European Journal of Pediatrics

, Volume 176, Issue 1, pp 89–97 | Cite as

Diabetes screening in overweight and obese children and adolescents: choosing the right test

  • Stefan Ehehalt
  • Susanna WiegandEmail author
  • Antje Körner
  • Roland Schweizer
  • Klaus-Peter Liesenkötter
  • Carl-Joachim Partsch
  • Gunnar Blumenstock
  • Ulrike Spielau
  • Christian Denzer
  • Michael B. Ranke
  • Andreas Neu
  • Gerhard Binder
  • Martin Wabitsch
  • Wieland Kiess
  • Thomas Reinehr
Original Article


Type 2 diabetes can occur without any symptoms, and health problems associated with the disease are serious. Screening tests allowing an early diagnosis are desirable. However, optimal screening tests for diabetes in obese youth are discussed controversially. We performed an observational multicenter analysis including 4848 (2668 female) overweight and obese children aged 7 to 17 years without previously known diabetes. Using HbA1c and OGTT as diagnostic criteria, 2.4% (n = 115, 55 female) could be classified as having diabetes. Within this group, 68.7% had HbA1c levels ≥48 mmol/mol (≥6.5%). FPG ≥126 mg/dl (≥7.0 mmol/l) and/or 2-h glucose levels ≥200 mg/dl (≥11.1 mmol/l) were found in 46.1%. Out of the 115 cases fulfilling the OGTT and/or HbA1c criteria for diabetes, diabetes was confirmed in 43.5%. For FPG, the ROC analysis revealed an optimal threshold of 98 mg/dl (5.4 mmol/l) (sensitivity 70%, specificity 88%). For HbA1c, the best cut-off value was 42 mmol/mol (6.0%) (sensitivity 94%, specificity 93%).

Conclusions: HbA1c seems to be more reliable than OGTT for diabetes screening in overweight and obese children and adolescents. The optimal HbA1c threshold for identifying patients with diabetes was found to be 42 mmol/mol (6.0%).

What is Known:

The prevalence of obesity is increasing and health problems related to type 2 DM can be serious. However, an optimal screening test for diabetes in obese youth seems to be controversial in the literature.

What is New:

In our study, the ROC analysis revealed for FPG an optimal threshold of 98 mg/dl (5.4 mmol/l, sensitivity 70%, specificity 88%) and for HbA1c a best cut-off value of 42 mmol/mol (6.0%, sensitivity 94%, specificity 93%) to detect diabetes. Thus, in overweight and obese children and adolescents, HbA1c seems to be a more reliable screening tool than OGTT.


OGTT HbA1c Children Overweight Diabetes Screening 



Confidence interval


Fasting plasma glucose


Impaired fasting glucose


Impaired glucose tolerance


Oral glucose tolerance test


Standard deviation score


Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.”

Conflict of interest

The authors declare that they have no competing interests.


W.K., T.R., M.W., and S.W. were supported by grants of the German Federal Ministry of Education and Research (BMBF) (project funding reference number 01GI1120A). This part of the study is integrated in the German Competence Network on Obesity (CNO). S.W. was supported by German Research Foundation (DFG), project “Hormonal regulation of body weight maintenance” (KFO 218). G. Bi., S.E., A.N., and M.B.R. were supported by a research grant from the Tübingen University Hospital (AKF-Program, nr. 221-2-0). A.K. was supported by German Research Foundation (DFG) for the Clinical Research Center “Obesity Mechanisms” CRC1052/1 C05 and the Integrated Research and Treatment Centre (IFB) Adiposity Diseases FKZ: 01EO1001.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Stefan Ehehalt
    • 1
    • 4
  • Susanna Wiegand
    • 2
    Email author
  • Antje Körner
    • 3
  • Roland Schweizer
    • 4
  • Klaus-Peter Liesenkötter
    • 5
  • Carl-Joachim Partsch
    • 6
  • Gunnar Blumenstock
    • 7
  • Ulrike Spielau
    • 3
  • Christian Denzer
    • 8
  • Michael B. Ranke
    • 4
  • Andreas Neu
    • 4
  • Gerhard Binder
    • 4
  • Martin Wabitsch
    • 8
  • Wieland Kiess
    • 3
  • Thomas Reinehr
    • 9
  1. 1.Public Health Department of Stuttgart, Department of Pediatrics, Dental Health CareHealth Promotion and Social ServicesStuttgartGermany
  2. 2.Department of Pediatric Endocrinology and Diabetes, Charité Children’s HospitalUniversitätsmedizin BerlinBerlinGermany
  3. 3.Hospital for Children and Adolescents, Department of Women and Child Health, University HospitalsUniversity of LeipzigLeipzigGermany
  4. 4.Pediatric Endocrinology and Diabetes, University Children’s HospitalUniversity of TübingenTübingenGermany
  5. 5.Endokrinologikum Berlin am GendarmenmarktBerlinGermany
  6. 6.Endokrinologikum HamburgHamburgGermany
  7. 7.Department of Clinical Epidemiology and Applied BiometryUniversity of TübingenTübingenGermany
  8. 8.Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, Department of Pediatrics and Adolescent MedicineUlm UniversityUlmGermany
  9. 9.Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children’s HospitalUniversity Witten/HerdeckeDattelnGermany

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