HbA1c: Not the Best Test for Children

Hemoglobin A1c not an accurate test for diagnosing diabetes in children

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) When it comes to diagnosing diabetes, the hemoglobin A1c (HbA1c) test is often the go-to tool for the job. Now, however, doctors may need to reconsider using the test to diagnose children.

Compared to other tests, the HbA1c test failed to identify more cases of prediabetes and diabetes among children.

"If you fear your child has diabetes, ask for multiple tests."

In 2009, a group of experts gathered by the American Diabetes Association (ADA) suggested that HbA1c should be the main method for diagnosing children with diabetes. This recommendation may need to be reexamined, according to new research by Joyce M. Lee, M.D., M.P.H., of the University of Michigan's C.S. Mott Children's Hospital, and colleagues.

According to Dr. Lee, the HbA1c is not as reliable as other tests for spotting children with diabetes or children at high risk of the disease. "In fact," she says, "it failed to diagnose two out of three children participating in the study who truly did have diabetes."

The HbA1c test is commonly used to diagnose diabetes in people of all ages. It works by measuring a person's blood sugar levels over the course of three months. Unlike other tests, the HbA1c test does not require patients to fast overnight.

While fasting tests are more accurate than the HbA1c test, they are also harder to come by in your average doctor's office. The results of this study illustrate the need for better diagnostic tests that do not require patients to fast, such as the one-hour glucose challenge or the random glucose test.

For their study, the researchers compared the one-hour glucose challenge and random glucose test to the HbA1c test. They found that HbA1c was significantly less accurate than the other two tests.

Dr. Lee points out that certain organizations - such as the American Academy of Pediatrics - have yet to endorse the use of HbA1c for children. If these organizations should decide to endorse the test, Dr. Lee and others fear that more doctors will use the method, which could increase the number of missed diagnoses among children.

The researchers are currently looking into whether nonfasting tests like the one-hour glucose challenge and random glucose test could be used in combination with other diagnostic tools to better identify children with diabetes and those at high risk.

This cross-sectional study - which included 254 overweight or obese children between 10 and 17 years of age - appears in the journal Diabetes Care.

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Review Date: 
November 23, 2011
Last Updated:
November 28, 2011