic Middle School Cohort

John B. Buse, MD, PHD, Francine R. Kaufman, MD, Barbara Linder, MD, PHD, Kathryn Hirst, PHD, Laure El ghormli, MS, Steven Willi, MD,
for the HEALTHY Study Group*

Diabetes Care November 27, 2012

Abstract
OBJECTIVE To characterize middle-school students from the HEALTHY study with glycemic abnormalities, specifically high-risk A1C (hrA1C; A1C = 5.7–6.4%) and impaired fasting glucose (IFG; fasting plasma glucose [FPG] = 100–125 mg/dL).

RESEARCH DESIGN AND METHODS History was collected by self-report, physical measurement was collected by trained study staff, and fasting blood was drawn by trained phlebotomists and analyzed centrally.

RESULTS At baseline, among 3,980 sixth graders, 128 (3.2%) had hrA1C and 635 (16.0%) had IFG. Compared with A1C <5.7%, hrA1C was associated with non-Hispanic black race/ethnicity, family history of diabetes, and higher measurements of BMI, waist circumference, and fasting insulin. Compared with FPG <100 mg/dL, IFG was associated with Hispanic ethnicity; increased BMI, waist circumference, and fasting insulin; higher frequency of high blood pressure; and higher mean triglycerides. Two years later, children with hrA1C persisted as hrA1C in 59.4%, and one child (0.8%) developed A1C ≥6.5%; children with IFG persisted with IFG in 46.9%, and seven children (1.1%) developed FPG ≥126 mg/dL. Those with hrA1C compared with IFG had a higher BMI in sixth grade, which persisted to eighth grade.

CONCLUSIONS In the HEALTHY study cohort, hrA1C and IFG define different groups of youth with differentially increased diabetes risk markers. IFG is approximately fivefold more common, but hrA1C is more persistent over time. Optimal screening strategies for diabetes in youth remain unresolved.