Abstract
Little is known about diabetes risk in adolescents and young adults with Fontan palliation. We sought to understand the prevalence of abnormal hemoglobin A1c (HbA1c) in the adolescent and young adult population with Fontan palliation. Between 2015 and 2021, 78 Fontan patients > 10 years of age were seen in our single ventricle clinic; 66 underwent screening with HbA1c. 50% of the study cohort (n = 33) had HbA1c ≥ 5.7%; 2% (n = 1) had HbA1c ≥ 6.5%. There was no correlation between BMI and HbA1c, with no difference in the prevalence of overweight or obesity (BMI ≥ 85th percentile) between those with and without abnormal HbA1c (31% versus 27%, p = 0.69). While 20% of the cohort had a family history of diabetes, there was no difference in family history between those with and without abnormal HbA1c (21% versus 19%, p = 0.85). There were no differences in other risk factors and characteristics (race, glomerular filtration rate, liver function, liver elastography, hematocrit, and years from Fontan surgery) between those with and without abnormal HbA1c. Our results highlight the importance of recognizing that abnormal HbA1c is highly prevalent in the Fontan population. Whether abnormal HbA1c in this population correlates with atherosclerotic cardiovascular disease in adulthood is not known. The mechanism for an abnormal HbA1c in the adolescent and young adult Fontan population remains unclear and further studies are needed.
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References
Rychik J, Atz AM, Celermajer DS, Deal BJ, Gatzoulis MA, Gewillig MH, Hsia TY, Hsu DT, Kovacs AH, McCrindle BW, Newburger JW, Pike NA, Rodefeld M, Rosenthal DN, Schumacher KR, Marino BS, Stout K, Veldtman G, Younoszai AK, DUdekem Y, American Heart Association Council on Cardiovascular Disease in the Young and Council on Cardiovascular and Stroke Nursing (2019) Evaluation and Management of the child and adult with fontan circulation: a scientific statement from the American Heart Association. Circulation. https://doi.org/10.1161/CIR.0000000000000696
Agarwal S, Sud K, Menon V (2016) Nationwide hospitalization trends in adult congenital heart disease across 2003–2012. J Am Heart Assoc 5(1):e002330
Andes LJ, Cheng YJ, Rolka DB, Gregg EW, Imperatore G (2020) Prevalence of prediabetes among adolescents and young adults in the United States, 2005–2016. JAMA Pediatr 174:e194498
American Diabetes Association Professional Practice Committee (2022) 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2022. Diabetes Care 45:S17–S38
Alzahrani BA, Salamatullah HK, Alsharm FS, Baljoon JM, Abukhodair AO, Ahmed ME, Malaikah H, Radi S (2023) The effect of different types of anemia on HbA1c levels in non-diabetics. BMC Endocr Disord 23(1):24
Lo C, Lui M, Ranasinha S, Teede HJ, Kerr PG, Polkinghorne KR, Nathan DM, Zheng H, Zoungas S (2014) Defining the relationship between average glucose and HbA1c in patients with type 2 diabetes and chronic kidney disease. Diabetes Res Clin Pract 104(1):84–91
Opotowsky AR, Valente AM, Alshawabkeh L, Cheng S, Bradley A, Rimm EB, Landzberg MJ (2018) Prospective cohort study of C-reactive protein as a predictor of clinical events in adults with congenital heart disease: results of the Boston adult congenital heart disease biobank. Eur Heart J 39:3253–3261
Sharma R, Bolger AP, Li W, Davlouros PA, Volk HD, Poole-Wilson PA, Coats AJ, Gatzoulis MA, Anker SD (2003) Elevated circulating levels of inflammatory cytokines and bacterial endotoxin in adults with congenital heart disease. Am J Cardiol 92:188–193
Tsalamandris S, Antonopoulos AS, Oikonomou E, Papamikroulis GA, Vogiatzi G, Papaioannou S, Deftereos S, Tousoulis D (2019) The role of inflammation in diabetes: current concepts and future perspectives. Eur Cardiol 14(1):50–59
Wang Y, Dong C, Han Y, Gu Z, Sun C (2022) Immunosenescence, aging and successful aging. Front Immunol 13:942796
Ohuchi H, Miyamoto Y, Yamamoto M, Ishihara H, Takata H, Miyazaki A, Yamada O, Yagihara T (2009) High prevalence of abnormal glucose metabolism in young adult patients with complex congenital heart disease. Am Heart J 158:30–39
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All authors whose names appear on the submission made substantial contributions to the conception of the work and interpretation of data. Specifically, Sharon Chen and Anitra Romfh contributed to the idea and design of the work. Jamie Han performed data acquisition. Jennifer Woo performed data acquisition, analyzed the data and wrote the main manuscript text. All authors reviewed the manuscript.
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Woo, J.P., Romfh, A., Levin, G. et al. High Prevalence of Abnormal Hemoglobin A1c in the Adolescent and Young Adult Fontan Population. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03139-4
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DOI: https://doi.org/10.1007/s00246-023-03139-4