Skipping breakfast or even that cup of coffee because you’re fasting for a blood test can get your day off to a bad start. But this is the reality of some diabetes tests; they require an empty stomach. Adults may not like it, but explaining to kids why a test requires fasting is even harder.

Newly published research from the Johns Hopkins School of Public Health is suggesting that a different type of testing that looks for a range of glucose levels over time could cut out fasting altogether and might be more accurate and efficient than the tests adults are used to. This is particularly important given that a 2018 change in glucose testing guidelines that screens for prediabetes and diabetes in children encouraged doctors to do three times the amount of screening than they were doing.

ADA Calls Test a Powerhouse

The American Diabetes Association calls the A1c test a “powerhouse,” but what is it? Diabetic conditions occur when the body struggles to manage the glucose, or sugar, in the blood. Usually, tests for diabetes show a patient's blood sugar level in a snapshot – how high or low the level is at that one time. But the recomended test, the A1c test, doesn’t just measure blood sugar on that particular day; it measures the levels of sugar in the blood over the past two to three months. And the big advantage with this test is that fasting is not necessary.

Fasting, not eating for 8 to 12 hours before a test, is not always easy for kids. “It can be challenging to get children to fast for a blood glucose test,” Ashanti Woods, MD, told Medical Daily. “Children do not always understand [or care] why they cannot eat for a period of time. [But] when we get an [hemoglobin] A1c test, which is different from the fasting glucose, the child is able to eat and it does not affect the measurement.” Dr. Woods is a pediatrician at Mercy Family Care Physicians in Baltimore.

More Children to Be Tested

In 2018 the criteria for who should be tested for diabetes and prediabetes was expanded. Dr. Woods explained that “the symptoms of diabetes or prediabetes can go unnoticed.” The old criteria suggested testing children who were 10 years and older, and then only high-risk kids. High risk means children who are overweight with at least two other risk factors, like a family history of diabetes, non-white ethnicity, the start of insulin resistance, or a mother with gestational diabetes. Under the old rules, in 2016, 3.6 million children would have been eligible for screening. The new guidelines call for all overweight youth with at least one risk factor to be screened. Using the new testing criteria, the researchers looked at the same group of children and found that 10.6 million children would be eligible for screening.

Dr. Woods is glad for the new guidelines. He explained that type 2 diabetes was once thought to primarily affect adults, but this is not the case. “With the obesity epidemic among youth over the past 3 decades, we understand that we as providers must be vigilant and proactive in detecting children at the highest risk for diabetes."

Detecting Prediabetes

Dr. Woods explained that with prediabetes, higher than normal blood sugar exists but diabetes is not yet diagnosable. “There may be no symptoms that one can detect on the outside.” This doesn’t mean that nothing is going on in the inside.

“One’s insides, specifically their cardiovascular system (heart, arteries, veins) and their renal system (kidneys) are likely being affected,” Dr. Woods said. This is serious business. The longer this damage goes on unchecked the more patients are at risk for strokes, brain hemorrhages, amputations and kidney disease. Quick and accurate testing and detection of diabetes is important; diabetes is usually not diagnosed for a number of years after onset.

Risky Business?

Although both fasting tests and A1c are accurate, if slightly different tests, the study found that A1c is at a clear advantage in predicting risk. Patients with high A1c levels were more likely to be positive for cardiometabolic risk factors. Cardiometabolic risk is your risk of diabetes, heart disease or stroke, and it can be predicted by obesity, especially around fat around the waist, high blood pressure and high levels of "bad" cholesterol. The researchers found that people who tested positive for A1c hyperglycemia were more likely to have associated risks than those tested with FPG – fasting plasma glucose.

Identifying patients with these risk factors is important, because in some cases lifestyle changes can make a difference. Testing kids could mean a lifetime of better health.

The Take-Away

Although the authors found several advantages for A1c, the other tests are still good measures. While the old guidelines left out many patients who likely should be screened, children with diabetes were still diagnosed. But the A1c specifically identifies children at risk before diabetes develops. Early direction and intervention is important in childhood diabetes and prediabetes, and the new criteria mean many more kids might get tested.

If you’re concerned about your child, ask your family doctor or pediatrician if screening is an option.