From the Guidelines
Diabetes Mellitus type 1 (DM1) in pediatric patients is diagnosed based on specific criteria, including a fasting plasma glucose (FPG) ≥ 126 mg/dL, 2-h plasma glucose (PG) ≥ 200 mg/dL, or A1C ≥ 6.5%.
Diagnostic Criteria
The diagnostic criteria for DM1 in pediatric patients are as follows:
- Fasting plasma glucose (FPG) ≥ 126 mg/dL (7 mmol/L) 1
- 2-h PG ≥ 200 mg/dL (11.1 mmol/L) 1
- A1C ≥ 6.5% 1
- Random PG ≥ 200 mg/dL (11.1 mmol/L) in the presence of typical symptoms of diabetes 1
Confirmation of Diagnosis
The diagnosis of DM1 in pediatric patients should be confirmed by:
- Repeating the same test on a separate day without delay using a new blood sample 1
- Using two different tests (such as A1C and FPG) that are both above the diagnostic threshold 1
- Measuring venous PG on an analytic instrument in a clinical chemistry laboratory, as glucose meters and urine ketone tests are useful for screening but not for diagnosis 1
Special Considerations
In asymptomatic children or adolescents with a high risk for diabetes, consultation with a pediatric endocrinologist is indicated if incidental or stress hyperglycemia is discovered 1. In children with typical symptoms of diabetes, a random PG ≥ 200 mg/dL (11.1 mmol/L) is sufficient for diagnosis without the need for further testing 1. Distinguishing between type 1 diabetes, type 2 diabetes, monogenic diabetes, and other forms of diabetes is based on history, patient characteristics, and laboratory tests, including an islet autoantibody panel 1.
From the Research
Diagnostic Criteria for Diabetes Mellitus Type 1 (DM1) in Pediatric Patients
The diagnostic criteria for DM1 in pediatric patients are not explicitly stated in the provided studies. However, some studies provide information on the diagnosis and classification of diabetes mellitus in children.
- The study 2 mentions that the diagnostic criteria for diabetes mellitus include two abnormal fasting plasma determinations, with a lower cutoff for fasting plasma glucose (126 mg per dL [7 mmol per L] or higher) to confirm the diagnosis of diabetes mellitus.
- The study 3 states that most of the study participants correctly answered the questions about the diagnostic criteria of diabetes, but does not provide specific information on the criteria for DM1 in pediatric patients.
- The study 4 mentions that diabetic ketoacidosis (DKA) development in children with new-onset type 1 diabetes is often the main consequence of delayed diagnosis, but does not provide specific diagnostic criteria for DM1.
- The study 5 mentions that the initial classification of DM frequently requires revision, and that the misclassification is highest among DM2 patients who initially present with higher HbA1c and DKA, but does not provide specific diagnostic criteria for DM1 in pediatric patients.
- The study 6 does not provide specific information on the diagnostic criteria for DM1 in pediatric patients, but mentions that all children with diabetes warrant screening of glomerular filtration rate, blood pressure, and urine albumin excretion, and that screening should begin after 5 years of DM1 or at puberty.
Challenges in Diagnosing DM1 in Pediatric Patients
- The study 4 found that difficulties in diagnosing T1DM were found in 67 cases (14.13%) and are the main cause of DKA development in these children.
- The study 5 found that 10% of studied patients had a subsequent change in classification, and that the misclassification is highest among DM2 patients who initially present with higher HbA1c and DKA.
- The study 3 found that most of the study participants correctly answered the questions about the diagnostic criteria of diabetes, but that the correct answers varied from 96% to 72% among medical specialists and physicians during the training, respectively.