Falling short: When testing is mandated and follow-up is not

Area of Science:

• Public Health
• Pediatrics
• Endocrinology

Background:

• Texas mandates school-based screening for acanthosis nigricans (AN), a skin condition linked to insulin resistance and type 2 diabetes (DMT2).
• Millions of children have been screened since 1999, with hundreds of thousands testing positive for AN.
• The current screening program lacks mandated follow-up, potentially leaving many at-risk children undiagnosed.

Purpose of the Study:

• To evaluate the effectiveness of Texas's AN screening program in identifying DMT2 in school-aged children.
• To highlight the need for mandated follow-up protocols to ensure early diagnosis and intervention for pediatric DMT2.

Main Methods:

• Analysis of the existing Texas House Bill 1860 mandating AN screening in primary schools.
• Review of current practices for children screening positive for AN.
• Discussion of the implications of lacking mandated diagnostic follow-up.

Main Results:

• The program identifies a significant number of children with AN, indicating a high prevalence of insulin resistance risk.
• No data exists on the program's effectiveness in diagnosing DMT2 due to the absence of mandated follow-up.
• Children screening positive are advised to seek medical assessment, but adherence and diagnosis rates are unknown.

Conclusions:

• Mandating follow-up assessments for children screening positive for AN could enable early intervention for DMT2.
• Implementing diagnostic follow-up could reduce long-term healthcare costs associated with untreated diabetes.
• The omission of mandated follow-up in the original legislation may be linked to the invasive nature and cost of diabetes blood tests.