Screening

Identification of children with obesity is the first screening test. The American Diabetes Association recommends the following regarding screening for pre-diabetes and type 2 diabetes mellitus (T2DM) in asymptomatic youth.​[1]​​

  • Testing for pre-diabetes and/or T2DM should be considered after the onset of puberty or ≥10 years of age (whichever occurs earlier) in those with overweight (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) and have one or more additional risk factors for diabetes:

    • Maternal history of diabetes or gestational diabetes during the child’s gestation

    • Family history of T2DM in first- or second-degree relative

    • American-Indian, African-American, Latino, Asian-American, or Pacific Islander race/ethnicity

    • Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidaemia, polycystic ovary syndrome, or small-for-gestational-age birth weight).

  • Age at initiation: 10 years or at onset of puberty, if puberty occurs earlier.

  • Frequency of screening: minimum of every 3 years. More frequent screening is indicated if BMI is increasing or if there are changes in risk factor profile.

  • Screening test: fasting plasma glucose, 2-hour plasma glucose during a 75-g oral glucose tolerance test, and haemoglobin A1c (HbA1c) can be used.

The American Academy of Pediatrics advises having an 'increased index of suspicion' for type 2 diabetes and pre-diabetes in all children with obesity, especially in the presence of other risk factors.[64]

The American Heart Association has proposed grouping diabetes, cardiovascular disease, obesity, and chronic kidney disease into a single spectrum known as cardiovascular-kidney-metabolic (CKM) syndrome, and proactively screening for all risk factors beginning in early life.[48]​ In a 2023 presidential statement, it recommends annual screening for overweight and obesity, and blood pressure measurement at all clinic visits, beginning from age 3 years. A lipid panel should be checked between aged 9 and 11 years and again between aged 17 and 21 years, with additional assessment of impaired glucose tolerance (using fasting glucose, oral glucose tolerance test, or HbA1c) and alanine aminotransferase in those with overweight or obesity. If initial screening for impaired glucose tolerance is normal, testing should be repeated every 2 to 3 years for all children with obesity, and for those who are overweight with additional risk factors such as tobacco use, raised blood pressure or lipids.[48]

Screening for T2DM is recommended for any Australian Aboriginal or Torres Strait Islander person aged >10 years (or past the onset of puberty) who is overweight or obese, has a positive family history of diabetes, has signs of insulin resistance, has dyslipidaemia, has received psychotropic therapy, or has been exposed to diabetes in utero.[54]

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