Interpreting screening results in children and adolescents

A new diagnosis of diabetes in an asymptomatic child or adolescent is a medical emergency. Immediate specialist assessment and management is required to avoid development of life-threatening complications of acute insulin deficiency, such as diabetic ketoacidosis (DKA). Refer the patient to the local emergency department, or phone the nearest children’s hospital or major healthcare service for specialist paediatrician or paediatric endocrinologist advice. All children and adolescents with hyperglycaemia should be regarded as having type 1 diabetes until proven otherwise.

Children and adolescents with impaired fasting glucose or impaired glucose tolerance should be assessed and managed by a specialist in a timely manner. See also Management of people at risk of developing type 2 diabetes.

Aboriginal, Torres Strait Islander, Māori and Pacific children and adolescents who have undergone screening with an HbA1c test only and have an HbA1c of 39 to 46 mmol/mol (5.7 to 6.4%) are at higher risk of developing type 2 diabetes. If possible, perform an oral glucose tolerance test to determine if they have diabetes, impaired fasting glucose or impaired glucose tolerance. If an oral glucose tolerance test cannot be done, see Management of people at risk of developing type 2 diabetes and repeat the HbA1c test in 6 months.

Children and adolescents at risk of developing type 2 diabetes who have a normal blood glucose concentration are still at risk for cardiovascular disease and future development of type 2 diabetes. It is important to minimise factors that increase their risk of cardiovascular disease, such as tobacco smoking, inactivity, excess weight, elevated blood pressure and hyperlipidaemia.