Based on its review, the task force has concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in this population. This is an “I” statement, and applies to children and adolescents younger than 18 years who have not been previously diagnosed with diabetes or prediabetes and do not have signs or symptoms of either condition.
The task force also stated that a diagnosis of prediabetes or type 2 diabetes should be confirmed with repeat testing before starting any intervention.
“This is the first time the task force reviewed the evidence on whether screening youth for prediabetes and type 2 diabetes leads to improvements in health,” said Michael Cabana, M.D., M.A., M.P.H., a member of the task force, in a USPSTF bulletin. “Unfortunately, there is very limited evidence, so we are calling for more research on this important topic. Clinicians should use their judgment when determining whether or not to screen children and teens for diabetes.”
Previously referred to as adult-onset diabetes type 2 diabetes prevalence has increased in children and adolescents, based most likely on increasing rates of overweight or obesity in these populations. According to the CDC, people who are overweight are more likely to have insulin resistance, which is a major risk factor for type 2 diabetes. Other risk factors include a family history of type 2 diabetes, being born to a mother with gestational diabetes and having one or more conditions related to insulin resistance. Black, Hispanic/Latino and Native American/Alaska Native youth also are at higher risk for type 2 diabetes than white youth, resulting from disparities in access to care, systemic racism and other social determinants of health.
Of the more than 34 million Americans who have diabetes, between 90% and 95% have type 2 diabetes. According to the National Institute of Diabetes and Digestive and Kidney Diseases, individuals who develop type 2 diabetes may experience significant health issues later in life, including heart disease, kidney disease, eye disease, nerve damage and foot problems.
Based in part on the increasing rate of type 2 diabetes in youth and the long-term health problems associated with the condition, the USPSTF commissioned a systematic review of the evidence on screening for prediabetes and type 2 diabetes in asymptomatic, nonpregnant persons younger than 18 years. The review focused on the effects of screening and interventions on health outcomes, such as cardiovascular morbidity, chronic kidney disease, visual impairment and quality of life, as well as on the effectiveness of interventions for prediabetes to delay or prevent progression to type 2 diabetes.
The review consisted of English-language articles published on PubMed/MEDLINE, the Cochrane Library and trial registries through May 3, 2021, along with reference lists of retrieved articles and data from outside experts and reviewers, with additional surveillance of the literature conducted through Oct. 31, 2021. A total of eight articles representing three studies were included in the review.
For the draft recommendation, the USPSTF considered a fasting plasma glucose level of 126 mg/dL or greater, an HbA1c level of 6.5% or greater or a 2-hour postload glucose level of 200 mg/dL or greater as consistent with the diagnosis of type 2 diabetes, and a fasting plasma glucose level of 100 to 125 mg/dL, an HbA1c level of 5.7% to 6.4% or a 2-hour postload glucose level of 140 to 199 mg/dL as consistent with prediabetes. These levels are in alignment with the American Diabetes Association’s Standards of Medical Care in Diabetes—2020 classifications.
The task force found no studies that addressed the direct benefits of screening for type 2 diabetes and prediabetes on health outcomes in asymptomatic children and adolescents.
In addition, the USPSTF found no studies that addressed the harms of screening for type 2 diabetes and prediabetes in these populations.
For youth with prediabetes or recently diagnosed (but not screen-detected) diabetes, the task force stated that the trials evaluating pharmacologic and nonpharmacologic interventions in the review reported few health outcomes and found no differences between intervention and control groups.
Based on the lack of available evidence, the task force noted that additional research is needed on the topic. Specifically, they called for trials of sufficient duration and sample size that focused on health outcomes, as well as trials to examine the effects of lifestyle interventions, pharmacotherapy or both for treatment of screen-detected prediabetes and diabetes on health outcomes in children and adolescents, particularly in racial and ethnic groups that have a higher prevalence of diabetes than white individuals.
In addition to the draft recommendation statement and draft evidence review, the USPSTF published a new consumer guide on screening for prediabetes and type 2 diabetes in children and adolescents.
The task force also noted that it has published related recommendations on screening for obesity in children and adolescents and screening for prediabetes and type 2 diabetes in adults.
The task force will accept comments on the draft recommendation statement and draft evidence review until 11:59 p.m. ET on Jan. 18. The task force noted in its bulletin that it extended the comment period an additional week to account for the holidays.
All comments will be considered as the USPSTF prepares its final recommendation. Once the final recommendation is published, the AAFP will review and determine its stance.