Kids in Jeopardy with Current Type 2 Diabetes Screening
Approximately 2.5 million kids in the United States are at risk for type 2 diabetes, according to the Centers for Disease Control and Prevention. However, many of those children may not get an accurate diagnosis because of current type 2 diabetes screening guidelines.
Do you have a child who is at risk for type 2 diabetes? If you do (see risk factors below), be sure to read on.
Since the American Diabetes Association modified its diabetes screening guidelines in 2010 to recommend that doctors use the hemoglobin A1c tests instead of glucose tests to identify prediabetes and type 2 diabetes in both kids and adults, some experts have stated that this testing change can miss diagnosis of the disease in children. Accurate, early detection is necessary to take steps to treat and reverse the disease.
The HbA1c test has commonly been used to get a broad picture of a person’s blood sugar history over about a three-month period. Among people who have type 2 diabetes, it is helpful in monitoring their disease and how well they are managing it with lifestyle and/or medication.
As a screening test for prediabetes and type 2 diabetes in children, however, the HbA1c test has two factors against it, according to the study’s authors: it has a worse test performance in children than in adults, and it is more costly overall because it is less effective.
The study’s lead author, Joyce M Lee, MD, MPH, associate professor in the University of Michigan’s Departments of Pediatrics and Communicable Diseases and Environmental Health Sciences, explained that she and her team found that 84 percent of the physicians surveyed said they would use the HbA1c test for screening rather than glucose tests. The problem, according to Lee and her colleagues, is that numerous studies have shown that the HbA1c screening approach can result in missed diagnoses of type 2 diabetes in young people.
In previous studies, Lee and her team reported that the HbA1c test is not reliable for identifying young people with diabetes or children at high risk for the disease. One study, for example, which involved 254 overweight children, found that the test “failed to diagnose two out of three children participating in the study who truly did have diabetes.”
Risk factors for type 2 diabetes in children
The risk of developing type 2 diabetes as a child or adolescent are similar to those for adults.
- Obesity or overweight
- Insufficient physical exercise
- Diet that is high in sugary foods and beverages and fats
- Being African-American, Japanese, Hispanic, or Native American
- Family members who have diabetes, insulin resistance, or impaired glucose tolerance
- Presence of acanthosis nigricans (thick, rough, dark skin under the arms, in the groin area, or around the neck)
Being overweight is believed to be the most important risk factor for type 2 diabetes in young people. Children who are overweight are twice as likely to develop diabetes.
Children and adolescents who have risk factors for type 2 diabetes should be screened by a healthcare provider. Parents should be sure to ask for the fasting glucose test rather than the HbA1c test and by all means, promote daily exercise, a nutritious diet, and weight management.
Lee JM et al. Screening practices for identifying type 2 diabetes in adolescents. Journal of Adolescent Health 2014; 54(2): 139
Lee JM et al. Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia. Diabetes Care2011; 34(12): 2597-2602