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The US Preventive Services Task Force has released their first recommendation statement outlining the organization’s stance on screening for prediabetes and type 2 diabetes in children and adolescents without known diabetes or prediabetes or without symptoms of either.
Released on September 13, the USPSTF concluded in their recommendation statement, which is the first on the subject for this particular patient population, that there was insufficient evidence to assess the balance of benefits and harms of screening for type 2 diabetes or prediabetes in children and adolescents, awarding an I grade to the statement.
“The rate of prediabetes and type 2 diabetes in youth is increasing. The challenge is that we don’t have the evidence to tell us whether or not screening in primary care helps improves the health of children and teens,” says Task Force member Michael Cabana, MD, MA, MPH, director of the Division of General Pediatrics at the University of California, San Francisco, in a statement from the USPSTF. “It is important that healthcare professionals be aware of the signs and symptoms of prediabetes and type 2 diabetes and use their judgment when determining whether or not to screen youth."
A 5-page document published in JAMA, the recommendation statement was composed by Mangione and represents the first time the USPSTF has issued a recommendation statement on the topic. Although they opted to issue an I grade, which indicates a lack of sufficient evidence to make a recommendation, for the statement, the authors noted the importance of diabetes prevention in this population and provided suggestions for practice. Among these suggestions were an emphasis on obesity and excess adipose tissue, awareness of the increased risk among minority populations,
In the past, the USPSTF has awarded B graded recommendations, which indicate high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial, on screening for obesity in children and adolescents, screening for prediabetes and type 2 diabetes in adults, and screening for gestational diabetes in pregnant persons.
As part of the writing process, the USPSTF conducted an evidence report and systematic review of available data related to the topic. From the PubMed/MEDLINE, Cochrane Library, and trial registries, investigators identified 8 publications for inclusion in their review. Of these 8, 6 were from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Upon review, investigators found none of the eligible studies directly assessed benefits or harms of screening in these populations.
Near the conclusion of their recommendation statement, authors highlighted multiple research needs and knowledge gaps in need of addressing. These included the effects of screening on health outcomes in children and adolescents considered to be at higher risk, effects of lifestyle interventions, pharmacotherapy, or both for treatment of screen-detected prediabetes and diabetes on health outcomes in children and adolescents, and the effects of screening on health outcomes in child and adolescent populations reflective of the prevalence of diabetes in the US, particularly in racial and ethnic groups with a higher prevalence of diabetes than non-Hispanic White youth.
In an accompanying editorial, Elvira Isganaitis, MD, MPH, and Lori Laffel, MD, MPH, both of Harvard Medical School, underlined the attention this statement should bring to existing knowledge and research gaps related to a subject that could have a substantial, population-level impact. Further in the editorial, the pair touched on optimal strategies while awaiting a firmer conclusion on the benefits and harms of screening in this patient population.
“For now, while awaiting more data and definitive guidelines, pediatricians and primary care clinicians can continue to emphasize the importance of healthy lifestyles for children and their families, maintain a watchful approach to detect clinical symptoms of hyperglycemia, and continue to follow risk-based screening recommendations for type 2 diabetes in overweight or obese youth with at least 1 additional risk factor,” Isganaitis and Laffel wrote.
This USPSTF recommendation statement, titled “Screening for Prediabetes and Type 2 Diabetes in Children and Adolescents,” was published in JAMA.