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Background <p>According to the ADA guideline, children with HbA1c between 5.7% and 6.4% are classified as “prediabetes”; however, the applicability of adult cut-offs to pediatric populations remains controversial due to pubertal physiology and ethnic variation.</p> Objective <p>We evaluated the clinical trajectory of children with HbA1c in the prediabetes range, focusing on the natural course, determinants of normalization, and the utility of repeated HbA1c measurements.</p> Methods <p>A total of 1817 children whose HbA1c was measured at our center between 2021 and 2023 were retrospectively examined. Individuals with type 1 diabetes mellitus (DM), type 2 DM, and MODY and those with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on oral glucose tolerance test (OGTT) were excluded. This study is defined as a retrospective cohort study, reflecting the temporal follow up of HbA1c levels.</p> Results <p>A total of 302 children had a first HbA1c in the prediabetes range and normalized (&lt; 5.7%) within 1&#xa0;year. The median HbA1c normalization time was 8&#xa0;months (range 2–12&#xa0;months). Kaplan–Meier analysis showed significantly delayed normalization in children with baseline HbA1c ≥ 6.0% compared with those between 5.7–6.0% (log-rank <i>p</i> &lt; 0.001). Cox regression demonstrated that baseline HbA1c ≥ 6.0% independently predicted slower normalization (HR: 0.62; 95% CI: 0.48–0.81). Puberty, age, sex, and BMI SDS were not significant predictors.</p> Conclusions <p>A single elevated HbA1c should not automatically lead to a prediabetes diagnosis. Physiological pubertal insulin resistance and ethnic factors may temporarily elevate HbA1c. Repeated HbA1c testing appears clinically valuable and may prevent unnecessary OGTT testing or pharmacologic interventions.</p>

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Course of HbA1c in prediabetic conditions in pediatric endocrine practice

  • 期刊论文

  • 发表日期：

    2026年2月11日

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  • Serkan Bilge Koca,
  • Pelin Baysal Uzun

摘要

Background

According to the ADA guideline, children with HbA1c between 5.7% and 6.4% are classified as “prediabetes”; however, the applicability of adult cut-offs to pediatric populations remains controversial due to pubertal physiology and ethnic variation.

Objective

We evaluated the clinical trajectory of children with HbA1c in the prediabetes range, focusing on the natural course, determinants of normalization, and the utility of repeated HbA1c measurements.

Methods

A total of 1817 children whose HbA1c was measured at our center between 2021 and 2023 were retrospectively examined. Individuals with type 1 diabetes mellitus (DM), type 2 DM, and MODY and those with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on oral glucose tolerance test (OGTT) were excluded. This study is defined as a retrospective cohort study, reflecting the temporal follow up of HbA1c levels.

Results

A total of 302 children had a first HbA1c in the prediabetes range and normalized (< 5.7%) within 1 year. The median HbA1c normalization time was 8 months (range 2–12 months). Kaplan–Meier analysis showed significantly delayed normalization in children with baseline HbA1c ≥ 6.0% compared with those between 5.7–6.0% (log-rank p < 0.001). Cox regression demonstrated that baseline HbA1c ≥ 6.0% independently predicted slower normalization (HR: 0.62; 95% CI: 0.48–0.81). Puberty, age, sex, and BMI SDS were not significant predictors.

Conclusions

A single elevated HbA1c should not automatically lead to a prediabetes diagnosis. Physiological pubertal insulin resistance and ethnic factors may temporarily elevate HbA1c. Repeated HbA1c testing appears clinically valuable and may prevent unnecessary OGTT testing or pharmacologic interventions.