Insulin reference intervals in Brazilian adolescents by direct and indirect approaches: validation of a data mining method from laboratory data

Monica D C Freire; Paulo R T P Dias; Thiago S P Souza; Caio K Hirose; Paula B M C Araujo; Mario F T Neves

doi:10.1016/j.jped.2024.03.009

Insulin reference intervals in Brazilian adolescents by direct and indirect approaches: validation of a data mining method from laboratory data

J Pediatr (Rio J). 2024 Apr 23:S0021-7557(24)00042-1. doi: 10.1016/j.jped.2024.03.009. Online ahead of print.

Authors

Monica D C Freire¹, Paulo R T P Dias², Thiago S P Souza³, Caio K Hirose⁴, Paula B M C Araujo⁵, Mario F T Neves⁶

Affiliations

¹ Universidade do Estado do Rio de Janeiro, Pós Graduação em Ciências Médicas, Rio de Janeiro, RJ, Brazil. Electronic address: freire5@yahoo.com.
² Universidade Federal Fluminense, Instituto de Saúde Coletiva, Departamento de Epidemiologia e Bioestatística, Niterói, RJ, Brazil; Instituto de Ensino e Pesquisa DASA, São Paulo, SP, Brazil; Universidade do Estado do Rio de Janeiro, Núcleo de Estudos e Pesquisas em Atenção ao Uso de Drogas, Rio de Janeiro, RJ, Brazil.
³ Universidade do Estado do Rio de Janeiro, Instituto de Matemática e Estatística, Rio de Janeiro, RJ, Brazil.
⁴ DASA, Analytics Department, São Paulo, SP, Brazil.
⁵ Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-graduação em Endocrinologia, Rio de Janeiro, RJ, Brazil.
⁶ Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brazil.

PMID: 38670169
DOI: 10.1016/j.jped.2024.03.009

Abstract

Objective: To determine reference intervals (RI) for fasting blood insulin (FBI) in Brazilian adolescents, 12 to 17 years old, by direct and indirect approaches, and to validate indirectly determined RI.

Methods: Two databases were used for RI determination. Database 1 (DB1), used to obtain RI through a posteriori direct method, consisted of prospectively selected healthy individuals. Database 2 (DB2) was retrospectively mined from an outpatient laboratory information system (LIS) used for the indirect method (Bhattacharya method).

Results: From DB1, 29345 individuals were enrolled (57.65 % female) and seven age ranges and sex partitions were statistically determined according to mean FBI values: females: 12 and 13 years-old, 14 years-old, 15 years-old, 16 and 17 years-old; and males: 12, 13 and 14 years-old, 15 years-old, 16 and 17 years-old. From DB2, 5465 adolescents (67.5 % female) were selected and grouped according to DB1 partitions. The mean FBI level was significantly higher in DB2, on all groups. The RI upper limit (URL) determined by Bhattacharya method was slightly lower than the 90 % CI URL directly obtained on DB1, except for group female 12 and 13 years old. High agreement rates for diagnosing elevated FBI in all groups on DB1 validated indirect RI presented.

Conclusion: The present study demonstrates that Bhattacharya indirect method to determine FBI RI in adolescents can overcome some of the difficulties and challenges of the direct approach.

Keywords: Adolescent; Data mining; Insulin; Reference interval.