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Best Test for Predicting Dysglycemia in Adolescents

A recent published study evaluated 98 youths aged 10 to 18 years with BMI ≥85th percentile and not on medication for glucose management to determine if HbA1c or the oral glucose tolerance test is a better predictor of free-living glycemia as measured by continuous glucose monitoring (CGM). A blinded CGM was used on all participants for 72 hours, and HbA1c, fasting plasma glucose and 2-hour glucose data were collected. Median fasting plasma glucose was normal in those with normal HbA1c (83 mg/ dL) and prediabetes HbA1c (91 mg/dL) categories. Compared with participants with normal HbA1c or oral glucose tolerance test results, participants with prediabetes had higher average glucose, area under the curve (AUC), peak glucose and time >120 and >140 mg/dL on CGM. HbA1c had a greater magnitude of correlation to CGM average glucose, AUC, and minimum glucose, and 2-hour glucose had a greater magnitude of correlation to CGM standard deviation, peak glucose and time >140 and >200 mg/dL. However the strengths of HbA1c and 2-hour glucose correlations to CGM variables were not significantly different. Both HbA1c and 2-hour glucose outperformed fasting plasma glucose in predicting multiple CGM variables. J Clin Endocrinol Metab. 2014; doi:10.1210/jc.2014-3612.