Materiały źródłowe

• #1 Pediatric Type 2 Diabetes – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431046/

  Type 2 diabetes mellitus is a metabolic disorder characterized by peripheral insulin resistance, leading to hyperglycemia. […] Early screening, recognition, and treatment of children with type 2 diabetes are crucial for preventing long-term complications. […] Risk factors for children are similar to those in adults: ethnicity, family history, obesity, and a sedentary lifestyle. However, presentation and management differ from adults with the disorder. Children with diabetes of any kind are at an increased risk of many complications. Early recognition, screening, and treatment of children and adolescents with T2DM are important for preventing long-term complications from the disease. […] The American Diabetes Association (ADA) recommends screening for T2DM every 3 years starting at age 10 years (or at the onset of puberty) for patients who are: Obese (BMI 95th percentile for age) or Overweight (BMI 85th percentile for age) and have at least 2 risk factors (positive family history, high-risk race or ethnicity, signs of insulin resistance, maternal history of gestational diabetes).

• #1 Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8040084/

  Therefore, relevant comprehensive, coordinated, and innovative strategies are urgently needed. […] T2DM in children and adolescents is even more worrying and complex, since it has been proven to be a particularly aggressive form of disease associated with high therapeutic failure rates and leading to much earlier complications than the adult-onset form of the disease. […] Management of these patients in a timely and efficient manner is essential to prevent or at least delay complications and to improve long-term outcomes. […] The present review focuses on the latest available data on diagnosis, treatment and prevention of T2DM in youth and suggests potential areas for future research. […] Since T2DM represents one of several different diabetes types, diagnosing a child or adolescent with the disease is a two-step process. Firstly, one has to confirm the diagnosis of diabetes and secondly, to establish that it is diabetes type 2.

• #1 Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8040084/

  According to the American Diabetes Association (ADA), the criteria used to diagnose diabetes in youth are the same as those used in adult populations. […] Once the diagnosis of diabetes is established, the next important step is to differentiate T2DM from T1DM as well as from other more rare diabetes types. […] The challenges of differentiating between T2DM and T1DM were demonstrated in a multicenter study of 2291 subjects aged 20 years with recently diagnosed diabetes that were classified based upon presence or absence of -cell autoimmunity and insulin sensitivity. […] Pediatric T2DM is still a rare disease but recent reports indicate an increasing prevalence around the world, possibly following the increasing prevalence and severity of obesity in children and adolescents.

• #1 Pediatric Type 2 Diabetes – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431046/

  Diagnostic Criteria: Random plasma blood glucose 200 mg/dl with symptoms of polyuria, polydipsia, or weight loss; Fasting blood glucose 126 mg/dl in an asymptomatic patient; Oral glucose tolerance test (GTT) with blood sugar 200 mg/dl at 2 hours post-ingestion; Hemoglobin A1c 6.5%. […] If the diagnosis between T1DM and T2DM is unclear, helpful labs include fasting insulin or C-peptide (both usually high or normal in T2DM, low in T1DM) and autoantibodies for T1DM.

• #1 Type 2 diabetes in children – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/786

  In the absence of unequivocal hyperglycaemia, the diagnosis requires two abnormal test results from the same sample, or in two separate test samples. […] Obesity, leading to insulin resistance, is the primary cause in children. […] Key diagnostic factors include presence of risk factors, polyuria, polydipsia, acanthosis nigricans, and nocturia. […] 1st investigations to order include urine dipstick, random plasma glucose, fasting plasma glucose, HbA1c, and autoantibodies to insulin, islet antigen 2 (IA-2), glutamic acid decarboxylase (GAD), and zinc transporter 8 (ZnT8).

• #1 Diabetes Mellitus in Children and Adolescents – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/endocrine-disorders-in-children/diabetes-mellitus-in-children-and-adolescents

  An oral glucose tolerance test is not required and should not be done if diabetes can be diagnosed by other criteria. […] The HbA1C criterion is typically more useful for diagnosing type 2 diabetes, and hyperglycemia should be confirmed with a fasting or random plasma glucose. […] Children at risk include those with overweight (body mass index 85th percentile for age and sex, or weight for height 85th percentile) and who have any 2 of the following: Family history of type 2 diabetes in a first- or second-degree relative, Native American, Black, Hispanic, Asian American, and Pacific Islander heritage, Signs of insulin resistance or conditions associated with insulin resistance (eg, acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or small-for-gestational-age birth weight), Maternal history of diabetes or gestational diabetes.

• #1 Distinguishing between Type 1 and Type 2 diabetes in children can be a challenge – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/distinguishing-between-type-1-and-type-2-diabetes-in-children-can-be-a-challenge/

  Distinguishing between Type 1 and Type 2 diabetes in children can be a challenge. […] Primary care providers play an invaluable role in the diagnosis of diabetes in children. […] A diagnosis of diabetes requires two abnormal lab tests: Fasting plasma glucose greater than 126 mg/dL, a two-hour postprandial glucose of 200 mg/dL during an oral glucose tolerance test using a glucose load of 1.75 grams per kilo to a max of 75 grams of glucose dissolved in water, or a hemoglobin A1c level of 6.5% or greater. […] If a patient has classic symptoms of hyperglycemia such as polyuria, polydipsia or nocturia, and if they are in a hyperglycemic crisis, a random plasma glucose greater than 200 mg/dL in addition to the symptoms is adequate for diagnosis. […] “One of the biggest challenges that we all face today as clinicians is differentiating between Type 1 and Type 2 diabetes,” Dr. Gandham said. “Given the current obesity epidemic, distinguishing between Type 1 and Type 2 diabetes in children can be quite difficult. Overweight and obesity are common in children with Type 1 diabetes, and diabetes-associated autoantibodies and ketosis may be present in pediatric patients with features of Type 2 diabetes.”

• #1 Pediatric Type 2 Diabetes Mellitus: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/925700-overview

  Although type 2 diabetes is widely diagnosed in adults, its frequency has markedly increased in the pediatric age group since the end of the 20th century. Most pediatric patients with type 2 diabetes belong to minority communities. […] Distinguishing between type 1 and type 2 diabetes at diagnosis is important. Typical characteristics of type 2 diabetes include the following: Slow and insidious onset, Most common in overweight or obese patients from a minority group (Native Americans, Blacks, and Pacific Islanders), Signs of insulin resistance, Strong family history of type 2 diabetes: Familial lifestyle risk factors leading to obesity may be present, as may a family history of cardiovascular disease or metabolic syndrome. […] Testing for type 2 diabetes should be considered when a patient is overweight and has any 2 of the following: Family history of type 2 diabetes in first-degree or second-degree relative, Minority race or ethnicity (eg, American Indian, Black, Hispanic, Asian or Pacific Islander), Signs of insulin resistance or conditions associated with insulin resistance (eg, acanthosis nigricans, hypertension dyslipidemia, PCOS).

• #1 Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents

  https://www.wjgnet.com/1948-9358/full/v12/i4/344.htm

  The goals of managing an adolescent with T2DM are the following: (1) To achieve and maintain near-normal glycemic levels with minimal hypoglycemic episodes; (2) To improve body weight, insulin sensitivity and possibly insulin secretion, in order to achieve better glycemic control and improved overall health; (3) To identify and manage the disease in a timely manner and, if necessary, comorbidities and complications such as hypertension, dyslipidemia, hepatic steatosis, nephropathy, and retinopathy; and (4) To prevent or delay, as much as possible, macrovascular complications of T2DM, such as cardiovascular disease and stroke. […] These goals can be achieved through the successful implementation of non-pharmacologic and pharmacologic measures. […] The challenges of differentiating between T2DM and T1DM were demonstrated in a multicenter study of 2291 subjects aged 20 years with recently diagnosed diabetes that were classified based upon presence or absence of -cell autoimmunity and insulin sensitivity. […] Pediatric T2DM is still a rare disease but recent reports indicate an increasing prevalence around the world, possibly following the increasing prevalence and severity of obesity in children and adolescents.

• #1 Pediatric Type 2 Diabetes Mellitus: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/925700-overview

  Initial screening may begin at age 10 years or at onset of puberty if puberty occurs at a young age. Screening should be performed every 2 years. A fasting plasma glucose test is the preferred screening study; if clinical suspicion is high but fasting blood glucose is normal ( 100 mg/dL), an oral glucose tolerance test should be considered. […] A random plasma glucose concentration of 200 mg/dL or greater in association with polyuria, polydipsia, or unexplained weight loss is diagnostic of diabetes. In an asymptomatic patient, a fasting plasma glucose value of 126 mg/dL or greater or a 2-hour plasma glucose value of 200 mg/dL or greater during an oral glucose tolerance test is also diagnostic of diabetes. […] Other laboratory results that usually suggest type 2 diabetes are as follows: Elevated fasting C-peptide level, Elevated fasting insulin level, Absence of autoimmune markers (glutamic acid decarboxylase [GAD] and islet cell antibodies).

• #1 Type 2 Diabetes Mellitus in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1101/p590.html

  The validity of A1C in the diagnosis of type 2 diabetes in children has been questioned because of inaccuracies among certain ethnicities and comorbidities (e.g., sickle-cell trait). The American Diabetes Association continues to support the use of A1C levels for diagnosis, while acknowledging a lack of studies supporting its use in children with type 2 diabetes.

• #1 Type 2 Diabetes in Children and Adolescents – Diabetes Canada

  https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-35

  A glycated hemoglobin (A1C) 6.0% is able to identify children with type 2 diabetes at 86% sensitivity and 85% specificity and had similar screening efficacy to FPG, when compared to the gold standard 2-hour OGTT. […] Therefore, A1C should not be relied upon as the sole diagnostic test to screen for type 2 diabetes but rather used in combination with FPG and/or 2-hour OGTT. […] Given the aforementioned limitations, we recommend using a combination of A1C and fasting or random blood glucose to screen for type 2 diabetes in children and youth with risk factors. […] Children with type 2 diabetes should receive care in conjunction or consultation with an interprofessional pediatric diabetes health-care team that should include either a pediatric endocrinologist or pediatrician with diabetes expertise, dietitian, diabetes nurse educator and mental health professional.

• #1 Type 2 diabetes in children – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318

  Type 2 diabetes in children may develop so gradually that there are no noticeable symptoms. Sometimes, the disorder is diagnosed during a routine check-up. […] Diabetes screening is recommended for children who have started puberty or are at least 10 years old, who are overweight or obese, and who have at least one other risk factor for type 2 diabetes.

• #1 10 Signs of Type 1 and Type 2 Diabetes in Kids

  https://www.parents.com/health/diabetes/signs-of-diabetes-in-children/

  On the other hand, type 2 diabetes tends to develop slowly over time, and many kids don’t experience any symptoms at all. Type 2 diabetes is often diagnosed during a check-up or appointment not related to a potential diagnosis. […] If your child is showing signs of diabetes, Feller recommends scheduling an appointment with your health care provider. […] Children with diabetes should begin insulin therapy as soon as possible to prevent permanent damage to vision, nerves, and blood vessels, which can lead to other complications.

