Change in guidelines for Type 2 diabetes screening may lead to under-diagnosis in children

February 11, 2014

Ann Arbor, Mich. - New American Diabetes Association (ADA) screening guidelines may lead to the missed diagnoses of type 2 diabetes in children, according to a new study by University of Michigan.

The research, published in the Journal of Adolescent Health, finds that both pediatric and family medicine providers who care for children are using screening tests for type 2 diabetes that may result in missed diagnoses for children, says lead author Joyce Lee, M.D., M.P.H., associate professor in U-M's Departments of Pediatrics and Communicable Diseases and Environmental Health Sciences.

In 2010, the ADA recommended that physicians use Hemoglobin A1c screening tests, rather than glucose tests for identifying children and adults with pre-diabetes 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 prediabetes and diabetes in children, and increased costs," says Lee.

"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."

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

"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."
-end-
Additional authors: All from the University of Michigan: Ashley Eason, M.P.H.; Courtney Nelson; Nayla G. Kazzi; Anne E. Cowan, M.P.H.; and Beth A. Tarini, M.D., M.S.

About the U-M Comprehensive Diabetes Center: The mission of the University of Michigan Comprehensive Diabetes Center (MCDC) is to pioneer the way diabetes research is conducted and applied by generating new knowledge, forging new relationships, and enabling collaborations -- both internally, among U-M researchers and clinicians, and externally, with diabetes experts from around the world. MCDC has been consistently ranked in the top 20 nationally for diabetes care. http://www.med.umich.edu/diabetes/

Dr. Lee was supported by NIDDK K08 DK082386 and the Clinical Sciences Scholars Program at the University of Michigan. She can be found on Twitter at @joyclee

University of Michigan Health System

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.