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Pediatric Pearl

When It Comes to Screening Children for Type 2 Diabetes, Use Best Clinical Judgement

Scott T. Vergano, MD
10/28/2023

  • A new United States Preventive Services Task Force (USPSTF) recommendation was formulated after examining the literature on screening, treatment, and prevention of type 2 diabetes and prediabetes in non-pregnant children and adolescents.1

    The Research

    Their systematic review found insufficient evidence of documented benefit of screening for type 2 diabetes or prediabetes and lack of proven benefit from treatment to delay the onset or complications of type 2 diabetes in the pediatric population. They conclude that evidence at present is insufficient to recommend for or against screening for type 2 diabetes in children and adolescents.

    The Other Recommendations

    Unlike the USPSTF recommendations, the American Diabetes Association (ADA) currently recommends screening for type 2 diabetes in all children and adolescents who are overweight or with obesity who have at least one risk factor. Screening should begin at 10 years of age and be performed at least every 3 years. The risk factors for type 2 diabetes include family history of type 2 diabetes, maternal diabetes or gestational diabetes during pregnancy, signs of insulin resistance on physical exam, and non-White race. The American Academy of Pediatrics (AAP) and ADA had previously recommended screening in children who are overweight or with obesity with at least two of the preceding risk factors.

    The Bottom Line

    I have generally followed the AAP recommendation and have yet to diagnose a child with type 2 diabetes, despite fairly extensive screening. But as the USPSTF guidelines note: “Clinicians should continue to use their clinical judgment to determine if screening is appropriate for individual patients.”

     

    Reference:

    1. Mangione CM, Barry MJ, Nicholson WK, et al; US Preventive Services Task Force. Screening for prediabetes and type 2 diabetes in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2022;328(10):963-967. doi:10.1001/jama.2022.14543

    Scott T. Vergano, MD is a pediatrician in the Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA