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ADA Screening Guideline Change Could Under-diagnose T2DM in Children

Lower test performance of HbA1c in children raises concern…. 

A new study conducted by the University of Michigan is warning that recent changes to the guidelines by the American Diabetes Association (ADA) may lead to missed diagnoses of type 2 diabetes in children. The ADA now recommends using HbA1c screening tests rather than glucose tests to identify children and adults with diabetes and pre-diabetes. This change has been very controversial because of lower test performance of HbA1c in children compared with adults.

Lead author Joyce Lee, M.D., and colleagues found that 84% of physicians would switch from glucose screening tests to now using HbA1c screening tests in order to comply with the new ADA guidelines. Lee commented, "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 pediatric 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 pediatric population. 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. 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."

The study was based on a national sample of providers from pediatrics and family practice.

Practice Pearls:
  • ADA guidelines now recommend the use of HbA1c screening tests rather than glucose screening to identify patients with diabetes and pre-diabetes.
  • A number of studies have shown that HbA1c has lower test performance in pediatric compared with adult populations.
  • As a result, this could lead to missed diagnoses of type 2 diabetes in the pediatric population.

Joyce M. Lee, Ashley Eason, Courtney Nelson, Nayla G. Kazzi, Anne E. Cowan, Beth A. Tarini. Screening Practices for Identifying Type 2 Diabetes in Adolescents. Journal of Adolescent Health, 2014; 54 (2): 139 DOI: