Laboratory screening in adolescents

All adolescents
Hematocrit once at baseline for girls after menarche
Total cholesterol for both girls and boys (once before age 18)
Risk-based screening
Family history of early cardiovascular disease or dyslipidemia
 Non-fasting lipids (instead of total cholesterol)
Obesity (BMI > 95%) starting at age 10 or pubertal (hair = screen!)
OR patients with BMI > 85% with 2 risk factors for diabetes (Hispanic, black, or American
Indian; family history of diabetes; signs of insulin resistance (PCOS, elevated blood pressure, or
acanthosis) ADD:
 Hemoglobin A1c (A1c) or fasting glucose
 Alanine aminotransferase (ALT)
Sexually active adolescents
 Urine gonorrhea and Chlamydia every 6 months (more often if new partner)
 HIV and syphilis testing in high-risk teens (multiple partners, IV drug use) or 3
months after + STI screen at time of follow-up GC/CT test
Diabetes screening frequency:
A1c < 5.7%:
Recheck A1c in 2 years; sooner if BMI increases > 1 kg/m2/year
A1c 5.7-5.9%:
Lifestyle change, letter; recheck A1c in 6 months
A1c 6.0-6.4%:
Lifestyle change, letter, phone call; A1c, glucose, and UA in 3 months
A1c 6.5%-7%:
Repeat A1c ASAP, with glucose and UA for ketones
Consider glucometer; check 2 hour postprandial glucose daily x 2 weeks
Recheck/review log in 2 weeks; recheck A1c 3 months with glucose/UA
A1c >7.0%:
Confirm ASAP with repeat A1c, glucose and UA for ketones
Contact TCH (720) 777-6128; ask for Dr. Zeitler, Nadeau, Kelsey or Chan
Contact Barbara Davis Center (303) 724-2323 if ketotic or ill appearing
Kathy Love-Osborne (303) 436-4688 pager (303 891-4967) for questions.
Dyslipidemia screening frequency:
Total cholesterol (TC) < 170 mg/dl: No need to repeat
TC 170-200 mg/dl (<18)
Letter & handout; lipid panel 1 year
TC >200 mg/dl
Letter & handout & phone call; fasting lipids 6-8 weeks
Non-alcoholic fatty liver disease (NAFLD) screening frequency:
ALT in normal range:
Recheck ALT in 2 years
ALT normal to 80 U/L
Lifestyle modification, check LFTs 1 year.
ALT 80-150 U/L
Lifestyle modification, check LFTs in 3-6 months
ALT > 150 U/L
Repeat full LFTs in 1-2 weeks, lifestyle modification;
recheck LFTs in 3 months if 2nd ALT still > 150 mg/dl
ALT > 150 U/L after 6 months
Further testing followed by GI consult
Kathy Love-Osborne 3/5/13