Skipping breakfast or even that cup of coffee because you’re fasting for a blood test can get your day off to a bad start. But this is the reality of some diabetes tests that must be done on an empty stomach. Adults may not like it, but explaining to kids why fasting for a test is important is even harder.
Newly published research from the Johns Hopkins School of Public Health suggested that a different type of testing – for A1c – could cut out fasting altogether and might be more accurate and efficient than the tests we’re used to. This is particularly important given that a 2018 change in glucose testing guidelines that screens for prediabetes and diabetes in children encouraged doctors to do three times the amount of screening than they were doing
ADA Calls Test a Powerhouse
The American Diabetes Association calls the A1C test a “powerhouse,” but what is it? The HbA1c test, which isn’t new, measures A1c in the blood. , as a possible testing solution. Diabetic conditions occur when your body struggles to manage the glucose, or sugar, in your blood. Usually, tests for diabetes show a patient’s blood sugar level in a snapshot – how high or low it the level is at that one time. But the A1c test doesn’t just measure blood sugar on that particular day; it measures the levels of sugar in the blood over the past three months. And the big advantage with test is that there’s no fasting.
Fasting, not eating for 8 to 12 hours before a test, is not always easy for kids. “It can be challenging to get children to fast for a blood glucose test,” Ashanti Woods, MD, told Medical Daily. “Children do not always understand [or care] why they cannot eat for a period of time. [But] when we get an HbA1c test, which is different from the fasting glucose, the child is able to eat and it does not affect the measurement.” Dr. Woods is a pediatrician at Mercy Family Care Physicians in Baltimore.
More Children to Be Tested
In 2018 the criteria for who should be tested for diabetes and prediabetes was expanded. Dr. Woods explained that “the symptoms of diabetes or prediabetes can go unnoticed.” The old criteria suggested testing children who were 10 years and older, and then only high-risk kids. High risk means children who are overweight with at least two other risk factors, like a family history of diabetes, non-white race, the start of insulin resistance, or a mother with gestational diabetes. The new guidelines meant that all overweight youth with at least one risk factor should be screened. Under the old rules, in 2016, 3.6 million children would have been eligible for screening. When the researchers looked at the same group of children with the new testing criteria, they found that under the 2018 rules, 10.6 million children would be eligible for screening.
Dr. Woods is glad for the new guidelines. He explained that type 2 diabetes was once thought to primarily affect adults, but this is not the case. “With the obesity epidemic among youth over the past 3 decades, we understand that we as providers must be vigilant and proactive in detecting children at the highest risk for diabetes,” he explained.
Dr. Woods explained that with prediabetes, when you have higher than normal blood sugar but not diagnosable diabetes, “…there may be no symptoms that one can detect on the outside.” This doesn’t mean you’re okay though.
“While there may be no symptoms on the outside, one’s insides, specifically their cardiovascular system (heart, arteries, veins) and their renal system (kidneys) are likely being affected,” Dr. Woods said. This is serious business. The longer this damage goes on unchecked the more patients are at risk for str o kes, brain hemorrhages, amputations and kidney disease. Quick and accurate testing and detection of diabetes is incredibly important.
Although both fasting tests and HbA1c are accurate, if slightly different tests, the study found that HbA1c is at a clear advantage in predicting risk. Patients with high HbA1c levels were more likely to be positive for cardiometabolic risk factors. Cardiometabolic risk is your risk of diabetes, heart disease or stroke, and it can be predicted by issues like obesity, metabolic syndrome and high cholesterol. The researchers found that people who tested positive for HbA1c hyperglycemia were more likely to have associated risks than those tested with FPG – fasting plasma glucose.
Identifying patients with these risk factors is important, because in some cases lifestyle changes can make a difference. Testing kids could mean a lifetime of better health.
Although the authors found several advantages for HbA1c, the other tests are still good measures. Although the old guidelines left out many patients who likely should be screened, children with diabetes were still diagnosed. But the A1c specifically identifies children at risk before diabetes develops. Early direction and intervention is important in childhood diabetes and prediabetes, and the new criteria mean many more kids might get tested.
If you’re concerned about your child, ask your family doctor or pediatrician if screening is an option.