Glucose screening and identification of pre-diabetes in children and adolescents 2007-2011 [abstract]
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This cohort study quantifies glucose screening rates in children and adolescents in defined age gender BMI and race strata. Subjects were 68 322 individuals ages 3-17 at cohort entry followed for a median of 37 months from 1/1/2007 to 12/31/2010 and with at least one clinic visit. Subjects’ laboratory data were examined for date and results of any outpatient fasting or random glucose glycated hemoglobin (A1c) or oral glucose tolerance tests (oGTT). We report descriptive statistics on glucose testing rates and results indicating pre-diabetes by age gender BMI race/ethnicity and year. Prediabetes was defined as fasting plasma glucose of 100-125 mg/dL 2-hour oGTT glucose of 140-199 mg/dL or glycated hemoglobin (A1c) of 5.7%-6.4% without a diabetes diagnosis. Overall the rate of glucose screening was 10.7% (7 278/68 322). It was similar in males and females but higher in those with older age obesity minority race or Hispanic ethnicity. The screening rate increased from 3.9% (1 132/28 948) per year in 2007 to 7.2% (2 301/32 167) in 2010. Glucose screening was most often done with fasting or random glucose but 7.7% (560/7 278) of tests were A1c. About 13.9% (1 013/7 278) of tests indicated pre-diabetes. Of 1 013 subjects with pre-diabetes 79.1% (801/1 013) were age 12 or older 60.0% (608/1 013) had minority race or Hispanic ethnicity and 30.9% (313/1 013) were obese. A diabetes diagnosis (250.xx) was present in 2.2% (161/7 278) of subjects with one or more glucose/A1c tests. We concluded that glucose screening rates in children and adolescents are low but increasing and the proportion of those screened who meet criteria for pre-diabetes is nearly 14%. Opportunistic screening rates are higher in demographic subgroups with the highest risk of pre-diabetes. Little is known about the overall health status comorbidities care or subsequent metabolic status of children and adolescents who meet criteria for pre-diabetes.