FPG plus fasting plasma insulin identified more children with diabetes

Retrospective data suggest that screening with fasting plasma insulin and fasting plasma glucose to calculate homeostasis model assessment of insulin resistance identified more children with diabetes, impaired glucose tolerance and insulin resistance compared with screening with fasting plasma glucose alone.

“For early identification, it is essential to have a screening tool which is very sensitive,” researchers wrote. “Screening with FPG and [fasting plasma insulin] identifies all patients with type 2 diabetes mellitus, and significantly more patients with precursors of type 2 diabetes … while the burden for the children is equal to screening with FPG alone.”

The charts of 311 patients who visited a pediatric obesity outpatient clinic in the Netherlands between 2006 and 2009 were reviewed; the data were interpreted based on the criteria of the American Diabetes Association.

According to data, four of five patients (80%) were diagnosed with diabetes; seven of 25 (28%) with IGT; and 0 of 93 patients with insulin resistance who demonstrated an oral glucose tolerance test if FPG ≥5.6 mmol/L, compared with an OGTT performed if FPG ≥5.6 mmol/L or homeostasis model assessment of insulin resistance (HOMA-IR) ≥3.4, according to data.

However, screening with FPG and fasting plasma insulin (followed by an OGTT if FPG ≥5.6 mmol/L and/or HOMA-IR ≥3.4) identified five of five patients (100%) with type 2 diabetes, 16 of 25 patients (64%) with IGT, and 93 of 93 patients (100%) with insulin resistance, according to data.

“Our study shows that a cutoff value of 3.4 for HOMA-IR is suitable for identifying children at risk of type 2 diabetes,” researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.

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