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ADA guidelines may lead to missed diagnosis of type 2 diabetes in youth
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Results from a cross-sectional survey indicated that health care providers are more likely to order HbA1c and fewer fasting glucose tests when screening adolescents for type 2 diabetes based on the guidelines recommended by the American Diabetes Association released in 2010. This approach has the potential for more missed diagnoses for prediabetes and diabetes in children, in addition to increased costs, according to Joyce M. Lee, MD, MPH, and colleagues.
“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,” Lee, an assistant professor of pediatric endocrinology and health services research at the Child Health Evaluation and Research Unit at the University of Michigan, said in a press release.
The mail survey was randomly sent to a sample of 1,400 United States pediatricians and family practitioners.
The overall response rate was 52% (57% for pediatricians and 48% for family practitioners); the most commonly ordered tests were fasting glucose and HbA1c, researchers wrote. At least 58% of physicians ordered HbA1c; 35% ordered HbA1c in conjunction with fasting tests; and 22% ordered HbA1c alone or with nonfasting tests, according to data.
However, only 38% of health care providers were aware of the 2010 ADA-recommended HbA1c screening guidelines, researchers wrote. After being made aware of those recommendations, 67% reported they would change their screening practices; based on the context of the guidelines, 84% reported they would subsequently order HbA1c tests and not glucose tests.
“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,” Lee said in the release.
Disclosure: The researchers report no relevant financial disclosures.
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