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Current screening test for prediabetes in children misses the diagnosis too often

June 16, 2008

Obese children, who are at increased risk for prediabetes and type 2 diabetes, may not be getting the most appropriate test to screen for these conditions, a new Canadian study found. Results were presented Sunday, June 15, at The Endocrine Society's 90th Annual Meeting in San Francisco.

The standard screening test for high blood sugar in children with risk factors-a blood test called the fasting plasma (or blood) glucose test-identified nearly 3 times fewer the children with prediabetes than did a longer blood test, said the study's lead author.

Katherine Morrison, MD, from the pediatrics department of McMaster University, Hamilton, Ontario, said the more accurate test was the glucose stress test, also called the oral glucose tolerance test. This test takes longer because the patient has blood drawn after fasting and again 2 hours after drinking a sugary solution.

Compared with the glucose stress test, the fasting blood glucose test also was not as sensitive in detecting metabolic syndrome. This syndrome is a cluster of risk factors for heart disease and diabetes, including a high blood sugar level.

"Prediabetes and metabolic syndrome are common in obese children but are not readily identified with the currently recommended test," Morrison said. "They require a glucose stress test."

The authors studied 172 obese children, ages 5 to 17, who joined a program to help attain a healthy weight. All children had evaluation of risk factors for diabetes (or its precursor, prediabetes) and metabolic syndrome, including testing of blood sugar. Using the glucose stress test, the researchers found that 25 percent of the children met the diagnostic criteria for prediabetes. But when they relied on results of the fasting blood glucose test, as recommended by the American and Canadian diabetes associations, they found that only 8 percent of the children had prediabetes.

"A large proportion of the children with prediabetes would not have had their condition recognized," Morrison said.

The same was true for the metabolic syndrome. Of the children in the study, 12.8 percent had a diagnosis of this syndrome (based on International Diabetes Federation pediatric criteria) using the glucose stress test, compared with just 5.2 percent using the standard test, the authors reported.

Prediabetes and the metabolic syndrome usually cause no obvious symptoms. Early detection is important because changes in diet, regular exercise, and moderate weight loss can help prevent or delay diabetes and the metabolic syndrome. Although adults receive diabetes screening with either blood test, children typically do not get the 2-hour glucose stress test, Morrison said.

"The commonest reasons are the increased time, inconvenience, and cost required for 2-hour testing," she said. "But this research suggests that the recommended test for screening obese children for prediabetes and metabolic syndrome should be changed."

The Endocrine Society