title: Impact of implementing glycated hemoglobin testing for identification of dysglycemia in youth.
abstract: OBJECTIVE
  To determine the impact of the introduction of the glycated hemoglobin (HbA1C) assay for diabetes mellitus diagnosis among children and adolescents aged 6-17 years and to describe the composition of the population of patients with, and at risk for, diabetes using fasting plasma glucose test and HbA1C assay.
  
  
  METHODS
  The Kaiser Permanente Hawaii (KPHI) and Kaiser Permanente Northwest (KPNW) sites identified a 2009 and a 2012 cohort of youth who were aged 6-17 years and continuously enrolled in their cohort year and for 1 year prior. We excluded youth with a type 1 or type 2 diabetes diagnosis before their cohort year.
  
  
  RESULTS
  In both sites, fasting plasma glucose testing was significantly more common in 2009 and HbA1C testing was more common in 2012. The proportion with either test increased from 2.56% to 4.02% in KPNW and from 3.18% to 10.48% in KPHI, but the characteristics of the population did not change between 2009 and 2012. In both sites, the characteristics of youth at risk of diabetes changed substantially with a much greater proportion being female (KPNW: 39% vs 55%; KPHI: 35% vs 46%; p < 0.001 for both) and children younger than 10 (KPNW: 7% vs 32%; KPHI: 11% vs 39%; p < 0.001 for both) between 2009 and 2012. The size and composition of the population of youth identified with diabetes was not affected.
  
  
  CONCLUSIONS
  Adoption of the HbA1C assay for diabetes diagnosis has increased glycemia testing among youth aged 6-17 years and has altered the composition of the population identified as at risk for diabetes. These findings have important ramifications for targeted screening and diabetes prevention efforts.
authors.affiliation: Research Associate at the Center for Health Research in Honolulu, HI. vinutha.x.vijayadeva@kp.org.
authors.forename: Vinutha
authors.initials: V
authors.lastname: Vijayadeva
authors.affiliation: Senior Investigator at the Center for Health Research in Portland, OR. greg.nichols@kpchr.org.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D002648:Child; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis; D005215:Fasting; D005260:Female; D044882:Glucose Metabolism Disorders / Q000175:diagnosis*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006254:Hawaii; D006801:Humans; D008297:Male; D008485:Medical Audit; D009922:Oregon; D011236:Prediabetic State / Q000175:diagnosis
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin