Update on the current modalities used to screen high risk youth for prediabetes and/or type 2 diabetes mellitus.
Level 5 - mechanism / opinion, no new human data
Narrative review of diagnostic screening modalities without systematic search criteria or meta-analysis.
PubMed 31261470 · doi:10.6065/apem.2019.24.2.71
What was done
Review of the diagnostic performance, advantages, and limitations of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour plasma glucose during an oral glucose tolerance test (OGTT) for screening high-risk youth for prediabetes and type 2 diabetes mellitus (T2DM).
What was found
Prevalence rates for T2DM varied from 0.53% in Chinese youth to 18.3% in high-risk overweight or obese Korean youth. Abnormal FPG (>100 to <126 mg/dL) was present in 15% of Korean youth versus 8.7% of Chinese youth. Prediabetes prevalence based on HbA1c (5.7%-6.4%) was 1.49% in Chinese youth versus 21% in Emirati youth. The overall coefficient of agreement (k) between screening tests for T2DM was fair at 0.45-0.5 across all youth, but agreement between HbA1c and FPG was weak (k=0.18 in German youth vs k=0.396 in Korean youth). OGTT and HbA1c did not consistently detect T2DM in the same individuals, with HbA1c noted as potentially non-ideal for Hispanic and African American youth.
Why it matters
Single-modality screening with HbA1c misses dysglycemia in certain pediatric populations due to racial, ethnic, and physiological variation. Combining or sequencing FPG, OGTT, and HbA1c is needed to fully capture pediatric glucose dysregulation.
Limits
This is a narrative review with no reported systematic search methodology, risk of bias assessment, or total participant sample size. Findings are drawn from disparate study populations with varying baseline risk profiles rather than a standardized comparative cohort.
Cited by
- contradicts Fasting glucose is typically targeted at 90 mg/dL or below, levels over 120 mg/dL classify type 2 diabetes, and values between those define pre-diabetes.