Routine A1C Screening in a 17-Year-Old Without Risk Factors
No, a 17-year-old patient without risk factors does not require routine A1C screening. 1, 2
Age-Based Screening Recommendations
- Screening should begin at age 45 years in adults without any risk factors, according to the American Diabetes Association guidelines 2
- For adults aged 40-70 years with BMI ≥25 kg/m², A1C testing is recommended, but this does not apply to a 17-year-old 2
- The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and type 2 diabetes in adults 40 to 70 years of age who are overweight or obese 3
Risk-Based Screening in Adolescents
While routine screening is not indicated for this patient, it's important to understand when screening would be appropriate in adolescents:
- Risk-based screening should be considered after the onset of puberty or ≥10 years of age (whichever occurs earlier) only in youth with overweight (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) AND one or more additional risk factors for diabetes 1
Additional Risk Factors That Would Warrant Screening Include:
- First-degree relative with diabetes 1
- High-risk race/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander) 1
- Maternal history of gestational diabetes 1
- Signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome) 1
- Physical inactivity 1
Key Clinical Considerations
- The patient described has no risk factors, which is the critical determinant here 1, 2
- Even if screening were indicated, if initial screening is normal, repeat testing should occur at minimum 2-3 year intervals, not annually 1
- The dramatic increase in type 2 diabetes prevalence in youth primarily affects those with obesity and other risk factors, not healthy-weight adolescents without risk factors 1
Common Pitfalls to Avoid
- Do not screen all adolescents universally – this leads to unnecessary testing and potential false positives 2
- Do not confuse screening recommendations for type 1 diabetes (which is not recommended) with type 2 diabetes screening (which is risk-based only) 3
- Be aware that A1C may underestimate glycemia in certain populations and has limited validation data in pediatric populations, though it remains the recommended screening test when indicated 1, 4