• #1 What Is Type 2 Diabetes? (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/type2.html

  Type 2 diabetes can show up in different ways. Some kids have symptoms, but others dont. Kids with diabetes symptoms may: […] Doctors may check for diabetes if a child has symptoms or risk factors, like being overweight and having acanthosis. Different kinds of blood tests can check for diabetes, including: […] The doctor uses the results from one or more of these tests to tell if the child has diabetes. The doctor can order other tests to find out if it is type 1 diabetes or type 2 diabetes.

• #1 Type 2 diabetes mellitus in children and adolescents

  https://www.racgp.org.au/afp/2016/june/type-2-diabetes-mellitus-in-children-and-adolescen

  The presentation of T2DM varies from asymptomatic hyperglycaemia in a well child, perhaps detected through incidental testing, to ketoacidosis in up to 25% of patients. These individuals are also at risk of hyperglycaemic hyperosmolar non-ketotic state, which is associated with a high mortality rate. The diagnosis of T2DM in youth requires the diagnosis of diabetes followed by the classification of diabetes type. It is worth noting that the prevalence of T1DM is approximately 10-fold higher than the prevalence of T2DM in most paediatric populations. Therefore, a diagnosis of T1DM should be made in the acute setting if there is any doubt regarding diabetes subclassifications. […] There are currently four accepted ways to diagnose diabetes as per the International Society of Paediatric and Adolescent Diabetes (ISPAD) guidelines and American Diabetes Association, based on the measurement of hyperglycaemia and the presence of symptoms. Several clinical characteristics, such as age, ethnicity, obesity, family history of T2DM and the presence of islet cell antibodies, are important factors in the differentiation between T1DM and T2DM.

• #1

  https://journals.lww.com/jaapa/fulltext/2022/07000/diagnosis_and_management_of_type_2_diabetes_in.3.aspx

  Because of this, identifying the appropriate at-risk population is a crucial step in determining which patients need to be screened. […] Consider risk-based screening for prediabetes and/or type 2 diabetes for children after the onset of puberty, or for children age 10 years or older who are overweight (BMI at or above the 85th percentile) and have one or more additional risk factors for diabetes. […] The history and physical examination are crucial elements for children suspected of having type 2 diabetes. […] Children with type 2 diabetes do not always present with symptoms, so a broad review of systems can uncover findings that could identify underlying comorbidities and quantify disease severity. […] Appropriate diagnostic tools to test for type 2 diabetes in children include any of the following: fasting plasma glucose (FPG), 2-hour plasma glucose during a 75-g oral glucose tolerance test (OGTT), or hemoglobin A1C. […] Confirmation of type 2 diabetes can be achieved by obtaining two abnormal test results from the same sample or in two separate test samples. […] When at-risk patients are identified, an extensive workup is indicated to provide a definitive diagnosis of type 2 diabetes.

• #1 Diabetes Mellitus (DM) in Children and Adolescents – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/hormonal-disorders-in-children/diabetes-mellitus-dm-in-children-and-adolescents

  Children who are diagnosed with type 2 diabetes have blood tests to determine how their liver and kidneys are functioning and urine tests. At diagnosis, children who have type 2 diabetes are also tested for other problems, such as high blood pressure, high blood levels of lipids (fats), and fatty liver, because these problems are common among children with type 2 diabetes.

• #1 Pediatric Type 2 Diabetes Mellitus: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/925700-overview

  Fasting lipid profiles should be obtained after stable glycemia is achieved and every 2 years thereafter if normal. Optimal values for children with type 2 diabetes are as follows: Triglycerides 150 mg/dL, Low-density lipoprotein (LDL) 100 mg/dL, High-density lipoprotein (HDL) 35 mg/dL. […] The goal of therapy is to achieve and maintain euglycemia and near-normal hemoglobin A1c (HbA1c) levels ( 7%). More specifically, glycemic and nonglycemic goals may include the following: Fasting glycemia of less than 126 mg/dL, Resolution of polyuria, nocturia, and polydipsia, Healthy body weight, Maintenance of cardioprotective levels of lipids and blood pressure (LDL level 100 mg/dL, triglyceride 150 mg/dL, HDL level 35 mg/dL; blood pressure 95th percentile for age, sex, and height). […] Education is an essential component of the treatment plan in type 2 diabetes; it is a continuing process involving the child, family, and all members of the diabetes team.

• #1 Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8040084/

  During the last two decades, there have been several reports of an increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents, especially among those belonging to minority ethnic groups. […] Youth T2DM differs not only from type 1 diabetes in children, from which it is sometimes difficult to differentiate, but also from T2DM in adults, since it appears to be an aggressive disease with rapidly progressive -cell decline, high treatment failure rate, and accelerated development of complications. […] Despite the recent research, many aspects of youth T2DM still remain unknown, regarding both its pathophysiology and risk factor contribution, and its optimal management and prevention. […] Current management approaches include lifestyle changes, such as improved diet and increased physical activity, together with pharmacological interventions, including metformin, insulin, and the recently approved glucagon-like peptide-1 analog liraglutide.

• #1 Type 2 Diabetes in Children and Adolescents – Diabetes Canada

  https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-35

  Regular targeted screening for type 2 diabetes is recommended in children at risk. […] Early screening, intervention and optimization of glycemic control are essential, as the onset of type 2 diabetes during childhood is associated with severe and early onset of microvascular and cardiovascular complications. […] The microvascular complications of type 2 diabetes have been identified at diagnosis, implying long-term, unrecognized hyperglycemia. […] This argues for a systematic screening program in children at high risk for type 2 diabetes in order to prevent an acute, life-threatening presentation and to decrease the development of chronic complications. […] Although not proven in children, it is generally assumed that earlier diagnosis of diabetes will lead to interventions that will improve glycemic control and reduce the related short- and long-term complications.

• #1 Inaccurate diagnosis of diabetes type in youth: prevalence, characteristics, and implications | Scientific Reports

  https://www.nature.com/articles/s41598-024-58927-6

  A substantial percentage of those with unknown diabetes type at the onset of diabetes were diagnosed with T2D at 34 years post-diagnosis. This aligns with our observation that a lack of T1D-suggestive phenotypic features in children plays an important role in delayed determination of diabetes type and underscores the urgent need for better diagnostic tools and biomarkers to confirm the timely diagnosis of T2D in children. […] Delayed diagnosis or misdiagnosis of diabetes type at diagnosis of diabetes in children is due, in part, to limitations of the current classification system of diabetes, which offers clinicians only limited options of diabetes types despite tremendous heterogeneity of diabetes. […] In conclusion, one in 15 children is affected by inaccurate diagnosis of diabetes type in a racially and ethnically diverse pediatric diabetes population.

• #1 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter35

  Given the aforementioned limitations, we recommend using a combination of A1C and fasting or random blood glucose to screen for type 2 diabetes in children and youth with risk factors. […] Children with type 2 diabetes should receive care in conjunction or consultation with an interprofessional pediatric diabetes health-care team that should include either a pediatric endocrinologist or pediatrician with diabetes expertise, dietitian, diabetes nurse educator and mental health professional. […] The target A1C for most children with type 2 diabetes should be 7.0%. […] To be effective, treatment programs for adolescents with type 2 diabetes need to address the lifestyle and health habits of the entire family, emphasizing healthy eating and physical activity. […] Children with type 2 diabetes should be screened for neuropathy at diagnosis and annually thereafter.

• #1 Children and type 2 diabetes | Guide to diabetes | Diabetes UK

  https://www.diabetes.org.uk/living-with-diabetes/life-with-diabetes/children-and-diabetes/type-2

  Type 2 diabetes cant be cured, but some people can go into remission. […] The limited evidence about remission has mainly come from young people who have undergone bariatric surgery. […] Younger people diagnosed with type 2 diabetes are at a much higher risk of developing diabetes complications as the condition is more aggressive compared to older adults. […] If your child is diagnosed with type 2 diabetes, the usual treatment is metformin, and insulin is also commonly used. […] There is evidence to suggest that children with type 2 diabetes who receive care from specialist paediatric diabetes clinics get better support to manage their diabetes. […] Your childs healthcare team will provide information on how and when to check blood sugar levels, what levels to aim for, and how to manage hypos.

• #1 A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03349-4

  Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. […] There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes. […] Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. […] We recommend HbA1c testing as the primary test for screening for type 2 diabetes. […] Identification of diabetes type can be challenging with all types having overlapping features, particularly in those with excess weight. […] Detection of diabetes antibodies identifies those at the highest risk of developing auto-immune driven loss of insulin production and can aid with the correct identification of diabetes subtype.

• #1 Inaccurate diagnosis of diabetes type in youth: prevalence, characteristics, and implications | Scientific Reports

  https://www.nature.com/articles/s41598-024-58927-6

  Classifying diabetes at diagnosis is crucial for disease management but increasingly difficult due to overlaps in characteristics between the commonly encountered diabetes types. […] In sum, among racially/ethnically diverse youth with diabetes, 6.4% had inaccurate diabetes classification at diagnosis. Further research is warranted to improve accurate diagnosis of pediatric diabetes type. […] The prompt and accurate diagnosis of diabetes type is an ongoing issue in the pediatric population. We found that, in a racially and ethnically diverse cohort, the type of diabetes is unknown at the time of diabetes diagnosis or reclassified 3 years later in 6.4% of youth (one in 15 children) with diabetes mellitus. […] Therefore, accurate and timely diagnosis of diabetes type at the time of diabetes onset is crucial.

• #1 Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents

  https://www.wjgnet.com/1948-9358/full/v12/i4/344.htm

  Therefore, relevant comprehensive, coordinated, and innovative strategies are urgently needed. […] The present review focuses on the latest available data on diagnosis, treatment and prevention of T2DM in youth and suggests potential areas for future research. […] T2DM in children and adolescents is even more worrying and complex, since it has been proven to be a particularly aggressive form of disease associated with high therapeutic failure rates and leading to much earlier complications than the adult-onset form of the disease. […] Management of these patients in a timely and efficient manner is essential to prevent or at least delay complications and to improve long-term outcomes. […] Consequently, not only management but also prevention of obesity and T2DM in children and adolescents should be a top priority for health services and society alike.

• #1 Diagnosis and Management of Type 2 Diabetes Mellitus in Children and AdolescentsSuggested Key Questions:1. What are the benefits and harms of screening for type 2 diabetes mellitus in children and adolescents?2. What is the accuracy of diagnostic | Effect

  https://effectivehealthcare.ahrq.gov/get-involved/nominated-topics/31698

  Diagnosis and Management of Type 2 Diabetes Mellitus in Children and Adolescents Suggested Key Questions: 1. What are the benefits and harms of screening for type 2 diabetes mellitus in children and adolescents? 2. What is the accuracy of diagnostic thresholds for fasting and random blood glucose, glucose tolerance tests, and HbA1c for diagnosing type 2 diabetes mellitus in adolescents? […] The long-term impact of treating type 2 diabetes mellitus in adolescence has not been established. With the increasing prevalence of diabetes in this age group, it is important to understand the long-term benefits and harms of screening and treatment modalities and the appropriate thresholds to target to prevent or delay complications from diabetes in adulthood. An independent systematic review of available evidence for this topic would provide guidance for appropriate treatment considerations.

• #1 Covid in children is linked to higher risk of type 2 diabetes | STAT

  https://www.statnews.com/2024/10/14/covid-diabetes-risk-children/

  It may be time to add Covid-19 infection to the list of possible risk factors for developing type 2 diabetes at a young age. […] An observational study published Monday in JAMA Network Open found that children and adolescents were one-and-a-half times more likely to be diagnosed with the metabolic disorder in the months after having Covid-19 compared to similar kids who weathered other respiratory infections. […] The absolute risk of type 2 being diagnosed in any child remained well under one percentage point. […] For parents, this means keeping a closer eye on their child’s health after recovering from Covid-19, especially if their child has risk factors like being overweight or if they were hospitalized during the illness. […] This study doesn’t imply that Covid-19 causes diabetes in every case, but it does suggest that the virus might trigger diabetes in some children, especially those who are already susceptible.

• #1 Covid in children is linked to higher risk of type 2 diabetes | STAT

  https://www.statnews.com/2024/10/14/covid-diabetes-risk-children/

  He advises parents to watch for signs of diabetes increased thirst, frequent urination, or unexplained weight loss and if they see them, talk to their pediatrician as soon as possible. Early detection is key, and regular follow-ups with healthcare providers are crucial for kids who’ve had Covid-19, particularly if they’re already at higher risk. […] The Case Western scientists said their study did not include sufficient data on vaccination to say what role that might play in managing risk. […] We certainly don’t understand everything about the interplay between Covid-19 infection and its downstream effects on blood sugar control, much less frank diabetes development. […] This is very important for follow-up because now Covid is endemic, Terebuh said. We’re not thinking about it as much, but it’s not gone.

• #1 Diagnosing Type 2 Diabetes In Children | London Diabetes

  https://londondiabetes.com/news-and-events/diagnosing-type-2-diabetes-in-children/

  It’s vital to diagnose type 2 diabetes in children promptly, to prevent complications, protect their future health and ensure they get the care and treatment they need. […] Some signs and symptoms can indicate that your child may have type 2 diabetes, but tests from your doctor can confirm the diagnosis. […] The GP or paediatrician will diagnose diabetes from your child’s clinical history, an examination and blood tests. Common signs and symptoms of type 2 diabetes in children include: […] Type 1 diabetes is more common in children than type 2 diabetes. However, more children and young people are developing type 2 diabetes. The management of type 1 and type 2 diabetes is different, so it’s crucial to get the correct diagnosis. […] If you are worried that your child may have diabetes, their GP or paediatrician will need to do blood tests to measure the concentration of glucose in their blood.

• #1 Diagnosing Type 2 Diabetes In Children | London Diabetes

  https://londondiabetes.com/news-and-events/diagnosing-type-2-diabetes-in-children/

  They will consider a diagnosis of type 2 diabetes if their glucose levels are persistently high. […] The HbA1c is a blood test that shows your child’s average blood glucose levels over the previous two to three months. It is useful to monitor blood glucose control in children already known to have diabetes but shouldn’t be used to diagnose diabetes in children. […] If your GP suspects that your child may have type 2 diabetes, they should arrange an immediate same-day referral to a multidisciplinary paediatric diabetes team in your local hospital. The team will confirm the diagnosis and provide immediate care.

• #1 Diagnosing and managing pediatric diabetes – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/diagnosing-and-managing-pediatric-diabetes/

  Primary care providers and pediatricians play an invaluable role in the diagnosis of pediatric diabetes and timely intervention in cases of hypoglycemia, hyperglycemia and diabetic ketoacidosis. […] “Diagnosing diabetes mellitus often starts with pediatricians or other primary care providers when parents bring in their child for unexplained weight loss, frequent urination and excessive fluid consumption,” said Brad Thrasher, D.O., MBA, pediatric endocrinologist with Wendy Novak Diabetes Institute, part of Norton Children’s Endocrinology, affiliated with the UofL School of Medicine. […] The diagnostic criteria for diabetes include: An A1C greater than 6.5% […] Fasting blood sugar greater than 126 milligrams per deciliter (mg/dL), with fasting defined as no caloric intake for at least eight hours

• #1 Diagnosing and managing pediatric diabetes – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/diagnosing-and-managing-pediatric-diabetes/

  Random blood sugar greater than 200 mg/dL in a patient with classic symptoms of hyperglycemia, such as increased thirst and urination and/or weight loss […] Or blood sugar greater than 200 mg/dL measured two hours after oral glucose tolerance test (This final criterion is not routinely done on children.) […] In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal test results from the same sample or in two separate samples. […] If a primary care provider is concerned one of their pediatric patients has developed diabetes mellitus, Wendy Novak Diabetes Institute is here to help. […] Suspected new onset diabetes mellitus, Type 2: Contact Norton Children’s Endocrinology at (502) 588-3400 to discuss with an endocrinology provider by phone to arrange for care.

• #2 Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8040084/

  During the last two decades, there have been several reports of an increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents, especially among those belonging to minority ethnic groups. […] Youth T2DM differs not only from type 1 diabetes in children, from which it is sometimes difficult to differentiate, but also from T2DM in adults, since it appears to be an aggressive disease with rapidly progressive -cell decline, high treatment failure rate, and accelerated development of complications. […] Despite the recent research, many aspects of youth T2DM still remain unknown, regarding both its pathophysiology and risk factor contribution, and its optimal management and prevention. […] Current management approaches include lifestyle changes, such as improved diet and increased physical activity, together with pharmacological interventions, including metformin, insulin, and the recently approved glucagon-like peptide-1 analog liraglutide.

• #2 Type 2 Diabetes Mellitus in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1101/p590.html

  The American Diabetes Association recommends screening for type 2 diabetes beginning at 10 years of age or the onset of puberty in children who are overweight or obese and have two additional risk factors. […] Diagnostic criteria for type 2 diabetes in children are the same as for adults: a fasting blood glucose level of at least 126 mg per dL (7.0 mmol per L), a two-hour plasma glucose level of at least 200 mg per dL (11.1 mmol per L) during an oral glucose tolerance test, an A1C level of 6.5% or greater, or a random plasma glucose level of at least 200 mg per dL plus symptoms of polyuria, polydipsia, or unintentional weight loss. […] Accurate diagnosis is based on a combination of clinical presentation and the patient history. There are currently no recommendations for diagnostic laboratory testing in children.

• #2 Diabetes Mellitus (DM) in Children and Adolescents – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/hormonal-disorders-in-children/diabetes-mellitus-dm-in-children-and-adolescents

  The diagnosis is based on symptoms and the results of urine and blood tests. […] The diagnosis of diabetes is a two-part process. Doctors first determine whether children have diabetes and then determine the type. […] Doctors suspect diabetes when children have typical symptoms or when a urine test done during a routine physical examination reveals glucose. To confirm the diagnosis, doctors measure blood glucose levels. […] Children whose HbA1C level is 6.5% or higher are considered to have diabetes. HbA1C levels are especially helpful for diagnosing type 2 diabetes in children who do not have typical symptoms. […] To help distinguish type 1 diabetes from type 2, doctors do blood tests that detect antibodies to various proteins made by the insulin-producing cells in the pancreas. […] After type 1 diabetes is diagnosed, doctors can determine the stage.

• #2 Diabetes Mellitus in Children and Adolescents – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/endocrine-disorders-in-children/diabetes-mellitus-in-children-and-adolescents

  Type 2 diabetes, once rare in children, has been increasing in frequency in parallel with the increase in childhood obesity. […] Type 2 is typically diagnosed after puberty, with the highest rate between 15 years and 19 years of age. […] Approximately 80% of children with type 2 diabetes have obesity. […] Diagnosis of diabetes and prediabetes is similar to that in adults, typically using fasting or random plasma glucose levels and/or HbA1C levels, and depends on the presence or absence of symptoms. […] Diabetes is diagnosed in patients with characteristic symptoms of diabetes and blood glucose measurements that meet either of the following criteria: Random plasma glucose 200 mg/dL (11.1 mmol/L) or Fasting plasma glucose 126 mg/dL (7.0 mmol/L); fasting is defined as no caloric intake for 8 hours.

• #2 Type 2 diabetes mellitus in children and adolescents

  https://www.racgp.org.au/afp/2016/june/type-2-diabetes-mellitus-in-children-and-adolescen

  The diagnosis of diabetes is made by the measurement of hyperglycaemia in the absence of any acute physiological stress and the presence of symptoms of hyperglycaemia: fasting plasma glucose of 7.0 mmol/L; plasma glucose of 11.1 mmol/L post-oral glucose tolerance test, with 1.75 g/kg (max 75g) of anhydrous glucose dissolved in water; symptoms of diabetes, such as polyuria, polydipsia, nocturia, unexplained weight loss and a random plasma glucose of 11.1 mmol/L; glycated haemaglobin (HbA1c) of 6.5%. […] The overall goal of initial treatment is to achieve an HbA1c of 6.5%. Education for home blood glucose level (BGL) monitoring is necessary to monitor fasting and postprandial BGLs to achieve target BGL (4-8 mmol/L) and HbA1c ranges (6.5%). A multidisciplinary approach involving paediatric/adult endocrinologists, diabetes educators, dietitians, social workers and psychologists is required to achieve this, as well as lifestyle changes.

• #2 Diabetes Diagnosis & Tests | ADA

  https://diabetes.org/about-diabetes/diagnosis

  Diabetes is diagnosed at an A1C of greater than or equal to 6.5% […] Diabetes is diagnosed at fasting blood glucose of greater than or equal to 126 mg/dl […] Diabetes is diagnosed at two-hour blood glucose of greater than or equal to 200 mg/dl […] Diabetes is diagnosed at blood glucose of greater than or equal to 200 mg/dl.

• #2 Type 2 diabetes in children – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/786

  In the absence of unequivocal hyperglycemia, the diagnosis requires two abnormal test results from the same sample, or in two separate test samples. […] Obesity, leading to insulin resistance, is the primary cause in children. […] Key diagnostic factors include polyuria, polydipsia, acanthosis nigricans, and nocturia. […] Initial treatment includes lifestyle modifications, metformin, and insulin.

• #2 Pediatric Type 2 Diabetes Mellitus: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/925700-overview

  Initial screening may begin at age 10 years or at onset of puberty if puberty occurs at a young age. Screening should be performed every 2 years. A fasting plasma glucose test is the preferred screening study; if clinical suspicion is high but fasting blood glucose is normal ( 100 mg/dL), an oral glucose tolerance test should be considered. […] A random plasma glucose concentration of 200 mg/dL or greater in association with polyuria, polydipsia, or unexplained weight loss is diagnostic of diabetes. In an asymptomatic patient, a fasting plasma glucose value of 126 mg/dL or greater or a 2-hour plasma glucose value of 200 mg/dL or greater during an oral glucose tolerance test is also diagnostic of diabetes. […] Other laboratory results that usually suggest type 2 diabetes are as follows: Elevated fasting C-peptide level, Elevated fasting insulin level, Absence of autoimmune markers (glutamic acid decarboxylase [GAD] and islet cell antibodies).

