2 tests better than 1 to diagnose diabetes in overweight children

A new study found that the recommended blood test may not be enough to catch type 2 diabetes in overweight children, missing more than two-thirds of children at high-risk for the condition. Researchers from Children's Mercy Hospital and Clinics found that performing two tests – both the recommended hemoglobin A1C test and an oral glucose tolerance test – could dramatically reduce the risk of delayed diagnosis in overweight children. The findings were presented Saturday at the Pediatric Academic Societies Annual Meeting in Denver.

The American Diabetes Association (ADA) revised clinical practice recommendations for type 2 diabetes screening in 2010 in an effort to encourage more screening and earlier diagnosis. While the oral glucose tolerance test was previously considered the gold standard for diabetes screening, diagnosis using hemoglobin A1C does not require a long fast beforehand, making it easier for patients.

"Our research indicates that special consideration may need to be given to overweight children being tested for diabetes," said lead researcher Ghufran S. Babar, MD, a pediatric endocrinologist at Children's Mercy. "Simply following the guidelines may not be enough to ensure these children get proper care."

The study evaluated the charts of 629 overweight and adolescent patients who had both tests. According to the findings, 40 percent of type 2 diabetes patients and 67 percent of high-risk patients identified through the oral glucose tolerance test would have shown a normal glycemic status if only the hemoglobin A1C test were used to diagnose them. Nearly nine out of ten patients (86 percent) had normal blood glucose levels according to their hemoglobin A1C results.

"Lifestyle changes and early treatment can help delay disease progression of diabetes," said Wayne Moore, MD, PhD, chief and medical director of the endocrine/diabetes section at Children's Mercy. "It is important that patients are diagnosed as early as possible for the best outcomes."

Clinical investigators from Children's Mercy presented a total of 39 studies at the Pediatric Academic Societies meeting.