Will New Diabetes Guidelines Under-Diagnose Children?

According to a new study by the University of Michigan, new American Diabetes Association (ADA) screening guidelines may lead to missed diagnoses of Type 2 diabetes in children.
The new research, published in the Journal of Adolescent Health, says that both pediatric and family practice medicine doctors who care for children are using screening tests for Type 2 diabetes that may miss the condition in some children, said lead author Joyce Lee, M.D., M.P.H., and associate professor at University of Michigan's Departments of Pediatrics and Communicable Diseases and Environmental Health Sciences.
The guidelines changed in 2010 when the ADA called for physicians to use Hemoglobin A1c screening tests, rather than glucose tests for identifying the disease in children and adults. This change has been controversial because of the low testing performance of HbA1c in children when compared to adults.
When presented with the ADA screening guidelines, physicians would make the switch from using glucose tests to HbA1c tests.
"This potential for increased uptake of HbA1c could to lead to missed cases of 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, 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 used national samples from providers across the country from both pediatricians and family practice doctors.
"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," said Dr. Lee
Reference: University of Michigan Health System
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