Diabetes screening test missing the mark?

The current recommended screening test for type 2 diabetes mellitus may be missing the diagnosis in many adolescents, according to a new study by the University of Michigan in Ann Arbor.

In 2010, the American Diabetes Association (ADA) recommended that physicians use the easier hemoglobin A_1c (HbA_1c) tests, rather than fasting plasma glucose tests that require 8 hours of fasting, to screen for diabetes and prediabetes in children and adults.

According to the study, which surveyed 1,400 US pediatricians and family practitioners, barely more than a third (38%) of those physicians surveyed are aware of the ADA testing recommendations. In addition, barely more than half (58%) are using HbA_1c tests (35% order HbA_1c tests in conjunction with fasting tests and 22% order them alone or with nonfasting tests). However, two-thirds (67%) of those surveyed said they would change their screening practices, and 84% reported that they would now order HbA_1c tests as a result of finding out about the ADA recommendations.

This latest study says this practice may not be such a good thing. The University of Michigan Comprehensive Diabetes Center explains that research has shown that HbA_1c tests are not as effective in children as they are in adults, which means that increased uptake of HbA_1c alone or in combination with nonfasting tests could lead to an increased number of missed diagnoses of diabetes and prediabetes in children.

The researchers also claim that HbA_1c tests are not as cost-effective as glucose tests, which would raise the overall cost of screening. 

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