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

Sections

Sections Pediatric Type 2 Diabetes Mellitus
Overview
Presentation
DDx
Workup
Treatment
Medication
Questions & Answers
References

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.

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]

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

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]:

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

Treatment & Management

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Simplified scheme for the pathophysiology of type 2 diabetes mellitus.

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Author

Alba E Morales Pozzo, MD Associate Professor, Department of Pediatrics, Division of Endocrinology and Diabetes, Kentucky Children's Hospital, University of Kentucky Healthcare

Alba E Morales Pozzo, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, American Telemedicine Association, Arkansas Foundation for Medical Care, Arkansas Medical Society, Endocrine Society, Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece; UNESCO Chair on Adolescent Health Care, University of Athens, Greece

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, American College of Endocrinology

Disclosure: Nothing to disclose.

Chief Editor

Sasigarn A Bowden, MD, FAAP Professor of Pediatrics, Section of Pediatric Endocrinology, Metabolism and Diabetes, Department of Pediatrics, Ohio State University College of Medicine; Pediatric Endocrinologist, Division of Endocrinology, Nationwide Children’s Hospital; Affiliate Faculty/Principal Investigator, Center for Clinical Translational Research, Research Institute at Nationwide Children’s Hospital

Sasigarn A Bowden, MD, FAAP is a member of the following medical societies: American Society for Bone and Mineral Research, Central Ohio Pediatric Society, Endocrine Society, International Society for Pediatric and Adolescent Diabetes, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Arlan L Rosenbloom, MD Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida College of Medicine; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology

Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society, International Society for Pediatric and Adolescent Diabetes

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Jean-Claude DesMangles, MD,to the development and writing of the source article.