Identifying children and adolescents who should be screened for type 2 diabetes

Paediatric-onset type 2 diabetes has a higher risk of early development of microvascular and macrovascular complications, and mortality, than both paediatric-onset type 1 diabetes and adult-onset type 2 diabetes. This can be attributed to accelerated beta-cell deterioration due to increased insulin resistance. As with adult-onset type 2 diabetes, paediatric-onset type 2 diabetes is asymptomatic in the early stages, so screening is important in people at high risk of developing type 2 diabetes to prevent the development of complications.

Aboriginal, Torres Strait Islander, Māori and Pacific children and adolescents have a higher risk of developing type 2 diabetes than non-Indigenous children and adolescents. Aboriginal and Torres Strait Islander children and adolescents also have an increased risk of hospitalisation due to type 2 diabetes. Prevalence data from Northern Australia (the Top End, Central Australia, Kimberley and Far North Queensland) show rates of type 2 diabetes in Aboriginal and Torres Strait Islander children and adolescents of 1.44 cases per 1000 people aged up to 14 years and 14.14 cases per 1000 people aged 15 to 24 years¹. These prevalence rates are substantially higher than the national rates of type 2 diabetes in children and adolescents in Australia (0.1 cases per 1000 people aged 10 to 14 years; 1.3 cases per 1000 people aged 15 to 24 years)².

Because of the increased risk of type 2 diabetes and its complications, guidelines from the Australasian Paediatric Endocrine Group³ recommend targeted screening for Aboriginal, Torres Strait Islander, Māori and Pacific children and adolescents from 10 years of age (or at onset of puberty, whichever occurs earlier) who have one or more of the following risk factors for type 2 diabetes:

• a body mass index (BMI) at or above the 85th percentile for age and sex, or a waist circumference to height ratio more than 0.5⁴
• maternal history of diabetes or gestational diabetes during the child’s gestation
• first-degree relative with type 2 diabetes
• signs of insulin resistance (ie acanthosis nigricans)
• other conditions associated with obesity and ‘metabolic syndrome’ (ie elevated blood pressure, dyslipidaemia, nonalcoholic fatty liver disease, polycystic ovary syndrome, small for gestational age)
• use of psychotropic drugs.

There is some debate about the value of screening for type 2 diabetes in non-Indigenous children and adolescents because the prevalence of type 2 diabetes in this population is much lower than in Aboriginal and Torres Strait Islander children and adolescents. However, screening should still be considered for those with multiple risk factors. Guidelines from the Australasian Paediatric Endocrine Group⁵ suggest screening non-Indigenous children and adolescents from 10 years of age (or at the onset of puberty, whichever occurs first) if they have both:

• a BMI at or above the 85th percentile for age and sex, and
• one or more of the additional risk factors for type 2 diabetes listed above, or are of South Asian, South-East Asian, Middle Eastern, North African or Latino descent.

If this suggested extensive screening program is undertaken, evaluation of the impact of this intervention on the rate of diagnosis of type 2 diabetes will be valuable to estimate the level of risk of type 2 diabetes in non-Indigenous children and adolescents.

Children and adolescents who are screened for type 2 diabetes should also be screened for other possible comorbidities (eg obesity, elevated blood pressure, dyslipidaemia, nonalcoholic fatty liver disease, polycystic ovary syndrome, retinopathy, sleep-disordered breathing).