CDC Statements on Diabetes Issues
 

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CDC STATEMENT ON SCREENING CHILDREN FOR ACANTHOSIS NIGRICANS IN SCHOOLS AND COMMUNITIES

The following CDC statement discusses the results and implications of an article that concludes that acanthosis nigricans is a predictor for high levels of insulin (hyperinsulinemia) in New Mexico adolescents.

Prevalence of acanthosis nigricans and its association with hyperinsulinemia in New Mexico adolescents. Journal of Adolescent Health 2001 May;28(5):372-6.

1. What is acanthosis nigricans?

Acanthosis nigricans (AN) is a skin problem often found on the neck, axilla, groin, and other flexural areas. Literally, AN means thick, coarse, and dark. Scientists once thought AN was associated with conditions such as polycystic ovarian syndrome, but recently, they have found that AN is a marker for high levels of insulin.

2. Do people with high levels of insulin develop type 2 diabetes?

A high level of insulin indicates insulin resistance, which is a primary risk factor for type 2 diabetes and other conditions, such as high cholesterol and high blood pressure.

3. How often do people with AN develop type 2 diabetes?

The relationship between AN and the development of type 2 diabetes is not known.

4. Could AN be used to screen adolescents for high levels of insulin?

Yes. According to this study, 34% of those with AN are also likely to have high levels of insulin; 47% of those with both AN and a body mass index (BMI) of greater than 25 are likely to have high levels of insulin.

5. Could AN be used to screen for adolescents who have diabetes?

The study found that although AN was a marker for high levels of insulin, it could not be used to predict diabetes.

6. Does physical activity protect against having high levels of insulin?

In this cross-sectional study, scientists observed that physical activity (>4 days/week) did help protect against high levels of insulin regardless of AN, BMI, family history, sex, and ethnicity. However, further studies using a prospective study design need to explore this association.

7. What do the authors of this article suggest?

• It is likely that increased physical activity may prevent or delay the onset of hyperinsulinemia in adolescents.
• Health care providers who evaluate adolescents for type 2 diabetes should assess obesity, presence of AN, and physical activity.
• Interventions directed at primary prevention, such as reducing obesity and increasing physical activity, also need to be evaluated.

8. Based on these findings, what is the position of CDC scientists regarding AN screening for diabetes in adolescents?

CDC is aware that some groups are interested in AN screening of children in school settings to identify those at high risk to develop type 2 diabetes. Although some studies have observed that half the children with type 2 diabetes had AN, insufficient evidence exists for us to conclude that having AN will lead to type 2 diabetes. Therefore, at this time, CDC scientists strongly discourage AN screening of children in school or community settings.

9. What is the rationale for CDC's position discouraging AN screening of children for diabetes in schools and communities?

• While AN is a reliable and independent marker of hyperinsulinemia, the extent to which AN predicts the development of type 2 diabetes is unclear. In this study, none of the 233 students screened had hyperglycemia.
• CDC scientists are not aware of any systematic guidelines for clinical detection of AN or a uniform AN case definition. The repeatability, reliability, and validity of AN screening, relative to expert diagnosis (gold standard), is unknown. This makes it impossible to meaningfully interpret AN screening results. Therefore, the utility of using AN as a screening tool for diabetes prevalence or as a predictor of developing diabetes is currently unknown.
• Those adolescents who have AN can be stigmatized by the screening process and subsequent identification. We are also concerned that if AN status becomes a part of adolescents' medical records, it might jeopardize their future insurance benefits.
• Most importantly, there are now no known interventions or protocols to treat those who have AN. There is some evidence that those with AN might benefit from physical activity. Because improved physical activity benefits everyone in school or communities, it makes sense to encourage physical activity for all children, regardless of AN status.

10. What scientific issues concern CDC?

CDC scientists are concerned that a standard definition and tool for AN screening in clinical and community settings do not currently exist. We are also concerned about the lack of evidence showing that the presence of AN predicts type 2 diabetes.

11. Summary

Given the absence of a uniform case definition and intervention protocols for those with AN and considering the risk of stigmatization for those with AN, CDC scientists believe that it is not ethical or cost-effective to mass screen children for AN. CDC recommends that state diabetes control programs consider an alternative primary prevention approach and use available resources to improve physical activity and nutrition in schools and communities.

 

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