For teens, annual “well care” visits don’t involve many laboratory screening tests. Rather, the emphasis is on preparing for teen health issues, such as accident and injury prevention, sexual health, and avoiding substance abuse. Preventive medicine for teens should emphasize healthy lifestyle choices that help protect against diseases that occur in adulthood.
The sections below discuss the few conditions and diseases for which teens 13 to 18 years old may be screened. They summarize the recommendations from various authorities on screening tests for teens, and there is consensus in many areas, but not all. Therefore, healthcare provider should consider the teen’s individual health situation and risk factors.
Screening Recommendations
High Cholesterol
Growing evidence shows that the biological processes that precede heart attacks and cardiovascular disease begin in childhood, although they don’t generally cause symptoms or lead to disease until middle age or later. Experts encourage physical activity and healthy eating in childhood and adolescence, limiting saturated fat and trans fat, to help protect against heart disease in adulthood.
Monitoring and maintaining healthy levels of cholesterol are important in staying healthy. Screening for high cholesterol, typically with a lipid profile, is important because there are usually no symptoms. A lipid profile usually includes total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. Non-HDL-cholesterol can also be calculated by subtracting the HDL-C value from the total cholesterol result. Typically, fasting for 9-12 hours before having the blood sample drawn is required; only water is permitted. However, some laboratories offer non-fasting lipid profiles. In particular, children and teens may have testing done without fasting.
Since screening recommendations are not always consistent between healthcare organizations, it’s important to develop a cholesterol-screening plan that is right for everyone.
Risk Factors
Family History: Youths are at increased risk if they have a parent, grandparent, aunt/uncle, or sibling who has high cholesterol or if they have a family history of cardiovascular disease (prior to age 55 in male relative and age 65 in female relative).
Personal Health: Youths are also at higher risk if they:
- Are overweight or obese
- Have a diet high in fats, especially saturated or trans fat
- Get little or no exercise
- Have diabetes or hypertension (high blood pressure)
- Smoke cigarettes or use other tobacco products
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Diabetes
While most cases of type 1 diabetes are diagnosed in those under the age of 18, the signs and symptoms often develop rapidly and the diagnosis is often made in an emergency room setting. Thirty percent of new-onset cases of type 1 diabetes in children present with diabetic ketoacidosis. Thus, blood glucose measurement as screening for type 1 diabetes in asymptomatic teens is presently not necessary. On the other hand, some youth with type 2 diabetes will have no obvious signs or symptoms of high blood glucose, especially early in the disease, and screening can be a useful tool. The incidence of type 2 diabetes has increased dramatically in the last decade, especially in minority populations, according to the American Diabetes Association (ADA).
Developing the disease early in life means that the patient is at increased risk for the development of diabetic complications because of the potentially prolonged duration of exposure to high blood glucose (hyperglycemia). This increases the risk of serious health problems earlier in adulthood, such as heart disease, kidney failure, blindness, and foot amputations.
Risk Factors
Overweight, obesity, and physical inactivity are all contributing factors to development of type 2 diabetes. Parents and teens should be aware that healthy eating habits and activity choices can lower an individual’s risk of developing type 2 diabetes and related complications later in life.
A youth who is overweight—defined as [1] a body mass index (BMI) greater than the 85th percentile for age and sex, [2] weight for height greater than the 85th percentile, or [3] overweight more than 120% of ideal for height— plus 2 other known risk factors faces a substantial risk of having or developing type 2 diabetes, warns the ADA. These risk factors include:
- Having a close relative with type 2 diabetes
- Having signs of or conditions associated with insulin resistance, including acanthosis nigricans, high blood pressure (hypertension), unhealthy lipid levels (dyslipidemia), polycystic ovary syndrome, or having a reduced birth weight (small-for-gestational age)
- Having a birth mother who has diabetes or had gestational diabetes
Recommendations
The ADA makes the following screening recommendations:
• Consider screening overweight adolescents who have 2 or more risk factors for diabetes every 3 years, starting at 10 years of age or at the onset of puberty
• Screen using one of the following tests:
- Fasting glucose (fasting blood glucose, FBG) – this test measures the level of glucose in the blood after an 8-12 hour fast.
- Hemoglobin A1c (also called A1c or glycated hemoglobin) – this test evaluates the average amount of glucose in the blood over the last 2 to 3 months and has been recommended as another test to screen for diabetes.
- 2-hour oral glucose tolerance test (OGTT) – this test involves drawing a fasting blood sample for glucose measurement, followed by having the person drink a solution containing 1.75 grams of glucose per kilogram body weight to a maximum of 75 grams and then drawing another sample two hours after the person begins to consume the glucose solutions.
If any of these results is abnormal, the test is repeated on another day. If the repeat result is also abnormal, a diagnosis of diabetes is made.
