Given an estimated 210,000 American youth with undetected diabetes, should children and adolescents be screened for type 2 diabetes? Evidence that the benefit of mass screening exceeds the harms is insufficient currently, according to a new recommendation from the U.S. Preventive Services Task Force (USPSTF).
“There is a lack of evidence on the effect of screening for, and early detection and treatment of, type 2 diabetes on health outcomes in youth, and the balance of benefits and harms cannot be determined,” the USPSTF writes. Research is needed in several areas to inform future updates to this recommendation, including the effects of risk-based screening on health outcomes in youth in certain minority racial or ethnic groups and in those with overweight or obesity or family histories of the disease. Studies are also needed into the effects on health outcomes of lifestyle interventions, pharmacotherapy, or both when used for the treatment of screen-detected prediabetes and diabetes.
The American Diabetes Association has made recommendations regarding screening for type 2 diabetes in younger age groups, the USPSTF notes. The group “recommends risk-based screening for type 2 diabetes after onset of puberty or age 10 years in children who have overweight (defined as a BMI ≥85th percentile) or obesity (defined as a BMI ≥95th percentile) and 1 or more additional risk factors for diabetes,” USPSTF explains. “In children who are deemed at high risk, it recommends screening every 3 years if tests are normal or more frequently if BMI increases.”
An evidence report and systematic review informed the USPSTF recommendation. “No eligible studies directly evaluated the benefits or harms of screening for prediabetes and type 2 diabetes in children and adolescents,” concludes the report. “For youths with prediabetes or recently diagnosed (not screen-detected) diabetes, the only eligible trials reported few health outcomes and found no difference between groups, although evidence was limited by substantial imprecision and a duration of follow-up likely insufficient to assess health outcomes.”