Detecting Diabetes Complications in Children

Question: Identify a research or evidence-based article that focuses comprehensively on a specific intervention or new diagnostic tool for the treatment of diabetes in adults or children? Answer: Introduction: Diabetes can be defined as metabolic disorder that increases the blood glucose or blood sugar level of a person either by decreasing the production of insulin or by making the cells less responsive to the hormone (Bertalan Gregory, 2011). With the advancement of time more and more adolescent and children are diagnosed with the metabolic disorder. Most of the children and adolescents who are detected having diabetes have the type-1 diabetes. In the United State, every year around 13,000 children are known to be diagnosed with type 1-diabetes (Kidshealth.org, 2015). But now, children and younger people are also diagnosed with type-2 diabetes. The risk of being detected with type-2 diabetes increases in children with obesity. Haemoglobin A1c (A1C) has been recommended by the American Diabetes Association to be used as a tool for diagnosing diabetes and to detect the subjects who are at risk of getting the disease in future. The recommendation was granted on the basis of studies carried out on adults. However its application to the children and adolescent are lacking. So, in this article, the authors have studied the implication of A1C diagnostic tool on the obese paediatric population. Research design and methodology: The samples for the study was chosen based on the following inclusion criteria- The subjects must be obese. The subjects were not under medications that alter the blood glucose level. They are not known to have type-1 or type-2 diabetes. Around 1156 children and adolescents with obesity were chosen following the inclusion criteria. Among them 40% were male and 60% were female. At first, an oral glucose tolerance test (OGTT) was performed to detect the status of glucose tolerance of the population, which would be the indication of the pre-diabetic condition. In order to determine the plasma glucose level YSI 2700 Stat Analyser was used. Radioimmunoassay was performed to detect the fasting plasma insulin and an Auto-Analyser was used to measure the lipid level. On the same day of performing OGTT, A1C levels were also measured using an assay which was based on the latex immune-agglutination inhibition methodology. In order to establish a relationship between A1C and type 2 diabetes pathogenesis the cell function and insulin sensitivity was checked based on the following index- The Insulinogenic Index The whole body insulin sensitivity index The disposition index. Repetition of the tests was performed after a period of 2 years with 218 samples. Results: Depending on the observations, the samples were classified based on the A1C category- Samples with normal glucose tolerance- 77% (A1C 5.7%) At risk of diabetes- 21% (A1C: 5.7- 6.4%) Sample with diabetes- 1% (A1C 6.5%) In case of diabetes category- Pre-diabetes- 47% Type 2 diabetes- 62% The threshold that was selected in order to identify type 2 diabetes was A1C 5.8% with a sensitivity of 67.7% and specificity of 87.64%. Discussion: From the results, the authors have found that A1C of 6.5% use would not clearly detect the presence of type-2 diabetes or pre diabetes. According to the authors, the A1C could be applied in order to detect type-2 diabetes along with 2-h glucose and fasting as a clinical tool but it cannot be recommended to detect pre-diabetes in case of children and adolescents. Other studies carried out in adults had shown that A1C could be used in making predictions regarding type-2 diabetes even in persons without the disease (Kleber, 2010). But concerns have been raised regarding the applicability of A1C for detecting type-2 diabetes in pregnant women and aged persons (Tuomilehto, 2011). Again the use of A1C is associated with the risk of over diagnosis in patients with anaemia and with rapid glycosylation (Yang, 2010). Overall, the authors have concluded that an A1C of 6.5% as suggested by the American Diabetes Association underestimates the issue in case of the diabetes and pre-diabetes children and adolescents with obesity. However the low specificity and sensitivity indicate that A1C is a poor diagnostic tool regarding the diagnosis of pre- diabetes and diabetes in adolescents and children with obesity. Conclusion: With the increasing rate of diabetes in children and adolescents proper diagnostics tools are needed in order to detect the disorder in the children as well as to detect the children who are at risk of developing the metabolic disorder. Again proper evaluation of the tools regarding their applicability is also very important. So, in this context, the study carried out by the authors is very relevant. References: Bertalan, R., Gregory, J. (2011). Detecting diabetes complications in children.Practical Diabetes,28(8), 352-357a. doi:10.1002/pdi.1634 Kidshealth.org,. (2015).Type 1 Diabetes: What Is It?. Retrieved 21 May 2015, from https://kidshealth.org/parent/diabetes_center/diabetes_basics/type1.html Kleber, M. (2010). Risk factors for impaired glucose tolerance in obese children and adolescents.WJD,1(4), 129. doi:10.4239/wjd.v1.i4.129 Nowicka, P., Santoro, N., Liu, H., Lartaud, D., Shaw, M., Goldberg, R. et al. (2011). Utility of Hemoglobin A1c for Diagnosing Prediabetes and Diabetes in Obese Children and Adolescents.Diabetes Care,34(6), 1306-1311. doi:10.2337/dc10-1984 Tuomilehto, J. (2011). A1C as the method for diagnosing diabetes how wise is the choice?.Primary Care Diabetes,5(3), 149-150. doi:10.1016/j.pcd.2011.07.005 Yang, W. (2010). Diagnosing diabetes using glycated haemoglobin A1c.BMJ,340(may17 2), c2262-c2262. doi:10.1136/bmj.c2262