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Cardiometabolic Screening Gaps in Pediatric Congenital Heart Disease

Cardiometabolic Screening Gaps in Pediatric Congenital Heart Disease 1024 683 Pam Georgiana

Retrospective review reveals inconsistent HbA1c screening in eligible patients.

Pediatric cardiology has achieved remarkable gains in survival for children with congenital heart disease. However, as more patients reach adolescence and adulthood, they are at risk for experiencing acquired cardiovascular and cardiometabolic conditions such as hypertension and diabetes. Little is known about how consistently clinicians identify and manage these risks in this growing population.

To better understand current practices, a cross-disciplinary team of investigators at Nationwide Children’s Hospital evaluated hemoglobin A1c (HbA1c) screening patterns in youth with congenital heart disease and the characteristics of those screened. The study was published in Pediatric Cardiology.

“Youth with congenital heart disease are living longer, which means lifelong exposure to cardiovascular risk,” says Andrew Tran, MD, MPH, MS, FAHA, FAAP, pediatric cardiologist and director of the Preventive Cardiology Program at Nationwide Children’s. “Because we are still learning how risk factors affect their overall health, our team wanted to know whether we consistently apply basic metabolic screening to these patients.”

The team conducted a retrospective review of 2,764 patients younger than 18 years with congenital heart disease who had a cardiology clinic visit at Nationwide Children’s between 2012 and 2019. The team used anthropometric, blood pressure and lab data to identify which patients received HbA1c testing. They also assessed which patients met the American Diabetes Association (ADA) criteria for diabetes screening. This included those with a high body mass index and other risk factors.

“Our aim was not to redefine screening guidelines,” Dr. Tran says. “We asked a simpler question. When these patients meet existing criteria, are we screening them?” Dr. Tran is also an assistant professor of Pediatrics at The Ohio State University College of Medicine.

When the researchers applied ADA criteria to the full cohort, 7.7% (213 patients) were eligible for screening. Yet only 27.2% of those eligible (58 patients) had an HbA1c obtained. Of the eligible children who were screened, 37.9% (22 patients) had prediabetic or diabetic values. This is a higher proportion than reported in the general pediatric population. Among the full cohort, 7.9% (219 patients) had an HbA1c measured. Among those screened, 21.9% had HbA1c values in the prediabetic or diabetic range.

From an endocrinology perspective, the findings are notable. “We already have clear ADA and International Diabetes Federation guidance on when to screen children for prediabetes and diabetes,” says Leena Mamilly, MD, pediatric endocrinologist at Nationwide Children’s. “This study shows that we are not screening many youths with congenital heart disease who meet the criteria. Even more striking is that when we do screen them, the rate of abnormal results is higher than the general pediatric population.”

Children with abnormal HbA1c results represent a higher-risk subgroup. They are more likely to have elevated body mass index, hypertensive blood pressure readings and dyslipidemia. These conditions are consistent with broader patterns of cardiometabolic risk.

Because the analysis centered around guideline adherence rather than population prevalence, the study cannot define an accurate rate of prediabetes or diabetes in youth with congenital heart disease. It does, however, highlight a persistent gap between recommended practice and real-world care for a population already at elevated cardiovascular risk.

“For all clinicians, the lesson is straightforward,” Dr. Tran says. “If a child has congenital heart disease and meets standard risk criteria for cardiometabolic disease, screening should be routine rather than discretionary.”

Dr. Mamilly adds that early identification is especially meaningful for patients with multiple risk factors. “For a child with congenital heart disease, every additional modifiable risk factor matters,” she says. “Systematic HbA1c screening, timely referral and attention to weight, blood pressure and lipids are practical steps clinicians can take now while we continue to study long-term outcomes.”

The authors note that these data provide a foundation for quality improvement efforts in cardiology, endocrinology and primary care. “There is a lot we do not know yet, but this is the first step towards integrating routine metabolic screening into care visits for all youth with congenital heart disease,” Dr. Mamilly concludes.

 

Reference:

Wheeler JA, Cheng PS, Alvarado C, Mamilly L, Walsh A, Hor KN, Tran AH. Hemoglobin A1c Screening Practices and Characteristics in Youth with Congenital Heart Disease. Pediatric Cardiology. Published online November 6, 2025. doi:10.1007/s00246-025-04092-0

Image credit: Nationwide Children’s

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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