The Dilemma of Diagnosing Type-2 Diabetes Mellitus [T2DM] in Overweight Children and Adolescents

American Diabetes Association [ADA] has recommended that diabetes should be diagnosed when HbA1c is ?6.5%. Subjects with HbA1c of 6.0 to < 6.5% were at the highest-risk for developing diabetes. Objectives: To determine the sensitivity and specificity of HbA1c ? 6.5% to diagnose Type 2 Diabetes Mellitus [T2DM] in overweight children and the adolescents as compared to an oral glucose tolerance test. Retrospective chart review was done from January 2004-December 2008, and search criteria included overweight children who had OGTT and HbA1c done. Based on OGGT we divided the data into normal, impaired and diabetic groups. The results shows that HbA1c cut-off of ? 6.5% had a specificity of 96% and a sensitivity of 40% in accurately diagnosing patients with T2DM. Sixty percent of T2DM and 44.60% of impaired OGTT subjects would show a normal glycemic status if only HbA1c is used to diagnose them. Homeostasis Model of Assessment - Insulin Resistance [HOMA-IR], Quantitative Insulin Sensitivity Check Index [QUICKI] and HbA1c levels were statistically significant between normal versus diabetic and normal versus impaired groups [p<0.05]. Due to the low sensitivity of the HbA1c test in diagnosing diabetes, it may result in missed or delayed diagnosis of T2DM if used exclusively to diagnose diabetes