Am I surprised at this, not at all, because at the time this decision was made by the ADA, there were many dissenting voices. They were saying that other tests were needed for accurate diagnosis. They were concerned that many labs did not have standardized testing procedures and the HbA1c did not account for ethnic differences. Granted this was mostly about using the A1c for adults, but studies are slowly chipping away at the ADA's decision.
The American Diabetes Association seems to have jumped on this too early and other problems are surfacing on a regular basis. The HbA1c has proven ineffective for people on dialysis, and this study shows that it is unreliable for diagnosis of diabetes in children.
The ADA recommended in 2009 that the HbA1c be the test for the diagnosis of diabetes in children. Now a study at the University of Michigan C.S. Mott Children's Hospital shows the HbA1c ineffective for diagnosis of diabetes in children. "We found that Hemoglobin A1c is not as reliable a test for identifying children with diabetes or children at high risk for diabetes compared with other tests in children," says Joyce M. Lee, M.D., M.P.H., lead author of the study and a pediatric endocrinologist at U-M's C.S. Mott Children's Hospital. "In fact, it failed to diagnose two out of three children participating in the study who truly did have diabetes."
Sounds like the ADA needs to reconsider their position. When 2 out of every 3 children are not diagnosed, that more harm is being done, and our children are at risk, the ADA should act in a timely fashion. Will they? This remains to be seen, but they should be held accountable and have their feet held to the fire.
When results of the study show that the HbA1c missed more cases of pre-diabetes or diabetes than other tests, then it is time to reevaluate. Of the 254 overweight children tested, they were first tested using the HbA1c and then the following day after fasting for 12 hours, they were retested using the fasting test.
Based on the results, researchers are urging a non-fasting one-hour glucose challenge test, or a random glucose as being best for identifying children with pre-diabetes or diabetes. The researchers are continuing to study if the non-fasting tests, including the one-hour glucose challenge test or the random glucose test could be used in combination with clinical indicators to better identify which children have pre-diabetes or diabetes.
Either way, the ADA needs to reconsider their position and recommendations. Read the press release here.
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