Impact of implementing glycated hemoglobin testing for identification of dysglycemia in youth

Abstract

OBJECTIVES: To determine the impact of the introduction of the glycated hemoglobin (HbA1C) assay for diabetes mellitus diagnosis among children and adolescents aged 6-17 years and to describe the composition of the population of patients with, and at risk for, diabetes using fasting plasma glucose test and HbA1C assay. RESEARCH DESIGN AND METHODS: The Kaiser Permanente Hawaii (KPHI) and Kaiser Permanente Northwest (KPNW) sites identified a 2009 and a 2012 cohort of youth who were aged 6-17 years and continuously enrolled in their cohort year and for 1 year prior. We excluded youth with a type 1 or type 2 diabetes diagnosis before their cohort year. RESULTS: In both sites, fasting plasma glucose testing was significantly more common in 2009 and HbA1C testing was more common in 2012. The proportion with either test increased from 2.56% to 4.02% in KPNW and from 3.18% to 10.48% in KPHI, but the characteristics of the population did not change between 2009 and 2012. In both sites, the characteristics of youth at risk of diabetes changed substantially with a much greater proportion being female (KPNW: 39% vs 55%; KPHI: 35% vs 46%; p < 0.001 for both) and children younger than 10 (KPNW: 7% vs 32%; KPHI: 11% vs 39%; p < 0.001 for both) between 2009 and 2012. The size and composition of the population of youth identified with diabetes was not affected. CONCLUSIONS: Adoption of the HbA1C assay for diabetes diagnosis has increased glycemia testing among youth aged 6-17 years and has altered the composition of the population identified as at risk for diabetes. These findings have important ramifications for targeted screening and diabetes prevention efforts.