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Screening for Prediabetes and Type 2 Diabetes in Children and AdolescentsEvidence Report and Systematic Review for the US Preventive Services Task Force

To identify the key insights or developments described in this article
1 Credit CME
Abstract

Importance  Of youths diagnosed with type 2 diabetes, many develop microvascular complications by young adulthood.

Objective  To review the evidence on benefits and harms of screening children and adolescents for prediabetes and type 2 diabetes to inform the US Preventive Services Task Force (USPSTF).

Data Sources  PubMed/MEDLINE, Cochrane Library, and trial registries through May 3, 2021; references; experts; literature surveillance through July 22, 2022.

Study Selection  English-language controlled studies evaluating screening or interventions for prediabetes or type 2 diabetes that was screen detected or recently diagnosed.

Data Extraction and Synthesis  Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings.

Main Outcomes and Measures  Mortality, cardiovascular morbidity, diabetes-related morbidity, development of diabetes, quality of life, and harms.

Results  This review included 8 publications (856 participants; mean age, 14 years [range, 10-17 years]). Of those, 6 were from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. No eligible studies directly evaluated the benefits or harms of screening. One randomized clinical trial (RCT) (TODAY; n = 699 adolescents with obesity; mean age, 14 years) comparing metformin, metformin plus rosiglitazone, and metformin plus lifestyle intervention reported that 2 youths with recently diagnosed diabetes developed kidney impairment (0 vs 1 vs 1, respectively; P > .99) and 11 developed diabetic ketoacidosis (5 vs 3 vs 3, respectively; P = .70). One RCT of 75 adolescents (mean age, 13 years) with obesity with prediabetes compared an intensive lifestyle intervention with standard care and reported that no participants in either group developed diabetes, although follow-up was only 6 months. Regarding harms of interventions, 2 RCTs assessing different comparisons enrolled youths with recently diagnosed diabetes. Major hypoglycemic events were reported by less than 1% of participants. Minor hypoglycemic events were more common among youths treated with metformin plus rosiglitazone than among those treated with metformin or metformin plus lifestyle intervention in TODAY (8.2% vs 4.3% vs 3.4%, P = .05). In 1 study, gastrointestinal adverse events were more commonly reported by those taking metformin than by those taking placebo (abdominal pain: 25% vs 12%; nausea/vomiting: 17% vs 10%; P not reported).

Conclusions and Relevance  No eligible studies directly evaluated the benefits or harms of screening for prediabetes and type 2 diabetes in children and adolescents. For youths with prediabetes or recently diagnosed (not screen-detected) diabetes, the only eligible trials reported few health outcomes and found no difference between groups, although evidence was limited by substantial imprecision and a duration of follow-up likely insufficient to assess health outcomes.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Daniel E. Jonas, MD, MPH, Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University, 2050 Kenny Rd, Columbus, OH 43221 (Daniel.Jonas@osumc.edu).

Accepted for Publication: April 26, 2022.

Author Contributions: Dr Jonas had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Jonas, Vander Schaaf, Allison, LeBlanc.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Jonas, Vander Schaaf, Allison, Ali, LeBlanc.

Statistical analysis: Jonas.

Obtained funding: Jonas.

Administrative, technical, or material support: Jonas, Riley, Middleton, Baker, Voisin.

Supervision: Jonas.

Conflict of Interest Disclosures: Dr Vander Schaaf reported receiving grants from The Duke Endowment to support collaboration to address food insecurity and participating on national committees of the American Academy of Pediatrics, which has position statements on pediatric screening. Dr LeBlanc reported that Dexcom donated continuous glucose monitoring devices for a multicenter National Institutes of Health study on which she is an investigator. No other disclosures were reported.

Funding/Support: This research was funded under contract HHSA290201500007I, Task Order 9, from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services, under a contract to support the USPSTF.

Role of the Funder/Sponsor: Investigators worked with USPSTF members and AHRQ staff to develop the scope, analytic framework, and key questions for this review. AHRQ had no role in study selection, quality assessment, or synthesis. AHRQ staff provided project oversight, reviewed the evidence review to ensure that the analysis met methodological standards, and distributed the draft for public comment and review by federal partners. Otherwise, AHRQ had no role in the conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript findings. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We gratefully acknowledge the following individuals for their contributions to this project, including AHRQ staff (Justin Mills, MD, MPH, and Tracy Wolff, MD, MPH) and RTI International—University of North Carolina–Chapel Hill Evidence-based Practice Center staff (Carol Woodell, BSPH, Sharon Barrell, MA, and Loraine Monroe). The USPSTF members, peer reviewers, and federal partner reviewers did not receive financial compensation for their contributions. Ms Woodell, Ms Barrell, and Ms Monroe received compensation for their role in this project.

Additional Information: A draft version of the full evidence review underwent external peer review from 3 content experts (Callie L. Brown, MD, MPH, Wake Forest University School of Medicine; Sheela N. Magge, MD, MSCE, Johns Hopkins University School of Medicine; Hanna Xu, MD, Cook County Health, Illinois) and 3 federal partner reviewers (Centers for Disease Control and Prevention, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Diabetes and Digestive and Kidney Diseases). Comments from reviewers were presented to the USPSTF during its deliberation of the evidence and were considered in preparing the final evidence review. USPSTF members and peer reviewers did not receive financial compensation for their contributions.

Editorial Disclaimer: This evidence review is presented as a document in support of the accompanying USPSTF Recommendation Statement. It did not undergo additional peer review after submission to JAMA.

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