From the Guidelines
Children over 10 years old who are overweight or obese should be screened for type 2 diabetes starting at age 10 or at the onset of puberty, whichever comes first, as recommended by the most recent guidelines 1. The criteria for screening include having a BMI at or above the 85th percentile for age and sex, plus at least one additional risk factor such as family history of type 2 diabetes in a first- or second-degree relative, signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome), or belonging to certain high-risk racial/ethnic groups (Native American, African American, Latino, Asian American, Pacific Islander) 1. Screening should be done using either a fasting plasma glucose test, a 2-hour plasma glucose during an oral glucose tolerance test, or a hemoglobin A1C test, as these methods are effective for diagnosing prediabetes or diabetes in children and adolescents 1. If initial results are normal, testing should be repeated at a minimum of 2-year intervals, or more frequently if BMI is increasing, to ensure early detection and intervention 1. Early screening is crucial because type 2 diabetes in youth often progresses more rapidly than in adults and can lead to serious complications if left undiagnosed, such as microvascular complications and accelerated decline in b-cell function 1. Additionally, early intervention with lifestyle modifications and possibly medication can significantly improve outcomes and potentially reverse the condition in its early stages, emphasizing the importance of comprehensive diabetes self-management education and support that is specific to youth with type 2 diabetes and is culturally appropriate 1.
Some key points to consider in the screening and management of type 2 diabetes in children and adolescents include:
- The importance of distinguishing between type 1 and type 2 diabetes, as the presence of islet autoantibodies can be associated with faster progression to insulin deficiency 1
- The need for close communication with and the cooperation of school personnel to ensure optimal diabetes management and safety and maximal academic opportunities 1
- The impact of social determinants of health on the development and management of type 2 diabetes in youth, highlighting the need for culturally appropriate and comprehensive lifestyle programs 1
From the Research
Screening Criteria for Type 2 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.
Diagnostic Criteria
Diagnostic criteria for type 2 diabetes include:
- A fasting blood glucose level of 126 mg per dL or greater
- A two-hour plasma glucose level of 200 mg per dL or greater during an oral glucose tolerance test
- An A1C level of 6.5% or more
- A random plasma glucose level of 200 mg per dL or greater plus symptoms of polyuria, polydipsia, or unintentional weight loss 2
Risk Factors
Risk factors for type 2 diabetes in children include:
- Overweight or obesity
- Family history of type 2 diabetes
- Minority ethnic groups (e.g., African American, Hispanic/Latino, American Indian)
- Signs of insulin resistance (e.g., acanthosis nigricans)
Screening Frequency
The frequency of screening for type 2 diabetes in children is not well established, but the American Diabetes Association recommends annual screening for children who are overweight or obese and have two or more risk factors 2.
Laboratory Tests
Laboratory tests used to screen for type 2 diabetes in children include: