Pediatric Type 2 Diabetes Mellitus Workup

Updated: Jun 18, 2019
  • Author: Alba E Morales Pozzo, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Workup

Approach Considerations

According to criteria established by the American Diabetes Association, testing for type 2 diabetes should be considered when a patient is overweight (eg, body mass index [BMI] at the 85th percentile for age and sex, weight at the 85th percentile, weight 120% of ideal for height) and any 2 of the following factors exist [1] :

  • 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)

Recommendations for screening are as follows:

  • 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

In children who do not meet the criteria described above but in whom diabetes is highly suspected, clinical judgment should be applied. If clinical suspicion for diabetes is high but a fasting blood glucose level is normal (< 100 mg/dL), an oral glucose tolerance test should be considered as a more sensitive screening tool.

Because the onset of type 2 diabetes frequently precedes the diagnosis by several years, testing for end-organ effects of the disease is important. In addition, perform dilated eye examination for retinopathy shortly after diagnosis and yearly thereafter.

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Plasma Glucose and Other Tests

A random plasma glucose concentration of 200 mg/dL or greater in association with polyuria, polydipsia, or unexplained weight loss is diagnostic of diabetes. [2]

In an asymptomatic patient, a fasting (ie, no caloric intake for at least 8 h) 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. [2]

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. [2]

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Evaluation for Diabetic Nephropathy

Microalbuminuria is said to be present if urinary albumin excretion is 30 mg/24 h (equivalent to 20 µg/min with a timed specimen or 30 mg of albumin per gram creatinine with a random sample; see Urinalysis). Testing for albuminuria can be performed using 1 of 3 methods, as follows:

  • Measurement of the ACR in a random spot collection

  • A 24–hour collection for albumin and creatinine determinations, which allows for simultaneous measurement of creatinine clearance

  • Timed (eg, 4-h or overnight) collection

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Evaluation for Dyslipidemia

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 [3] :

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