Testing Method Fails To Diagnose Diabetes In Children

by Mark Benson on November 28, 2011

Hemo test unreliable according to study

One of the largest groups on diabetes, the American Diabetes Association made a recommendation in 2009 that the Hemoglobin A1c test be used to determine diabetes in children. This test determines long-term diabetes levels without fasting requirements. A new study though has indicated that this test does not reveal accurate results in children.

According to Dr. Joyce M. Lee, M.P.H., the lead author of the study and current pediatric endocrinologist at U-M’s C.S. Mott Children’s Hospital said, “We found that Hemoglobin A1c is not as reliable a test for identifying children with diabetes or children at high risk for diabetes compared with other tests in children. In fact, it failed to diagnose two out of three children participating in the study who truly did have diabetes.”

In a previous study, it found that this particular test is not a reliable to test to identify children with either actual diabetes or pre-diabetes compared with adults. The more accurate tests would require the patient to fast before actual testing but this would be difficult to observe in clinical practice. This reality requires that other tests that do not need fasting be created, especially for children.

Because of the increasing numbers of obese children, the Centers for Disease Control estimates that nearly three million children need to be tested for diabetes or pre-diabetes.

This study had 254 overweight children using both fasting and non-fasting testing methodologies. The study authors found that Hemoglobin A1c, the recommended test, had missed more cases of children who had either pre-diabetes or diabetes compared to other tests used.

The study participants were considered to have either pre-diabetes or diabetes using the gold standard test. They were first tested using the Hemoglobin A1c test and after fasting for twelve hours, these same participants were tested using the fasting method. Depending on the results, researchers reached the conclusion that a non-fasting one hour glucose challenge test or the random glucose test to get a better assessment on determining if the child is either pre-diabetic or has already developed diabetes.

Lee added, “Other pediatric organizations, like the American Academy of Pediatrics, have not endorsed the use of HbA1c yet. However, there is concern that should they endorse it, more and more providers would use these testing methods, leading to an increase in missed diagnoses in the pediatric population.”

The goal of the study is to use the data to drive future recommendations on how to better screen for diabetes. The study was already published in the online edition of the journal Diabetes Care.

“We are currently studying whether the promising non-fasting tests, including the one hour glucose challenge test or the random glucose, could be used in combination with clinical characteristics to better identify which children have pre-diabetes or diabetes,” according to Dr. Lee.

The opinions expressed in this article do not necessarily reflect the views of the DiabetesForum.com 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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