Development and Validation of a Tool for Assessing Glucose Impairment in Adolescents

INTRODUCTION Childhood obesity is associated with an increased risk for type 2 diabetes. Early identification of adolescents at risk for impaired fasting glucose may lead to earlier and more comprehensive evaluation and intervention. Because widespread glucose testing of adolescents is not recommended, community-based tools are needed to identify those who could benefit from further testing. One such tool, developed for adults, was the Tool for Assessing Glucose ImpairmenT (TAG-IT). Our objective was to validate whether a similar tool could be useful for community-based screening of glucose impairment risk among adolescents. METHODS Our study sample consisted of 3,050 adolescents aged 12 to 18 years who had participated in the 1999-2008 National Health and Nutrition Examination Survey (NHANES). Half of participants were female and 40% were nonwhite. NHANES measured fasting glucose and height, weight, and resting heart rate. We used Pearson correlations and regression analysis to determine key variables for predicting glucose impairment. From these measurements, we created a composite TAG-IT score for adolescents called TAG-IT-A. We then applied the TAG-IT-A model to 1988-1994 NHANES data, using linear regression analysis and receiver operating characteristic analysis to determine how well the TAG-IT-A score predicted a fasting glucose at or above 100 mg/dL. RESULTS We determined that age, sex, body mass index, and resting heart rate were important predictors of impaired fasting glucose and that TAG-IT-A was a better predictor of impaired fasting glucose than body mass index alone (area under the curve, 0.61, P < .001 vs 0.55, P = .10, respectively). A TAG-IT-A score of 3 or higher correctly identified 50% of adolescents with impaired fasting glucose, while a score of 5 or higher correctly identified 76%. CONCLUSION The TAG-IT-A score is a simple screening tool that clinicians and public health professionals could use to easily identify adolescents who may have impaired fasting glucose and need a more comprehensive evaluation.