4.4.2.0 Screen­ing and Test­ing for Predi­a­betes and Type 2 Di­a­betes in Chil­dren and Ado­les­cents

In the last decade, the in­ci­dence and preva­lence of type 2 di­a­betes in ado­les­cents has in­creased dra­mat­i­cal­ly, es­pe­cial­ly in racial and eth­nic mi­nor­i­ty pop­u­la­tions (33). See Table 2.4 for rec­om­men­da­tions on risk-‍based screen­ing for type 2 di­a­betes or predi­a­betes in asymp­tomat­ic chil­dren and ado­les­cents in a clin­i­cal set­ting (13). See Ta­bles 2.2 and 2.5 for the cri­te­ria for the di­ag­no­sis of di­a­betes and predi­a­betes, re­spec­tive­ly, which apply to chil­dren, ado­les­cents, and adults. See Sec­tion 13 “Chil­dren and Ado­les­cents” for ad­di­tion­al in­for­ma­tion on type 2 di­a­betes in chil­dren and ado­les­cents.

Some stud­ies ques­tion the va­lid­i­ty of A1C in the pe­di­atric pop­u­la­tion, es­pe­cial­ly among cer­tain eth­nicities, and sug­gest OGTT or FPG as more suit­able di­ag­nos­tic tests (62). How­ev­er, many of these stud­ies do not rec­og­nize that di­a­betes di­ag­nos­tic cri­te­ria are based on long-‍term health out­comes, and val­i­da­tions are not cur­rently avail­able in the pe­di­atric pop­u­la­tion (63). The ADA ac­knowl­edges the lim­it­ed data sup­port­ing A1C for di­ag­nos­ing type 2 di­a­betes in chil­dren and ado­les­cents. Al­though A1C is not rec­om­mend­ed for di­ag­no­sis of di­a­betes in chil­dren with cys­tic fibro­sis or symp­toms sug­gestive of acute onset of type 1 di­a­betes and only A1C as­says with­out in­ter­fer­ence are ap­pro­pri­ate for chil­dren with hemoglobinopathies, the ADA con­tin­ues to rec­om­mend A1C for di­ag­no­sis of type 2 di­a­betes in this co­hort (64,65).