• #2 Inaccurate diagnosis of diabetes type in youth: prevalence, characteristics, and implications | Scientific Reports

  https://www.nature.com/articles/s41598-024-58927-6

  Classifying diabetes at diagnosis is crucial for disease management but increasingly difficult due to overlaps in characteristics between the commonly encountered diabetes types. […] In sum, among racially/ethnically diverse youth with diabetes, 6.4% had inaccurate diabetes classification at diagnosis. Further research is warranted to improve accurate diagnosis of pediatric diabetes type. […] The prompt and accurate diagnosis of diabetes type is an ongoing issue in the pediatric population. We found that, in a racially and ethnically diverse cohort, the type of diabetes is unknown at the time of diabetes diagnosis or reclassified 3 years later in 6.4% of youth (one in 15 children) with diabetes mellitus. […] Therefore, accurate and timely diagnosis of diabetes type at the time of diabetes onset is crucial.

• #2 Type 2 diabetes in children – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318

  Type 2 diabetes in children may develop so gradually that there are no noticeable symptoms. Sometimes, the disorder is diagnosed during a routine check-up. […] Diabetes screening is recommended for children who have started puberty or are at least 10 years old, who are overweight or obese, and who have at least one other risk factor for type 2 diabetes.

• #2 Type 2 Diabetes Mellitus in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1101/p590.html

  The validity of A1C in the diagnosis of type 2 diabetes in children has been questioned because of inaccuracies among certain ethnicities and comorbidities (e.g., sickle-cell trait). The American Diabetes Association continues to support the use of A1C levels for diagnosis, while acknowledging a lack of studies supporting its use in children with type 2 diabetes.

• #2 Type 2 Diabetes in Children and Adolescents – Diabetes Canada

  https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-35

  A glycated hemoglobin (A1C) 6.0% is able to identify children with type 2 diabetes at 86% sensitivity and 85% specificity and had similar screening efficacy to FPG, when compared to the gold standard 2-hour OGTT. […] Therefore, A1C should not be relied upon as the sole diagnostic test to screen for type 2 diabetes but rather used in combination with FPG and/or 2-hour OGTT. […] Given the aforementioned limitations, we recommend using a combination of A1C and fasting or random blood glucose to screen for type 2 diabetes in children and youth with risk factors. […] Children with type 2 diabetes should receive care in conjunction or consultation with an interprofessional pediatric diabetes health-care team that should include either a pediatric endocrinologist or pediatrician with diabetes expertise, dietitian, diabetes nurse educator and mental health professional.

• #2 Type 2 diabetes mellitus in children and adolescents

  https://www.racgp.org.au/afp/2016/june/type-2-diabetes-mellitus-in-children-and-adolescen

  The presentation of T2DM varies from asymptomatic hyperglycaemia in a well child, perhaps detected through incidental testing, to ketoacidosis in up to 25% of patients. These individuals are also at risk of hyperglycaemic hyperosmolar non-ketotic state, which is associated with a high mortality rate. The diagnosis of T2DM in youth requires the diagnosis of diabetes followed by the classification of diabetes type. It is worth noting that the prevalence of T1DM is approximately 10-fold higher than the prevalence of T2DM in most paediatric populations. Therefore, a diagnosis of T1DM should be made in the acute setting if there is any doubt regarding diabetes subclassifications. […] There are currently four accepted ways to diagnose diabetes as per the International Society of Paediatric and Adolescent Diabetes (ISPAD) guidelines and American Diabetes Association, based on the measurement of hyperglycaemia and the presence of symptoms. Several clinical characteristics, such as age, ethnicity, obesity, family history of T2DM and the presence of islet cell antibodies, are important factors in the differentiation between T1DM and T2DM.

• #2

  https://journals.lww.com/jaapa/fulltext/2022/07000/diagnosis_and_management_of_type_2_diabetes_in.3.aspx

  Because of this, identifying the appropriate at-risk population is a crucial step in determining which patients need to be screened. […] Consider risk-based screening for prediabetes and/or type 2 diabetes for children after the onset of puberty, or for children age 10 years or older who are overweight (BMI at or above the 85th percentile) and have one or more additional risk factors for diabetes. […] The history and physical examination are crucial elements for children suspected of having type 2 diabetes. […] Children with type 2 diabetes do not always present with symptoms, so a broad review of systems can uncover findings that could identify underlying comorbidities and quantify disease severity. […] Appropriate diagnostic tools to test for type 2 diabetes in children include any of the following: fasting plasma glucose (FPG), 2-hour plasma glucose during a 75-g oral glucose tolerance test (OGTT), or hemoglobin A1C. […] Confirmation of type 2 diabetes can be achieved by obtaining two abnormal test results from the same sample or in two separate test samples. […] When at-risk patients are identified, an extensive workup is indicated to provide a definitive diagnosis of type 2 diabetes.

• #2 Pediatric Type 2 Diabetes Mellitus Workup: Approach Considerations, Plasma Glucose and Other Tests, Evaluation for Diabetic Nephropathy

  https://emedicine.medscape.com/article/925700-workup

  Fasting C-peptide and insulin levels are usually elevated in type 2 diabetes. Autoimmune markers (glutamic acid decarboxylase [GAD] and islet cell antibodies) are usually negative in type 2 diabetes but are frequently present in type 1 diabetes. […] Microalbuminuria is said to be present if urinary albumin excretion is 30 mg/24 h (equivalent to 20 g/min with a timed specimen or 30 mg of albumin per gram creatinine with a random sample; see Urinalysis). […] Obtain fasting lipid profile after stable glycemia has been achieved and every 2 years thereafter if normal. Optimal lipid levels for children with type 2 diabetes are as follows: Triglycerides optimal level – Less than 150 mg/dL, Low-density lipoprotein (LDL) optimal level – Less than 100 mg/dL, High-density lipoprotein (HDL) optimal level – More than 35 mg/dL.

