There isn’t enough evidence to recommend routine prediabetes and type 2 diabetes screening for children and teens, according to the latest findings on the topic from the U.S. Preventive Services Task Force (USPSTF).
The USPSTF is an independent, nonprofit and nongovernmental panel of volunteer medical experts who are tasked with “making evidence-based recommendations about clinical preventive services.” Both the U.S. government and private health insurers often take cues from the USPSTF when deciding what types of health screening services are covered or recommended. Right now, the USPSTF recommends screening for prediabetes and type 2 diabetes in adults ages 35 to 70 who are overweight or obese — along with referring people with prediabetes to interventions that may help prevent type 2 diabetes.
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For the latest review of evidence, USPSTF panel members looked for studies that demonstrated benefits — or a lack of benefits — from screening children and teens for prediabetes (elevated blood glucose that doesn’t reach the threshold for diabetes) and type 2 diabetes. Screening, it’s important to note, means looking for evidence of disease in people who aren’t showing any symptoms — anyone showing possible signs of diabetes should promptly see a doctor, who will then order tests to look for diabetes. The latest review focused on the effects of screening and follow-up interventions on health outcomes including death, cardiovascular problems, kidney disease, amputation, skin ulcers, vision problems, neuropathy, and quality of life, as well as whether interventions could be effective to prevent prediabetes from progressing to type 2 diabetes in young people.
Limited evidence found related to screening for prediabetes, type 2 in youth
The task force found no studies that directly looked at the effects of screening for prediabetes and type 2 diabetes on health outcomes in young people without any symptoms of diabetes. But they did find two studies looking at the benefits of interventions for young people with recently diagnosed prediabetes or type 2 diabetes. One of these studies, with 699 participants, randomly assigned young people with obesity and recently diagnosed type 2 diabetes to one of three treatments — the diabetes drug metformin, metformin plus Avandia (rosiglitazone), or metformin plus a lifestyle intervention program. No significant differences were seen between the three groups for outcomes including diabetic ketoacidosis (a medical emergency involving very high blood glucose) or kidney problems.
The second study involved 82 participants ages 10 to 16 who had never previously been treated for type 2 diabetes. Among those who took metformin, there were no cases of diabetic ketoacidosis during the follow-up period, and among those who took a placebo (inactive pill), there was one case. For both of these studies, the task force found that there weren’t enough participants to meaningfully compare health outcomes from various interventions.
In a third study that compared a lifestyle intervention program with standard care in 75 people ages 10 to 16 with obesity and prediabetes, none of the participants developed type 2 diabetes during the six-month follow-up period. This means it’s possible that there weren’t enough participants, or a long enough follow-up period, to detect any differences in outcomes between the two groups. What’s more, 23% of participants dropped out or were withdrawn from the study — in some cases because they started taking metformin, which wasn’t the focus of the study.
“This is the first time the Task Force reviewed the evidence on whether screening youth for prediabetes and type 2 diabetes leads to improvements in health,” said panel member Michael Cabana, MD, a pediatrician at the Albert Einstein College of Medicine in New York City, in a press release. “Unfortunately, there is very limited evidence, so we are calling for more research on this important topic. Clinicians should use their judgment when determining whether or not to screen children and teens for diabetes.”