title: Use of glycosylated hemoglobin increases diabetes screening for at-risk adolescents in primary care settings.
abstract: OBJECTIVE
  To examine rates of diabetes screening in obese adolescents in an ethnically diverse primary care health care system before and after an internal recommendation to use HbA1c-based screening.
  
  
  METHODS
  Adolescents 12-18-years old with BMI > 95% were identified through electronic medical record review during two 18-month periods in 8 community health clinics and 13 school-based health centers: period 1 (P1, 19 April 2008 to 19 October 2009) and period 2 (P2, 3 May 2010 to 3 November 2011). Testing for diabetes in the 2 yr preceding the most recently elevated BMI was reviewed.
  
  
  RESULTS
  A total of 2870 obese adolescents were identified in P1 and 3940 in P2. Ethnicity was primarily Hispanic, with smaller populations of Black and White youth. The percent of obese teens screened for diabetes increased from 40% in P1 to 47% in P2. Use of HbA1c increased 493% during P2. Older teens (>15 yr), those seen during P2, and those with BMI ≥ 30 kg/m2 were more likely to be screened. Record review confirmed equal rates of type 2 diabetes in the two periods: 8 incident (0.7%) cases in P1 and 13 (0.7%) in P2.
  
  
  CONCLUSIONS
  The use of HbA1c, a non-fasting and logistically simpler test, was associated with increased diabetes screening in primary care. The percentage of screened patients with confirmed type 2 diabetes remained unchanged. Thus, despite potential pitfalls, the use of HbA1c for screening appears to be as successful as previous approaches in identifying adolescents with diabetes.
authors: Pediatrics/Adolescent Medicine, Denver Health and Hospitals and University of Colorado School of Medicine, Denver, CO, 80205, USA.
authors: Kathryn A
authors: KA
authors: Love-Osborne
authors: Jeanelle
authors: J
authors: Sheeder
authors: Anna
authors: A
authors: Svircev
authors: Christine
authors: C
authors: Chan
authors: Phil
authors: P
authors: Zeitler
authors: Kristen J
authors: KJ
authors: Nadeau
mesh_terms: D000293:Adolescent; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D005951:Glucose Tolerance Test / Q000191:economics; D006442:Glycated Hemoglobin / Q000032:analysis*; D006630:Hispanic or Latino; D006801:Humans; D008403:Mass Screening / Q000191:economics; D009765:Obesity / Q000150:complications*; D011320:Primary Health Care
chemical_list: D006442:Glycated Hemoglobin
keywords: adolescent; obesity; primary care; type 2 diabetes