• #2 Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents

  https://www.wjgnet.com/1948-9358/full/v12/i4/344.htm

  Therefore, relevant comprehensive, coordinated, and innovative strategies are urgently needed. […] The present review focuses on the latest available data on diagnosis, treatment and prevention of T2DM in youth and suggests potential areas for future research. […] T2DM in children and adolescents is even more worrying and complex, since it has been proven to be a particularly aggressive form of disease associated with high therapeutic failure rates and leading to much earlier complications than the adult-onset form of the disease. […] Management of these patients in a timely and efficient manner is essential to prevent or at least delay complications and to improve long-term outcomes. […] Consequently, not only management but also prevention of obesity and T2DM in children and adolescents should be a top priority for health services and society alike.

• #2 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter35

  Children with type 2 diabetes should be screened at diagnosis for retinopathy and yearly thereafter. […] Children with type 2 diabetes should be screened for chronic kidney disease at diagnosis and yearly thereafter with a first morning urine ACR (preferred) or a random ACR. […] Children with type 2 diabetes should be screened at diagnosis for comorbid conditions associated with insulin resistance, including NAFLD, OSA, and PCOS in pubertal females, and yearly thereafter as clinically indicated. […] Children with type 2 diabetes should be screened at diagnosis for depression and disordered eating (in particular binge eating) and at every diabetes-related clinical encounter thereafter.

• #2 Diabetes Canada | Clinical Practice Guidelines

  https://guidelines.diabetes.ca/cpg/chapter35

  Although not proven in children, it is generally assumed that earlier diagnosis of diabetes will lead to interventions that will improve glycemic control and reduce the related short- and long-term complications. […] In a recent national Canadian diabetes incidence study, the mean age of diagnosis of type 2 diabetes in youth was 13.7 years. […] A fasting plasma glucose (FPG) is the recommended routine screening test for children, although ensuring a fasting state may be a challenge. […] The oral glucose tolerance test (OGTT) may have a higher detection rate in children who have severe obesity and who have multiple risk factors for type 2 diabetes, but it has poor reproducibility. […] A glycated hemoglobin (A1C) 6.0% is able to identify children with type 2 diabetes at 86% sensitivity and 85% specificity and had similar screening efficacy to FPG, when compared to the gold standard 2-hour OGTT.

• #2 Covid in children is linked to higher risk of type 2 diabetes | STAT

  https://www.statnews.com/2024/10/14/covid-diabetes-risk-children/

  It may be time to add Covid-19 infection to the list of possible risk factors for developing type 2 diabetes at a young age. […] An observational study published Monday in JAMA Network Open found that children and adolescents were one-and-a-half times more likely to be diagnosed with the metabolic disorder in the months after having Covid-19 compared to similar kids who weathered other respiratory infections. […] The absolute risk of type 2 being diagnosed in any child remained well under one percentage point. […] For parents, this means keeping a closer eye on their child’s health after recovering from Covid-19, especially if their child has risk factors like being overweight or if they were hospitalized during the illness. […] This study doesn’t imply that Covid-19 causes diabetes in every case, but it does suggest that the virus might trigger diabetes in some children, especially those who are already susceptible.

• #2 Diagnosing and managing pediatric diabetes – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/diagnosing-and-managing-pediatric-diabetes/

  Primary care providers and pediatricians play an invaluable role in the diagnosis of pediatric diabetes and timely intervention in cases of hypoglycemia, hyperglycemia and diabetic ketoacidosis. […] “Diagnosing diabetes mellitus often starts with pediatricians or other primary care providers when parents bring in their child for unexplained weight loss, frequent urination and excessive fluid consumption,” said Brad Thrasher, D.O., MBA, pediatric endocrinologist with Wendy Novak Diabetes Institute, part of Norton Children’s Endocrinology, affiliated with the UofL School of Medicine. […] The diagnostic criteria for diabetes include: An A1C greater than 6.5% […] Fasting blood sugar greater than 126 milligrams per deciliter (mg/dL), with fasting defined as no caloric intake for at least eight hours

• #2 Diagnosing and managing pediatric diabetes – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/diagnosing-and-managing-pediatric-diabetes/

  Random blood sugar greater than 200 mg/dL in a patient with classic symptoms of hyperglycemia, such as increased thirst and urination and/or weight loss […] Or blood sugar greater than 200 mg/dL measured two hours after oral glucose tolerance test (This final criterion is not routinely done on children.) […] In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal test results from the same sample or in two separate samples. […] If a primary care provider is concerned one of their pediatric patients has developed diabetes mellitus, Wendy Novak Diabetes Institute is here to help. […] Suspected new onset diabetes mellitus, Type 2: Contact Norton Children’s Endocrinology at (502) 588-3400 to discuss with an endocrinology provider by phone to arrange for care.

• #3 Covid in children is linked to higher risk of type 2 diabetes | STAT

  https://www.statnews.com/2024/10/14/covid-diabetes-risk-children/

  It may be time to add Covid-19 infection to the list of possible risk factors for developing type 2 diabetes at a young age. […] An observational study published Monday in JAMA Network Open found that children and adolescents were one-and-a-half times more likely to be diagnosed with the metabolic disorder in the months after having Covid-19 compared to similar kids who weathered other respiratory infections. […] The absolute risk of type 2 being diagnosed in any child remained well under one percentage point. […] For parents, this means keeping a closer eye on their child’s health after recovering from Covid-19, especially if their child has risk factors like being overweight or if they were hospitalized during the illness. […] This study doesn’t imply that Covid-19 causes diabetes in every case, but it does suggest that the virus might trigger diabetes in some children, especially those who are already susceptible.

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