Study questions the effectiveness of type 2 diabetes screening in children

by Barbara Hewitt on March 5, 2014

Screening tests recommended in the United States for the diagnosis of type 2 diabetes in children may be leading to youngsters with the condition being missed, it is claimed.


The ADA recommended HbA1c test has a lower test performance in children compared with adults, research has found

According to a study by the University of Michigan, the tests most commonly used by family doctors and paediatricians may not be enough.

‘Both paediatric and family medicine providers who care for children are using screening tests for type 2 diabetes that may result in missed diagnoses for children,’ said lead author Dr Joyce Lee, associate professor in the University of Michigan’s Departments of Paediatrics and Communicable Diseases and Environmental Health Sciences.

In 2010, the American Diabetes Association (ADA) recommended that health professionals use Hemoglobin A1c screening tests, rather than glucose tests for identifying children and adults with prediabetes and diabetes. However, this change has been controversial, because of lower test performance of HbA1c in children compared with adults.

The study found that when presented with the ADA screening guidelines, 84% of physicians reported that they would switch from using glucose tests to using HbA1c tests.

‘This potential for increased uptake of HbA1c could lead to missed cases of prediabetes and diabetes in children, and increased costs. A number of studies have shown that HbA1c has lower test performance in paediatric compared with adult populations, and as a result, increased uptake of HbA1c alone or in combination with non-fasting tests could lead to missed diagnoses of type 2 diabetes in the paediatric population,’ explained Lee.

‘Also, a recent analysis of screening strategies found that HbA1c is much less cost effective than other screening tests, which would result in higher overall costs for screening,’ she added.

The study was based on a national sample of providers from paediatrics and family practice and looked at the use of the guidelines which are held in high esteem and recommended by the American Diabetes Association.

‘Greater awareness of the 2010 ADA guidelines will likely lead to increased uptake of HbA1c and a shift to use of non-fasting tests to screen for adolescents with type 2 diabetes. This may have implications for detection rates for diabetes and overall costs of screening,’ Lee concluded.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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