Hemoglobin A1c Screening Practices and Characteristics in Youth with Congenital Heart Disease

Pediatric congenital heart disease (CHD) patients have increased risk for cardiovascular (CV) disease. Acquired conditions such as elevated Hemoglobin A1c (HbA1c) are known risk factors for adverse CV outcomes in the adult population. With the increasing rates of pediatric prediabetes and diabetes, data are limited on the screening practices for HbA1c in children with CHD. Presence of elevated HbA1c in this population would potentially increase future CV risk. Our study aimed to evaluate screening practices for HbA1c in youth with CHD and the characteristics of those screened. Youth with CHD with primary cardiology encounters from 2012 to 2019 were evaluated. Available anthropometric, demographic, and lab data were analyzed to determine rates of HbA1c screening, screening eligibility, and compare those screened with HbA1c versus those unscreened. Of 2764 total patients, 7.9% (219/2764) had HbA1c labs with 21.9% (48/219) in the prediabetic/diabetic range. Screened patients had a higher proportion of individuals with elevated or hypertensive blood pressure measurements and overweight/obese body mass index versus unscreened patients. Although 213 patients (7.7%) were screen-eligible for HbA1c per American Diabetes Association recommendations, only 27.2% (58/213) were screened with 37.9% (22/58) in the prediabetic/diabetic range. Only a small percentage of screen-eligible patients were screened with HbA1c. Of those screened, a sizable proportion of patients were in the prediabetic/diabetic range. Improved screening practices for HbA1c and metabolic syndrome in children with CHD are needed.