Mass screening of all children and teens for type 2 diabetes is not justified, says a systematic review ordered by the USPSTF. Screening makes sense only for high-risk children. That holds even as childhood obesity rises and type 2 diabetes grows more common in kids and youth.
Childhood obesity is common. So more and more children show signs of metabolic disease. Type 2 diabetes has also been rising in kids and youth. That raises a question. Should all kids and youth get regular checks for type 2 diabetes? Finding and treating it early is tied to better outcomes. But a systematic review ordered by USPSTF says screening for type 2 diabetes is only justified in high-risk children. Mass screening is not.
First, let us be clear. The US Preventive Services Task Force (USPSTF) advice is for type 2 diabetes. That type is mostly found in obese adults. Type 1 diabetes is mainly found in kids and teens. About 90% of all those living with diabetes in the US have type 2 diabetes. It is caused by insulin resistance, and it is a lifestyle disease. It takes years to develop in most cases. So it is rarely found in kids or youth. But it is common in older adults, affecting more than 10% of the population.
Kids are more likely to get type 1 diabetes. It is an autoimmune disease. Immune cells destroy the beta cells in the pancreas that make insulin. Right now, about 210,000 kids live with diabetes, and most of them have type 1 diabetes. The problem is that type 2 diabetes is also rising in kids. Higher obesity rates and more metabolic disease are driving it.
So out of 210,000 kids living with diabetes, about 23,000 have type 2 diabetes. These numbers are not massive, but they are significant. This raises one key question. Should doctors regularly screen kids and youth for type 2 diabetes? Metabolic problems like dyslipidemia, non-alcoholic fatty liver disease, and even high blood pressure are rising in children and young adults. The COVID-19 pandemic made the trend even worse.
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Type 2 diabetes in the young is also more harmful. It is more likely to move fast. It causes long-term problems like heart and blood vessel disease, chronic kidney disease, and so on. However, the latest study by USPSTF says that there is no need for regular screening for type 2 diabetes in kids and youth, as the distress caused by this kind of screening cannot yet be justified. In 2022, USPSTF ordered a systematic review to weigh the harms and benefits of such screening. They wanted to know if regular screening for type 2 diabetes is justified in kids or youth who do not have many symptoms.
They concluded that screening should only be done in high-risk kids and youth. That means those with some symptoms who are grossly overweight. There is no reason for mass screening for type 2 diabetes in this young group. It would do more harm than good. The study also gave other advice on early diagnosis and care. For example, there are more than 30 drugs to treat type 2 diabetes. Only three are approved for use in children: metformin, insulin, and liraglutide.
Among these drugs, metformin is good for managing diabetes in young people. But it is not approved to stop prediabetes from turning into diabetes in the young. The study also found that intensive lifestyle change works less well in children and teens than in adults. That is the method of choice for early diabetes.
Even so, the study says prediabetes and mild type 2 diabetes in children should be managed with weight loss, diet, and more physical activity. Lifestyle changes like weight loss work less well in children. Still, health experts say it is the safest and most effective way to slow type 2 diabetes in children. To sum up, USPSTF says screening is only good for high-risk children. That means those who are grossly obese and show other signs of insulin resistance, like acanthosis nigricans or polycystic ovary syndrome.
Frequently asked questions
Can a child have type 2 diabetes?
Yes, and it is becoming more common as childhood obesity rises. About 210,000 kids in the US live with diabetes. Most have type 1, an autoimmune disease. In it, immune cells destroy the cells of the pancreas that make insulin. About 23,000 have type 2, the insulin-resistance form. It usually takes years to develop and is far more common in adults.
Which children should be screened for type 2 diabetes?
High-risk children only. That means kids who are grossly overweight and have some symptoms. It also means kids who show other signs of insulin resistance, such as acanthosis nigricans or polycystic ovary syndrome. The review ordered by the USPSTF found no reason to screen every child and teen who has no symptoms.
Why not screen all children for type 2 diabetes?
Because the review found mass screening would do more harm than good. Testing upsets children without symptoms. The benefit cannot yet justify that distress, even though early diagnosis and treatment are tied to better outcomes. Screening pays off where the risk is already high, not across all kids.
How is type 2 diabetes treated in children?
Prediabetes and mild type 2 diabetes in children are managed with weight loss, diet changes and more physical activity. Lifestyle change works less well in kids than in adults. Yet it is still the safest and most effective way to slow the disease. Of the more than 30 drugs for type 2 diabetes, only metformin, insulin and liraglutide are approved for children.
Is type 2 diabetes more dangerous in young people?
Yes. Type 2 diabetes that starts in youth tends to move faster than the adult form. It leads sooner to long-term problems such as cardiovascular (heart and blood vessel) disease and chronic kidney disease. That is why a child with clear risk factors should be tested, not just watched. Those risks include severe obesity or signs of insulin resistance.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
