From the Guidelines
The recommended age for diabetes screening for EC's younger sibling would be at the onset of puberty or 10 years of age, whichever occurs earlier, but since the child is currently 8 years old with a BMI at the 50th percentile (normal weight) and no mentioned risk factors, they should be screened in approximately 2 years, at age 10. According to the American Diabetes Association, as stated in the 2025 standards of care in diabetes 1, risk-based screening for prediabetes and/or type 2 diabetes should be considered after the onset of puberty or 10 years of age, whichever occurs earlier, in youth with overweight (BMI ≥ 85th percentile) or obesity (BMI ≥ 95th percentile) and who have one or more additional risk factors for diabetes. However, since EC's younger sibling has a normal BMI (50th percentile) and no mentioned risk factors, the standard screening timeline can be followed. The screening typically involves a fasting plasma glucose test, 2-h plasma glucose during a 75-g oral glucose tolerance test, and A1C, as recommended by the American Diabetes Association 1. Regular screening is important because early detection of diabetes or prediabetes allows for prompt intervention with lifestyle modifications or medical treatment if needed, potentially preventing complications associated with uncontrolled blood glucose levels. It is also worth noting that the prevalence of type 2 diabetes in youth has continued to increase over the past 20 years, and evidence suggests that type 2 diabetes in youth is different from type 1 diabetes and type 2 diabetes in adults, with unique features such as a more rapidly progressive decline in b-cell function and accelerated development of diabetes complications 1. Therefore, it is crucial to follow the recommended screening guidelines to ensure early detection and proper management of diabetes in children and adolescents. Key points to consider include:
- Risk-based screening for prediabetes and/or type 2 diabetes should be considered after the onset of puberty or 10 years of age, whichever occurs earlier, in youth with overweight or obesity and who have one or more additional risk factors for diabetes 1.
- The screening typically involves a fasting plasma glucose test, 2-h plasma glucose during a 75-g oral glucose tolerance test, and A1C 1.
- Regular screening is important because early detection of diabetes or prediabetes allows for prompt intervention with lifestyle modifications or medical treatment if needed, potentially preventing complications associated with uncontrolled blood glucose levels.
From the Research
Screening for Diabetes in Children
- The American Diabetes Association recommends screening for type 2 diabetes beginning at 10 years of age or the onset of puberty in children who are overweight or obese and have two additional risk factors 2.
- Since EC's younger sibling is 8 years old and their BMI is 50th percentile for their age, they do not have any known risk factors mentioned in the studies.
- However, based on the American Diabetes Association's recommendation, EC's younger sibling should be screened for diabetes at the age of 10 years, assuming they have two additional risk factors and are overweight or obese.
Age of Screening
- The studies do not provide a specific age for screening children with a normal BMI, like EC's younger sibling.
- However, the American Diabetes Association's recommendation suggests that screening should start at 10 years of age or the onset of puberty in children who are overweight or obese and have two additional risk factors 2.
- Therefore, the correct answer would be 10 years, assuming EC's younger sibling meets the additional risk factors and is overweight or obese.
Additional Considerations
- The US Preventive Services Task Force concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in children and adolescents 3.
- Other studies suggest that HbA1c is a specific and useful nonfasting test to identify high-risk youth who could benefit from lifestyle interventions to prevent diabetes and cardiovascular risk in adulthood 4.