From the Guidelines
A1c can be used for diagnosing type 2 diabetes in 12-year-olds, but its reliability may vary depending on individual factors, such as ethnicity and hemoglobinopathies, as noted in the 2023 standards of care in diabetes 1. When considering the diagnosis of type 2 diabetes in children and adolescents, healthcare providers have several options, including fasting plasma glucose, 2-h plasma glucose during a 75-g oral glucose tolerance test, and A1C, as stated in the 2023 standards of care in diabetes 1. Some studies suggest that oral glucose tolerance tests or fasting plasma glucose values may be more suitable diagnostic tests than A1C in the pediatric population, especially among certain ethnicities 1. However, the American Diabetes Association (ADA) continues to recommend A1C for diagnosis of type 2 diabetes in children and adolescents, with the acknowledgement that there is limited data supporting its use in this population 1. Key considerations for using A1C in 12-year-olds include:
- The potential for interference from hemoglobinopathies, which may affect A1C results 1
- The importance of using A1C assays without interference in children with hemoglobinopathies 1
- The need for individualized targets and monitoring schedules, taking into account the child's specific situation and growth and development stage 1. Healthcare providers should carefully evaluate the benefits and limitations of A1C testing in 12-year-olds and consider alternative diagnostic tests when necessary, as recommended in the 2023 standards of care in diabetes 1.
From the Research
Diagnostic Tools for Diabetes in Children and Adolescents
- The reliability of HbA1c as a screening tool for diabetes in children and adolescents has been questioned, especially due to its potential alteration by several nonglycemic factors 2.
- However, HbA1c has been found to be a reliable criterion for diagnosing type 1 diabetes in childhood and adolescence, with a sensitivity and specificity of 100% 3.
Performance of HbA1c in Detecting Prediabetes and Diabetes
- HbA1c has been found to have comparable performance to fasting plasma glucose (FPG) and better than oral glucose tolerance test (OGTT) in classifying subjects with diabetes, particularly when laboratory methods with smaller analytical variation are used 4.
- The performance of HbA1c in distinguishing between prediabetes and diabetes groups was higher than its ability in distinguishing between healthy and prediabetes groups 5.
Considerations for Using HbA1c in Children
- None of the diagnostic tests, including HbA1c, have been validated in the pediatric population 2.
- The use of HbA1c as a diagnostic tool in children and adolescents should be considered in the context of its potential limitations and the need for further validation in this population.
- Alternative tests, such as new OGTT-derived biomarkers and additional nonfasting glycemic markers, have been proposed for risk-based screening of prediabetes and type 2 diabetes in children and adolescents with overweight or obesity 2.