The following is a summary of the ADA recommendations for screening for type 2 diabetes or prediabetes in asymptomatic children and adolescents.
Risk-Based Screening for Type 2 Diabetes or Prediabetes in Asymptomatic Children and Adolescents in a Clinical Setting:
Screening should be considered in youth who are overweight (≥85th percentile) or obese (≥95th percentile) and who have one or more additional risk factors based on the strength of their association with diabetes such as the following:
- Maternal history of diabetes or GDM during the child’s gestation
- Family history of type 2 diabetes in first- or second-degree relative
- Race and ethnicity (e.g., Native American, African American, Latino, Asian American, Pacific Islander)
- Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or small-for-gestational-age birth weight)
Screening for youth should be after the onset of puberty or after 10 years of age, whichever occurs earlier. If tests are normal, repeat testing at a minimum of 3-year intervals, or more frequently if BMI is increasing or risk factor profile deteriorating. Reports of type 2 diabetes before age 10 years exist, and this can be considered with numerous risk factors.
Specific glycemic target recommendations by the ADA are the following:
- A reasonable A1C target for most children and adolescents with type 2 diabetes is <7%. More stringent A1C targets such as <6.5% may be appropriate for selected individual patients if they can be achieved without significant hypoglycemia or other adverse effects of treatment.
- Appropriate patients might include those with a short duration of diabetes and lesser degrees of β-cell dysfunction and patients treated with lifestyle or metformin only who achieve significant weight improvement.
- Less stringent A1C goals such as 7.5% may be appropriate if there is an increased risk of hypoglycemia.
