Are diabetic children falling off the radar? New guidelines may lead to underdiagnoses

New guidelines from the American Diabetes Association could lead to missed diagnoses in children with type 2 diabetes, say researchers from the University of Michigan.

In 2010, ADA recommendations stated that physicians should use Hemoglobin A1c screening tests instead of glucose tests to identify children at risk for diabetes. Yet HbA1c tests seem to perform worse on children than they do on adults. Researchers found that 84 percent of physicians would switch from using glucose tests to HbA1c tests when presented with the ADA guidelines – a concerning statistic, given that the switch could lead to errors in catching or preventing type 2 diabetes in children.

"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," said study author Joyce Lee, M.D., M.P.H., associate professor in U-M's Departments of Pediatrics and Communicable Diseases and Environmental Health Sciences.

Different tests mean higher costs

Not only do HbA1c tests have a lower performance level, but they are also more expensive to administer than other tests, which will drive up costs for both providers and patients, Lee said.

The study concluded that more education about the ADA recommendations will probably lead to increased use of HbA1c tests and could have potentially far-reaching, detrimental effects on pediatric diabetes prevention.

"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," Lee said. "This may have implications for detection rates for diabetes and overall costs of screening."

Source: University of Michigan

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