At what age should A1C (Hemoglobin A1C) testing be initiated in a male transitioning from pediatric care?

A1C Testing Initiation for Males Transitioning from Pediatric Care

A1C testing should begin at age 35 years for all males without risk factors, but should start at age 10 or at the onset of puberty (whichever comes first) in males who are overweight or obese with additional risk factors for diabetes. 1

Risk-Based Screening Algorithm

For Males Without Risk Factors:

• Begin A1C testing at age 35 years 1
• If results are normal, repeat testing at minimum 3-year intervals 1

For Males With Risk Factors:

• Begin screening after the onset of puberty or at age 10 years, whichever occurs earlier, if the individual has:
  • Overweight (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) 1
  • AND one or more additional risk factors:
    • First-degree relative with diabetes
    • High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)
    • Signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia)
    • History of cardiovascular disease
    • HDL cholesterol <35 mg/dL and/or triglycerides >250 mg/dL 1

Special Considerations

Medication-Related Risk:

• Earlier screening should be considered for males taking:
  • Second-generation antipsychotics (especially olanzapine, clozapine, quetiapine, risperidone)
  • Glucocorticoids
  • Statins
  • Thiazide diuretics
  • Certain HIV medications 1

For Males with HIV:

• Screening should be performed at baseline when starting antiretroviral therapy
• Rescreened 12-16 weeks after medication initiation
• Screened annually thereafter 1

Transition of Care Considerations

The transition from pediatric to adult care is a critical period for males with diabetes or at risk for diabetes. Research shows that inadequate transition planning can lead to gaps in care exceeding 6 months 2. While transition preparation doesn't necessarily improve A1C levels, it does help prevent these dangerous gaps in care 2.

Young adults report feeling unprepared for transition, with many describing it as coming "out of the blue" 3. This highlights the importance of incorporating A1C testing discussions into transition planning.

Testing Methods

For screening and diagnosis, any of these methods can be used:

• A1C
• Fasting plasma glucose
• 2-hour plasma glucose during a 75-g oral glucose tolerance test 1

Important Caveats

• A1C may not be reliable in certain conditions:

  • Hemoglobinopathies
  • Anemias
  • Conditions with increased red blood cell turnover
  • Recent blood loss or transfusion
  • Erythropoietin therapy 1

• In these cases, only blood glucose criteria should be used for screening and diagnosis 1

• If A1C results are near diagnostic thresholds, repeat testing in 3-6 months is recommended 1

By following these guidelines, clinicians can ensure appropriate timing of A1C testing for males transitioning from pediatric care, with special attention to risk factors that necessitate earlier screening.