Prevention and screening for type 2 diabetes in youth

Despite the rising prevalence of T2DM in adolescents and the significant implication that this has for future health and healthcare, T2DM and more mild forms of impairment in glucose metabolism remain relatively uncommon in the general pediatric population, and there is no evidence that widespread screening for glucose abnormalities is cost-effective. Even among children presumed to be at high risk due to medical or family history, ethnicity, or associated comorbidities, the low prevalence of unrecognized T2DM in children and adolescents does not support extensive screening efforts of unselected patients. Furthermore, both clinicians and clinical investigators need to address the economic and ethical implications of identifying number of children with impaired glucose metabolism that far exceed those with frank diabetes. Until we have evidence for prevention of progression to diabetes and related comorbidities through early intervention in these children, the value of identifying them is uncertain. Rather, studies reviewed here suggest that screening for T2DM in the pediatric population should be clinically focused and take into account not only those risk factors identified in the ADA guidelines, but also the clinical context, pubertal status, and the results of simple screening measures such as fasting glucose and triglycerides. The aim of such screening should be the identification of overt T2DM early enough to minimize risk for acute and chronic complications. More outcome-based research is required before general screening to identify children and adolescents with prediabetes or insulinresistance can be recommended.