What are the recommended preventive care and screening guidelines for children with diabetes?

Preventative Care and Screening Guidelines for Children with Diabetes

All children with diabetes require comprehensive, systematic screening for complications and comorbidities starting at specific ages and diabetes durations, with the exact timing and frequency depending on diabetes type and individual risk factors.

Type 1 Diabetes Screening Schedule

Psychosocial Screening

• Screen for diabetes distress, depression, and anxiety starting at age 7-8 years using validated tools for both youth and parents/caregivers 1
• Screen for depression specifically in youth aged 12-18 years, with additional screening when treatment goals are not met or significant life changes occur 1
• Screen for anxiety in youth aged 8-18 years 1
• Screen for disordered eating behaviors starting between ages 10-12 years, or earlier if signs such as unexplained weight loss, hyperglycemia, or excessive weight concern are present 1
• Assess for fear of hypoglycemia in youth as young as 6 years old, particularly those with history of severe or frequent hypoglycemic events 1

Nephropathy (Kidney) Screening

• Begin annual screening for albuminuria at puberty or age ≥10 years (whichever comes first), once the child has had diabetes for 5 years 1
• Use random spot urine sample (morning preferred) for albumin-to-creatinine ratio 1
• Elevated ratio (>30 mg/g) should be confirmed with two of three samples over 6 months 1
• Measure estimated glomerular filtration rate (GFR) at diagnosis and annually thereafter 1

Retinopathy (Eye) Screening

• Initial dilated comprehensive eye examination once youth have had type 1 diabetes for 3-5 years, provided they are age ≥10 years or puberty has started (whichever is earlier) 1, 2
• After initial examination, annual follow-up is generally recommended, though every 2 years may be acceptable based on eye care professional advice 1

Neuropathy (Nerve) Screening

• Consider annual comprehensive foot examination starting at puberty or age ≥10 years, once the youth has had type 1 diabetes for 5 years 1, 2
• Examination should include inspection, assessment of foot pulses, pinprick and 10-g monofilament sensation, vibration testing with 128-Hz tuning fork, and ankle reflexes 1

Cardiovascular Risk Factor Screening

Blood Pressure

• Measure blood pressure at every routine visit 1, 2
• If elevated (≥90th percentile for age, sex, height or ≥120/80 mmHg in adolescents ≥13 years), confirm on three separate days 1
• Consider ambulatory blood pressure monitoring for confirmed high blood pressure 1

Lipid Screening

• Perform initial lipid profile soon after diagnosis (preferably after glycemia improves) if age ≥2 years 1
• If initial LDL cholesterol ≤100 mg/dL, repeat screening at ages 9-11 years 1
• Can use nonfasting non-HDL cholesterol with confirmatory fasting lipid panel 1
• Repeat every 3 years if normal 2

Thyroid Screening

• Test for antithyroid peroxidase and antithyroglobulin antibodies soon after diagnosis 2
• Measure thyroid-stimulating hormone (TSH) at diagnosis once clinically stable or after optimizing glycemia 1, 2
• Repeat screening within 2 years of diagnosis, then again after 5 years 1
• Consider more frequent screening if symptoms develop or first-degree relative has celiac disease 1

Celiac Disease Screening

• Screen by measuring IgA tissue transglutaminase (tTG) antibodies with documentation of normal total serum IgA levels soon after diagnosis 1, 2
• If IgA deficient, use IgG to tTG and deamidated gliadin antibodies 1
• Repeat screening within 2 years of diagnosis, then again after 5 years 1
• Consider more frequent screening with symptoms or family history 1

Glycemic Monitoring

• A1C testing every 3 months to assess glycemic status 2
• Target A1C <7% (53 mmol/mol) for most children and adolescents 1

Type 2 Diabetes Screening Schedule

At Diagnosis Screening (Critical Difference from Type 1)

Type 2 diabetes requires immediate comprehensive comorbidity screening at diagnosis because complications may already be present 1:

• Blood pressure measurement 1
• Fasting lipid panel 1
• Random urine albumin-to-creatinine ratio 1
• Dilated eye examination 1
• Liver enzymes (AST and ALT) for nonalcoholic fatty liver disease 1

Ongoing Screening

Nephropathy

• Annual albumin-to-creatinine ratio screening 1
• Annual estimated GFR 1

Neuropathy

• Annual foot examination at diagnosis and annually thereafter (earlier than type 1) 1
• Include inspection, foot pulses, pinprick and 10-g monofilament sensation, vibration with 128-Hz tuning fork, and ankle reflexes 1

Lipid Screening

• Initially after optimizing glycemia, then annually 1
• Goals: LDL <100 mg/dL, HDL >35 mg/dL, triglycerides <150 mg/dL 1

Liver Disease

• Annual AST and ALT measurement for nonalcoholic fatty liver disease 1
• Refer to gastroenterology for persistently elevated or worsening transaminases 1

Sleep Apnea

• Screen for symptoms at each visit 1
• Refer to pediatric sleep specialist if indicated 1

Polycystic Ovary Syndrome

• Evaluate in female adolescents with type 2 diabetes, including laboratory studies when indicated 1

Psychosocial Screening

• Same recommendations as type 1 diabetes (starting age 7-8 years for distress, 8-18 years for anxiety, 12-18 years for depression) 1

Social Determinants of Health Screening (Both Types)

• Screen for food security, housing stability/homelessness, health literacy, financial barriers, and social/community support at every visit 1
• Apply this information to treatment decisions 1
• Ask about social adjustment (peer relationships) and school performance 1

Preconception Counseling

• Starting at puberty, incorporate preconception counseling into routine care for all individuals of childbearing potential 1
• Educate about risks of fetal malformations with elevated A1C and effective contraception use 1

Key Pitfalls to Avoid

Do not delay screening based on symptoms alone—many complications are asymptomatic in early stages, particularly nephropathy and retinopathy 1. The 5-year diabetes duration requirement for certain screenings in type 1 diabetes does not apply to type 2 diabetes, where screening begins immediately at diagnosis 1.

Do not screen for complications too early in type 1 diabetes—retinopathy and nephropathy rarely occur before puberty or within the first 5 years of diabetes duration 1, making earlier screening low-yield and potentially anxiety-provoking.

Do not overlook psychosocial screening—mental health problems significantly impact diabetes management, A1C levels, and quality of life 1. Validated screening tools exist and should be used systematically rather than relying on clinical impression alone 1.

Confirm abnormal results before initiating treatment—elevated albumin-to-creatinine ratio requires confirmation with two of three samples over 6 months, and elevated blood pressure requires confirmation on three separate days 1. This prevents overtreatment based on transient abnormalities.