2.2.0.0 Screen­ing and Di­ag­no­sis

Rec­om­men­da­tions

13.45 Risk-‍based screen­ing for predi­a­betes and/‍or type 2 di­a­betes should be con­sid­ered in chil­dren and ado­les­cents after the onset of pu­ber­ty or ≥10 years of age, whichev­er oc­curs ear­li­er, who are over­weight (BMI ≥85th per­centile) or obese (BMI ≥95th per­centile) and who have one or more ad­di­tional risk fac­tors for di­a­betes (see Table 2.4 for ev­i­dence grad­ing of other risk fac­tors).

13.46 If tests are nor­mal, re­peat test­ing at a min­i­mum of 3-year in­ter­vals E, or more fre­quent­ly if BMI is in­creas­ing. C

13.47 Fast­ing plas­ma glu­cose, 2-h plas­ma glu­cose dur­ing a 75-g oral glu­cose tol­er­ance test, and A1C can be used to test for predi­a­betes or di­a­betes in chil­dren and ado­les­cents. B

13.48 Chil­dren and ado­les­cents with over­weight/obe­si­ty in whom the di­ag­no­sis of type 2 di­a­betes is being con­sid­ered should have a panel of pan­cre­at­ic au­toan­ti­bod­ies test­ed to ex­clude the pos­si­bil­i­ty of au­toim­mune type 1 di­a­betes. B

In the last decade, the in­ci­dence and preva­lence of type 2 di­a­betes in ado­les­cents has in­creased dra­mat­i­cal­ly, es­pe­cial­ly in racial and eth­nic mi­nor­i­ty pop­u­la­tions (98,127). A few re­cent stud­ies sug­gest oral glu­cose tol­er­ance tests or fast­ing plas­ma glu­cose val­ues as more suit­able di­ag­nos­tic tests than A1C in the pe­di­atric pop­u­la­tion, es­pe­cial­ly among cer­tain eth­nicities (128), al­though fast­ing glu­cose alone may over­diag­nose di­a­betes in chil­dren (129,130). In ad­di­tion, 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 (131). 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, ADA con­tin­ues to rec­om­mend A1C for di­ag­no­sis of type 2 di­a­betes in this pop­u­la­tion (132,133).