Children and adolescents with diabetes and their parents and caregivers should receive culturally sensitive and developmentally appropriate individualized diabetes self-management education and support (DSMES) according to national standards at diagnosis and routinely thereafter. Recommendations for managing type 1 diabetes are comprehensively addressed in the complete American Diabetes Association (ADA) Standards of Care in Diabetes—2025.

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Refer to the ADA position statements “Diabetes Care in the School Setting” and “Care of Young Children With Diabetes in the Childcare and Community Setting” and the ADA’s Safe at School website (https://diabetes.org/advocacy/safe-at-school-state-laws/position-statements) for additional details.

Type 2 Diabetes in Youth and Adolescents 
 

  • Consider screening for diabetes after puberty onset or ≥10 years of age, whichever occurs first, in youth with overweight (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) and at least one other risk factor; if results are normal, recheck at least every 2 years.

 
 

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

  • Those in whom a diagnosis of type 2 diabetes is being considered should have a panel of pancreatic autoantibodies tested to exclude the possibility of autoimmune type 1 diabetes.

 
 

  • Lifestyle management includes comprehensive DSMES and lifestyle programs, along with physical activity and nutrition recommendations similar to those for adults with diabetes.

  • Pharmacological treatment of type 2 diabetes in youth may include: metformin, insulin, and a glucagon-like peptide 1 (GLP-1) receptor agonist and/or a sodium–glucose cotransporter 2 (SGLT2) inhibitor approved for use in youth. (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 diagnosis and annually thereafter.

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

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

  • Evaluation for metabolic dysfunction–associated steatotic liver disease by measuring AST and ALT should be done at diagnosis and annually thereafter.

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

  • Evaluation for polycystic ovary syndrome in female adolescents should be done when indicated.

  • Lipid screening should be done after optimizing glycemia and annually thereafter.

 
Type 2 Diabetes in Youth and Adolescents 
 

  • Consider screening for diabetes after puberty onset or ≥10 years of age, whichever occurs first, in youth with overweight (BMI ≥85th percentile) or obesity (BMI ≥95th percentile) and at least one other risk factor; if results are normal, recheck at least every 2 years.

 
 

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

  • Those in whom a diagnosis of type 2 diabetes is being considered should have a panel of pancreatic autoantibodies tested to exclude the possibility of autoimmune type 1 diabetes.

 
 

  • Lifestyle management includes comprehensive DSMES and lifestyle programs, along with physical activity and nutrition recommendations similar to those for adults with diabetes.

  • Pharmacological treatment of type 2 diabetes in youth may include: metformin, insulin, and a glucagon-like peptide 1 (GLP-1) receptor agonist and/or a sodium–glucose cotransporter 2 (SGLT2) inhibitor approved for use in youth. (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 diagnosis and annually thereafter.

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

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

  • Evaluation for metabolic dysfunction–associated steatotic liver disease by measuring AST and ALT should be done at diagnosis and annually thereafter.

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

  • Evaluation for polycystic ovary syndrome in female adolescents should be done when indicated.

  • Lipid screening should be done after optimizing glycemia and annually thereafter.

 
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A1C 8.5% = 69 mmol/mol. BGM, blood glucose monitoring; DKA, diabetic ketoacidosis; GLP-1, glucagon-like peptide 1; HHS, hyperosmolar hyperglycemic state; MDI, multiple daily injection; SGLT2, sodium–glucose cotransporter 2. Adapted from Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association. Diabetes Care 2018;41:2648–2668
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A1C 8.5% = 69 mmol/mol. BGM, blood glucose monitoring; DKA, diabetic ketoacidosis; GLP-1, glucagon-like peptide 1; HHS, hyperosmolar hyperglycemic state; MDI, multiple daily injection; SGLT2, sodium–glucose cotransporter 2. Adapted from Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association. Diabetes Care 2018;41:2648–2668

A1C 8.5% = 69 mmol/mol. BGM, blood glucose monitoring; DKA, diabetic ketoacidosis; GLP-1, glucagon-like peptide 1; HHS, hyperosmolar hyperglycemic state; MDI, multiple daily injection; SGLT2, sodium–glucose cotransporter 2. Adapted from Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association. Diabetes Care 2018;41:2648–2668
View largeDownload slide

A1C 8.5% = 69 mmol/mol. BGM, blood glucose monitoring; DKA, diabetic ketoacidosis; GLP-1, glucagon-like peptide 1; HHS, hyperosmolar hyperglycemic state; MDI, multiple daily injection; SGLT2, sodium–glucose cotransporter 2. Adapted from Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association. Diabetes Care 2018;41:2648–2668

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