Screening and Diagnosis of Prediabetes and Diabetes in US Children and Adolescents.
Level 4 - case-series / case-control
Cross-sectional analysis of national survey data evaluating screening and diagnostic test performance.
PubMed 32778539 · doi:10.1542/peds.2020-0265
What was done
A cross-sectional analysis of 14,119 youth aged 10 to 19 years from the 1999–2016 National Health and Nutrition Examination Survey (NHANES). The authors evaluated the performance of American Diabetes Association (ADA) risk-based screening criteria and compared definitions of prediabetes and diabetes based on hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), or both in identifying youth at high cardiometabolic risk.
What was found
An estimated 25.5% of US youth (10.6 million in 2016) met ADA criteria for screening. Sensitivity and specificity of the screening criteria were low for detecting HbA1c ≥5.7% (sensitivity 55.5%, specificity 76.3%) and FPG ≥100 mg/dL (sensitivity 35.8%, specificity 77.1%). Confirmed undiagnosed diabetes (HbA1c ≥6.5% and FPG ≥126 mg/dL) was present in <0.5% of youth, with >85% of diabetes cases already diagnosed. HbA1c-defined hyperglycemia was more specific but less sensitive for identifying cardiometabolic risk (specificity 98.6%, sensitivity 4.0%) than FPG-defined hyperglycemia (specificity 90.1%, sensitivity 19.4%).
Why it matters
ADA screening criteria qualify a quarter of US youth for testing but perform poorly in capturing hyperglycemia, whereas true undiagnosed diabetes is very rare. Measuring HbA1c offers a practical nonfasting method that specifically identifies the small subset of youth carrying substantial cardiometabolic risk.
Limits
The cross-sectional design cannot determine whether screen-detected prediabetes progresses to clinical diabetes or adult cardiovascular disease. Measurements were taken at a single time point without clinical confirmatory retesting on a separate day, and oral glucose tolerance tests were not assessed.
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.