There is strong evidence of a link between Type 2 diabetes and childhood obesity. This link, which was previously only seen in adults, is now being seen in children with increasing frequency. Recent studies in the US show that up to 45% of children that have been recently diagnosed with diabetes are Type 2 diabetic, a condition that used to only affect adults over 40. In addition, 85% percent of children with Type 2 diabetes are either overweight or obese, according to the sex-specific body mass index, or BMI, for age-based growth charts.
Since serious complications can result from Type 2 diabetes, physicians must be made fully aware of the risk factors and screening guidelines in order to more effectively diagnose and treat Type 2 diabetes in children. A thorough examination of the available research on childhood diabetes and the current statistics regarding the increase in the number of children who are diagnosed with Type 2 diabetes each year, show that there are several gaps in the existing policies and practices in screening for Type 2 diabetes in children.
Physician Guidelines for Screening
In 2000, the American Diabetes Association (ADA) issued recommendations for screening children for Type 2 diabetes. Two independent studies, one in 2014 in Chicago at an urban pediatric clinic,and the other in 2013 in Boston at an urban primary care clinic, showed that although physicians were screening for diabetes, they were either not doing so according to ADA recommendations or following the recommendations inconsistently. Both studies found that the degree of compliance with the ADA guidelines for screening was limited for five reasons:
- At the time of the studies, the ADA screening recommendations were relatively new and not completely understood by the medical community. A third independent study supports this as only 21% of the pediatricians surveyed reported actively screening children according to the ADA screening recommendations.
- Physicians were using visual inspection to determine overweight status instead of using the age- and sex-appropriate BMI charts, as established by the ADA. As a result, screening rates for the highest risk children were substantially lower and many children who did not meet the ADA criteria were screened.
- Physicians and other health care providers lack referral resources for nutrition and exercise counseling, and therefore may be less likely to screen higher-risk children for Type 2 diabetes.
- Physicians have reported that they ordered a non-fasting blood sugar test, which is less reliable, instead of the ADA-recommended fasting blood sugar test, due to non-medical factors such as access to or cost of transportation.
- Patient noncompliance may be a factor even when the physician has recommended screening.
Physical and Economic Toll
It is well documented that if Type 2 diabetes goes undiagnosed and/or untreated, serious long-term complications can occur, which can be disabling, irreversible, and even life threatening. These complications can include heart and blood vessel damage, nerve damage, liver and kidney damage, eye damage, foot damage, and skin infections. In 2015 alone, it was estimated that the economic impact on the US for diagnosed Type 2 diabetes was $159.5 billion and an additional $18 billion on undiagnosed Type 2 diabetes.
What Physicians Should Be Doing
The ADA states that physicians and other health care providers are expected to regularly screen children for Type 2 diabetes in adherence to their established criteria. Instead, physicians are relying on visual cues of obesity instead of using age- and sex-appropriate BMI charts, appear to misunderstand or receive inadequate training on the ADA screening recommendations, order non-ADA-recommended screening tests, and do not have adequate patient education materials or outside resources to combat non-compliance with screening recommendations and diabetes management after diagnosis. As a result, Type 2 diabetes in children is rising.
According to the CDC, 8% to 46% of all new cases of diabetes (both Type 1 and Type 2) that were referred to pediatric centers were Type 2 diabetes and this percentage is most likely underestimated, especially since the ADA criteria is not used regularly or consistently. Physicians and other health care providers need to be re-educated in the ADA screening recommendations for Type 2 diabetes in children in order to properly diagnose and treat their patients. Physicians also need to be educated on outside resources for screening and managing pediatric Type 2 diabetes.