Obese, inactive pediatric patients may develop Type 2 diabetes. A pediatric patient should be screened for Type 2 diabetes if certain findings are present.
In the past most pediatric patients who developed diabetes had Type 1 diabetes. The evolution of Type 2 diabetes in children reflects increasing body weight, decreasing activity and changes in diet.
Indications for testing a pediatric patient for Type 2 diabetes - both of the following:
(1) overweight (see below)
(2) 2 or more of the following:
(2a) family history (first or second degree relatives) of Type 2 diabetes
(2b) ethnic background African-American, Asian American, Hispanic, Native American, Pacific Islander
(2c) clinical findings that may be associated with insulin resistance
(2d) mother with diabetes, including gestational diabetes
where:
• Family history should include more than 1 relative.
• A mother with diabetes would be included in family history.
• Findings associated with insulin resistance may include acanthosis nigricans, dyslipidemia, hypertension and/or polycystic ovary syndrome (PCOS).
Being overweight is indicated by one or more of the following:
(1) > 1 standard deviation above mean for body mass index for age and gender (> 85th%ile)
(2) > 1 standard deviation above mean for weight for height
(3) weight > 1.2 times ideal body weight for height
Testing is done every 2 years and is started at either:
(1) 10 years of age
(2) age of puberty onset if < 10 years of age
