Non-fasting blood test can help screen youth for prediabetes and
diabetes

Date:
August 10, 2020
Source:
Johns Hopkins University Bloomberg School of Public Health
Summary:
A simple blood test that does not require overnight fasting has
been found to be an accurate screening tool for identifying youth
at risk for type 2 diabetes and heart disease risk later in life.



FULL STORY ==========================================================================
A simple blood test that does not require overnight fasting has been found
to be an accurate screening tool for identifying youth at risk for type
2 diabetes and heart disease risk later in life, according to a study
from researchers at the Johns Hopkins Bloomberg School of Public Health.


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The results suggest that the simple blood test, hemoglobin A1c (HbA1c),
should be used more frequently to screen youth for diabetes and related
health risks.

The HbA1c test is accurate and easy to administer in younger patients.

For the study, published online August 10 in Pediatrics, the researchers analyzed national survey and medical exam data on more than 14,000
youth ages 10 to 19. One aim was to see how closely a positive result
on different tests for high blood sugar (hyperglycemia) is related to
risk factors for diabetes and heart disease such as obesity and high
blood cholesterol.

The researchers found that hyperglycemia as defined by a blood test
called HbA1c was strongly associated with these cardiometabolic risk
factors, compared to hyperglycemia defined by the traditional fasting
glucose test. Among youth with HbA1c-defined hyperglycemia, for example,
51 percent were obese, compared to just 29 percent of youth with
hyperglycemia defined by the fasting glucose test.

The HbA1c test measures the degree to which sugar molecules have
linked irreversibly to molecules in red blood cells in the previous few
months. This makes it an accurate marker of chronic hyperglycemia. The
HbA1c test, however, does not require compliance with overnight fasting
before the test, and thus - - compared to the fasting plasma glucose
test -- is less complicated to administer and can be less prone to error.

"Our study demonstrates that HbA1c is a useful non-fasting test for
identifying high-risk youth who could benefit from lifestyle interventions
to prevent diabetes and cardiovascular disease later in life," says study senior author Elizabeth Selvin, PhD, MPH, professor in the Bloomberg
School's Department of Epidemiology.



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The American Diabetes Association (ADA) has estimated that more than
34 million or roughly 10 percent of Americans have diabetes, and many
of these cases are undiagnosed. Children and young people who develop
diabetes more often develop the rarer form, type 1 diabetes, which
is caused by an autoimmune reaction that destroys insulin-producing
cells. However, the obesity-associated type 2 diabetes, which is far
more common in adults, is rapidly becoming more prevalent in children,
due to the rise in obesity, poor diet, and sedentary lifestyles. That
trend has led researchers to emphasize early diabetes detection and
lifestyle intervention in youth to reduce or even reverse hyperglycemia
-- thus helping prevent a lifetime of diabetes and associated medical complications, which can include heart disease, stroke, hypertension,
and kidney disease.

In the study, Selvin and colleagues addressed some key questions about screening tools for diabetes and cardiometabolic risk by examining data
on 14,119 youth aged 10 to 19 from the U.S. National Health and Nutrition Examination Surveys conducted between 1999 and 2016. The data included
results of blood tests that are commonly used to detect hyperglycemia.

The ADA currently recommends such blood tests to screen for diabetes
risk in youth who are at least 10 years old, are overweight or obese,
and have at least one other risk factor such as a history of type 2
diabetes in close relatives, non-white race, or hypertension. One aim
of the study was to evaluate how often the youth who are eligible for
screening by these criteria actually have hyperglycemia -- at least at
the moderate level known as prediabetes.

The analysis suggested that the current screening criteria, despite
covering about a quarter of U.S. children and adolescents, do not capture
many youth with hyperglycemia. For example, only about one-third of the
youth who had hyperglycemia as defined by a fasting glucose test would
have been eligible for screening by the current ADA criteria.

"Current screening criteria miss a lot of children who are at high risk
for diabetes," says study lead author Amelia Wallace, a PhD student in
the Department of Epidemiology at the Bloomberg School.

The researchers also analyzed the dataset to see how closely
different measures of hyperglycemia were linked to cardiometabolic risk factors. Here the HbA1c blood test was particularly useful as a screening
tool, with stronger associations with the risk factors examined, compared
to the fasting glucose test. For example, having hyperglycemia as defined
by the HbA1c test was associated with a 4.1 times greater prevalence
of obesity, whereas having hyperglycemia defined by the fasting glucose
test was associated with an only 1.8 times greater prevalence of obesity.

"Some pediatricians have already been using HbA1c, but there hasn't been sufficient guidance from pediatric organizations," Selvin says. "I'm
hoping that these results will help inform and guide the use of this
important screening tool in clinical practice." Funding was provided
by the National Institutes of Health (T32 HL007024, K01 DK121825,
K24 DK106414).


========================================================================== Story Source: Materials provided by Johns_Hopkins_University_Bloomberg_School_of_Public Health. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Amelia Wallace, Dan Wang, Jung-Im Shin, and Elizabeth
Selvin. Screening
and Diagnosis of Prediabetes and Diabetes in Children and
Adolescents.

Pediatrics, 2020 DOI: 10.1542/peds.2020-0265 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200810141010.htm

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