Screening for II DM in high-risk children and adolescents

Question 1

Diagnosis of type 2 diabetes can be based on:

Answer 1

Symptoms of diabetes or hyperglycaemic crisis and a random plasma glucose ≥ 11.1 mmol/L

Fasting plasma glucose ≥ 7.0 mmol/L

2-hour plasma glucose ≥ 11.1 mmol during an OGTT

HbA1c ≥ 50 mmol/mol

Question 2

Screening recommendations for type 2 diabetes in children and adolescents are guided by risk factors

Answer 2

A lower threshold for screening is recommended for Māori and Pacific children

• due to the higher rates of II DM, obesity and CVD at younger ages in these groups.

A screening frequency of 2-3 years is recommended,

• although earlier testing may be indicated in cases where there has been excessive weight gain

Question 3

Consider the possibility of I DM or a monogenic form of diabetes in children or younger adults with:

Answer 3

• an elevated HbA1c without obesity,
• a family history or
• hypertension,
• dyslipidaemia or
• non-alcoholic fatty liver disease.

Its incidence peaks in children aged 10 – 19 years,

• but > 1/2 of cases are diagnosed in people aged over 20 years.

Monogenic diabetes is estimated to be present in up to 8% of children with features of II DM.