Section 14: Children and Adolescents

Risk-based screening should be considered after the onset of puberty or ≥10 years of age, whichever occurs earlier, in youth with overweight (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) and who have one or more additional risk factors for diabetes.

Fasting plasma glucose, 2-h plasma glucose during a 75-g oral glucose tolerance test, and A1C can be used to diagnose prediabetes or diabetes in children and adolescents.

In those in whom a diagnosis of type 2 diabetes is being considered, a panel of pancreatic autoantibodies should be tested to exclude the possibility of autoimmune type 1 diabetes.

Treatment of type 2 diabetes in youth may include: metformin, insulin, a glucaogon-like peptide 1 (GLP-1) receptor agonist approved for use in youth with type 2 diabetes, and/or the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin. (See figure on the next page.)

Blood pressure should be measured at every clinic visit and treated if found to be elevated on three separate measurements.

Urine albumin-to-creatinine ratio and estimated glomerular filtration rate should be obtained at the time of diagnosis then annually

Neuropathy screening by foot exam should be done at diagnosis and then annually.

Retinopathy screening by dilated fundoscopy should be done at diagnosis and then annually.

Evaluation for nonalcoholic fatty liver disease (by measuring AST and ALT) should be done at diagnosis and then annually.

Screening for symptoms of obstructive sleep apnea should be done at each visit.

Evaluate for polycystic ovary syndrome in female adolescents when indicated.

Lipid screening should be done after optimizing glycemia and then annually.