Increased Levels of Glycated Hemoglobin (HbA1c) in Obese Adolescents

The Increment of Glycated Hemoglobin (HbA1c) in Obese Adolescent. Obesity in children and adolescents is a serious concern because the prevalence is increasing every year throughout the world. Obesity in children and adolescents is associated with an increased risk of impaired glucose tolerance, dyslipidemia and diabetes. Glycated hemoglobin (HbA1c) has been recommended as a diagnostic tool to identify diabetes. The purpose of this study was to determine differences in levels of glycated hemoglobin (HbA1c) in obese and non-obese adolescents aged 15-19 years. This study was an observational analytic study with a cross-sectional approach. The study was conducted in Palembang 1 Public High School and the Faculty of Medicine of Sriwijaya University and found 50 subjects consisting of obese adolescents and non-obese adolescent groups. Nutritional status was determined by measuring body mass index according to age and gender. Examination of HbA1c levels was carried out using a Nycocard Reader. The results of the study with Mann Whitney alternative test showed a p value of 0,000 (p <0.05) with an average HbA1c level in obese adolescents by 6.1% and an average HbA1c level in non-obese adolescents by 4.7%. In conclusion, HbA1c levels in obese adolescents aged 15-19 years are higher than non-obese adolescent.


Introduction
Obesity describes the high amount of fat accumulation that can cause various health problems. 1 Obesity in childhood and adolescence is considered as a serious health problem in this 21 century. Globally, 1 in 6 children aged 5-17 years are overweight and obese. In 2016, the number of obese children reached 124 million. This number has increased 10 times from 11 million people in 1975. 2 In Indonesia, based on data from Riskesdas 2010 and 2013, it shows that the prevalence of obesity and obesity in school children (6-12 years) has increased five times from 1.4 to 9.2% .
South Sumatra is included in one of eleven provinces where the prevalence of obesity is above the national prevalence (11.6%). 3,4 The increasing prevalence of obesity in children and adolescents has an impact on the onset of type 2 diabetes mellitus and the metabolic syndrome. 5 Research shows that more than 85% of children with type 2 diabetes mellitus are overweight or obese at diagnosis. 6 Most of the patients with diabetes initially experiencing impaired glucose tolerance (TGT), which is a developmental stage of the onset diabetes of type 2. 7 .
Early diagnosis and intervention in a person with TGT has been shown to prevent the development of type 2 diabetes mellitus so it is important to screen children and adolescents who are at high risk. 8 The American Diabetes Association in 2010 recommended checking

Biomedical Journal of Indonesia
Journal Homepage: https://www.jurnalkedokteranunsri.id/index.php/BJI/index the level of glycated hemoglobin (HbA1c) as one of the variables for diagnosing diabetes.
HbA1c is a standard examination that describes glucose homeostasis in the form of fasting and postprandial blood glucose variations over a 3 month period. 27 Thus, the HbA1c test is used to assess diabetes control and has a high predictive value for diabetes complications. 10,11 The HbA1c test is very stable compared to plasma glucose assay because it has lower biological variability and preanalytic instability. 12

Result
The characteristics of the research respondents studied include nutritional status, age, and gender which can be seen in Table 1. The distribution of respondent characteristics in the form of gender and age based on their nutritional status can be seen in Table 2.

Respondents in this study
Based on Table 2, it is known that the nutritional status of obesity in this study was dominated by male respondents, namely 13 respondents (26%). And most of the respondents were in the obese group aged 17 years, as many as 8 respondents (16%).
The frequency distribution of respondents' HbA1c based on nutritional status can be seen in This study obtained data that all respondents who had HbA1c levels greater than or equal to 6.5% were respondents in the obese group, namely 9 respondents (18%); Likewise, all respondents with HbA1c levels of 5.7% to 6.4% were 6 respondents (12%) who were also in the obese group, while respondents who had HbA1c levels less than 5.7% were dominated by respondents who were in the non-obese group, namely 25 respondents (50%).
The Mann Whitney statistical test was performed to determine the difference in glycated hemoglobin (HbA1c) levels in the obese and nonobese adolescent groups and the results can be seen in Table 4.  found that the proportion of overweight and obesity in children aged less than 10 years is greater than those over or equal to 10 years of age. 27 To obtain rapid growth, children aged 9-10 years need adequate nutrition. However, if food intake is not considered properly, the problem of obesity at this age is prone to occur. Growth and development in children aged [6][7][8][9][10][11][12] years are more stable than children aged <5 years (toddlers) as motor, cognitive, and social emotional development begins to mature. This period is marked by puberty in girls 11 Given the morbidity associated with insulin resistance and type 2 diabetes, medical professionals and the general public face the challenge of preventing, not just treating, chronic metabolic and vascular complications in obese patients. Recent studies have shown that lifestyle interventions can reduce risk factors, and the incidence of impaired glucose tolerance and type-2 diabetes mellitus in children and adults.
That people with prediabetes can also be converted back to normal sugar tolerance with appropriate lifestyle management. Measurement of HbA1c levels can be a useful measure to identify children who are screened for impaired glucose tolerance and should be treated with early lifestyle management.

CONCLUSION
HbA1c levels in adolescents aged 15-19 years in the obese group were higher than in the non-obese group.