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However, it has not been validated in U.S. youth. Because higher BMI increases insulin resistance and insulin requirements, we hypothesized that IDAA1c would perform suboptimally in participants with overweight or obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We analyzed data from 422 SEARCH for Diabetes in Youth study participants with mixed-meal tolerance test (MMTT)-stimulated C-peptide within 12 months of diagnosis. Partial remission was defined using MMTT-stimulated area under the curve (AUC) mean C-peptide. Participant characteristics were compared by BMI category (&amp;lt;85th percentile [normal or underweight] and \u226585th percentile [overweight or obese]) using Wilcoxon rank sum and Fisher exact tests. Sensitivity, specificity, and receiver operating characteristic (ROC) AUC of IDAA1c \u22649 for identifying partial remission were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Participants with normal or underweight versus participants with overweight or obesity had lower IDAA1c (8.95 vs. 9.28, P = 0.043) despite lower stimulated C-peptide (1.25 vs. 1.88 ng\/mL, P &amp;lt; 0.001). Overall, IDAA1c \u22649 had 61% sensitivity and 79% specificity for predicting C-peptide \u22650.91 ng\/mL with an ROC AUC of 0.77. Among participants with overweight or obesity, sensitivity was 45% and specificity 81%. A Youden index\u2013derived cutoff of IDAA1c \u226411.6 improved sensitivity to 93%, with specificity of 54% in participants with overweight or obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>IDAA1c \u22649 demonstrated suboptimal accuracy as a screening test for partial remission, especially underestimating \u03b2-cell function in youth with overweight or obesity. BMI-specific cutoffs improved sensitivity but reduced specificity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-1313","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:44:53Z","timestamp":1790693093000},"update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Insulin Dose\u2013Adjusted Hemoglobin A1c Has Suboptimal Performance for Identifying C-Peptide\u2013Defined Partial Remission: The SEARCH for Diabetes in Youth Study"],"prefix":"10.2337","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8188-5000","authenticated-orcid":false,"given":"Michael L.","family":"Ferm","sequence":"first","affiliation":[{"name":"1Division of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofan","family":"Huang","sequence":"additional","affiliation":[{"name":"2Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles G.","family":"Minard","sequence":"additional","affiliation":[{"name":"2Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0440-3339","authenticated-orcid":false,"given":"Daniel J.","family":"DeSalvo","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7297-139X","authenticated-orcid":false,"given":"Amy S.","family":"Shah","sequence":"additional","affiliation":[{"name":"3Division of Diabetes and Endocrinology, Cincinnati Children\u2019s Hospital Medical Center and University of Cincinnati, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9074-7770","authenticated-orcid":false,"given":"Catherine","family":"Pihoker","sequence":"additional","affiliation":[{"name":"4Department of Pediatrics, University of Washington, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna C.","family":"Bellatorre","sequence":"additional","affiliation":[{"name":"5Lifecourse Epidemiology of Adiposity & Diabetes (LEAD) Center, University of Colorado Anschutz, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5871-4645","authenticated-orcid":false,"given":"Maria J.","family":"Redondo","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,9,29]]},"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/doi\/10.2337\/dc26-1313\/897303\/dc261313.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/doi\/10.2337\/dc26-1313\/897303\/dc261313.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:44:54Z","timestamp":1790693094000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/doi\/10.2337\/dc26-1313\/172659\/Insulin-Dose-Adjusted-Hemoglobin-A1c-Has"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":0,"URL":"https:\/\/doi.org\/10.2337\/dc26-1313","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"article-number":"dc261313"}}