Mass screening of all children and teens for type 2 diabetes is not justified, according to a systematic review commissioned 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 children and youth.
Childhood obesity is pretty common. Thus, children are increasingly showing signs of metabolic disorders. The incidence of type 2 diabetes has also been rising in children and youth. Thus, the question arises if it is good to regularly screen all children and youth for type 2 diabetes since early identification and treatment of the condition are associated with better outcomes. However, a systematic review commissioned by USPSTF shows that screening for type 2 diabetes is only justified in high-risk children, and mass screening for the condition is not justified.
First and foremost, let us be clear that US Preventive Services Task Force (USPSTF) recommendations are for type 2 diabetes, which is generally diagnosed in obese adults, unlike type 1 diabetes, which is mainly diagnosed in kids and adolescents. About 90% of all those living with diabetes in the US are living with type 2 diabetes. It is a condition caused by insulin resistance and is a lifestyle disorder. It takes years to develop in most cases. It means that it is rarely diagnosed in kids or youth. However, it is pretty common in older adults, affecting more than 10% of the population.
Kids are more likely to be affected by an autoimmune condition called type 1 diabetes, in which immune cells destroy insulin-producing beta cells in the pancreas. At present, there are about 210,000 kids living with diabetes, but most of them are living with type 1 diabetes. However, the issue is that type 2 diabetes is also increasing in kids due to higher obesity rates and the prevalence of the metabolic disorder.
Thus, out of 210,000 kids living with diabetes, about 23,000 have type 2 diabetes. These numbers are not massive but significant. This raises one important question: should doctors regularly screen kids and youth for type 2 diabetes? Especially considering that metabolic disorders like dyslipidemia, non-alcoholic fatty liver disease, and even hypertension are on the rise in children and young adults. Moreover, the COVID-19 pandemic has further magnified the trend.
For families dealing with diabetic neuropathy, it is important to seek out specialized treatment options. There are a number of healthcare providers and clinics that specialize in diabetic neuropathy treatment, including nerve conduction studies, pain management, and physical therapy. Effective treatment for diabetic neuropathy can help manage symptoms and prevent further damage to the nerves. If you or a loved one are dealing with diabetic neuropathy, it is important to reach out to a qualified healthcare provider to discuss treatment options and find the right solution for your needs.
Additionally, type 2 diabetes in the young is more harmful to health. It is more likely to progress fast, causing chronic health complications like cardiovascular issues, 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 commissioned a systematic review to understand the harms and benefits of such screening. They wanted to understand if regular screening for type 2 diabetes is justified in kids or youth who do not have many symptoms.
They concluded that any such screening should only be done in high-risk kids and youth, like those with some symptoms and grossly overweight. However, there is no reason for mass screening for type 2 diabetes in this young population, as it will do more harm than good. The study also made other recommendations related to the early diagnosis and management of the condition. For example, though 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. However, it is not approved for preventing the progression of prediabetes to diabetes in the young population. Additionally, the study also found that extensive lifestyle intervention, which is the method of choice for managing early diabetes, is less effective in children and adolescents than in adults.
Nonetheless, the study recommends that prediabetes and mild type 2 diabetes in children should be managed through weight loss, dietary measures, and enhancing physical activity. Though lifestyle interventions like weight loss are less effective in children, health experts say that it is still the safest and most effective way to reduce the progression of type 2 diabetes in children. To sum up, USPSTF says screening is only good for high-risk children like those grossly obese and showing 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 which immune cells destroy the insulin-producing cells of the pancreas. About 23,000 have type 2, the insulin-resistance form that 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, or who show other signs of insulin resistance such as acanthosis nigricans or polycystic ovary syndrome. The USPSTF-commissioned review 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. The distress that testing causes in children without symptoms cannot yet be justified by the benefit, even though early diagnosis and treatment are tied to better outcomes. Screening pays off where the risk is already high, not across the whole population of 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 remains 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 progress faster than the adult form and leads sooner to chronic complications such as cardiovascular disease and chronic kidney disease. That is why a child with clear risk factors, like severe obesity or signs of insulin resistance, should be tested rather than watched.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
