Importance of Early Screening and Intervention for Diabetes in Children

The prevalence of diabetes is rapidly increasing among children, leading to higher risks of serious complications that can cause significant health issues and mortality later in life. Early detection and treatment are crucial for reducing long-term complications, underscoring the importance of screening in pediatric populations.

Type 1 Diabetes Screening

Type 1 diabetes (T1D) is an autoimmune disorder that destroys insulin-producing pancreatic β-cells, leading to insulin deficiency and high blood sugar. T1D is the most prevalent form of diabetes in children, especially between ages 10 and 14, with a rising incidence of 22.9 new cases per 100,000 children under 15. Early symptoms of T1D can be subtle, resulting in 40% of new patients being diagnosed only after experiencing severe complications like diabetic ketoacidosis (DKA). DKA is a life-threatening condition, and a significant portion of T1D-related deaths in young individuals is attributed to delays in diagnosis. Screening high-risk patients can significantly lower the risk of DKA.

In 2015 the American Diabetes Association (ADA), Juvenile Diabetes Research Foundation, and Endocrine Society worked together to define clinical stages in the progression from autoantibody positivity to diabetes development in patient, which is as follows:

Current recommendations advocate for screening first-degree relatives of T1D patients for islet autoantibodies, with follow-up testing for diabetes if two or more autoantibodies are found. If diagnosed with two or more autoantibodies, a referral to a pediatric endocrinologist is advised for further monitoring and treatment.

Type 2 Diabetes Screening

Type 2 diabetes (T2D) is characterized by insulin resistance and is increasingly prevalent among youth in the United States. The incidence for individuals under 20 was 13.8 per 100,000 in 2014-2015, with a striking 95% increase in prevalence from 2001 to 2017. T2D is often linked to factors such as family history, obesity, and socioeconomic status. Early-onset T2D is concerning as it correlates with poorer health outcomes.

ADA first recommended screening for T2D in asymptomatic youth aged 10 and older in 2000, initially targeting high-risk groups. In 2018, this was expanded to include all overweight youths with at least one risk factor. The main guidelines followed in pediatrics include those of the ADA and the International Society for Pediatric and Adolescent Diabetes (ISPAD) and its diagnostic criteria is as follows:

• Fasting Plasma Glucose >/=126 mg/dL (7.0 mmol/L)
• Two-hour Plasma Glucose >/=200 mg/dL (11.1 mmol/L) during OGTT
• A1C >/=6.5% (48 mmol/mol)
• Random plasma glucose >/=200 mg/dL and symptoms of diabetes (polyuria, polydipsia, weight loss, fatigue)

If a child is identified as prediabetic, it is crucial to implement lifestyle interventions to prevent the progression to T2D. While no medications are currently approved for prediabetes treatment, lifestyle changes, including dietary adjustments and increased physical activity, have been effective. If diabetes is diagnosed, a referral to a pediatric endocrinologist for medical management is essential.

Source: Huston J, Sudhakar D, Malarvannan P, Aradhyula R, Clark AL. Diabetes and Dyslipidemia Screening in Pediatric Practice. Mo Med. 2024 May-Jun;121(3):206-211. PMID: 38854609; PMCID: PMC11160381.