USPSTF finalizes recommendation on prediabetes, type 2 diabetes screening in youth

Key takeaways

• The U.S. Preventive Services Task Force said there was not enough evidence to assess the potential benefits and harms of screening for prediabetes and type 2 diabetes in asymptomatic children and adolescents aged younger than 18 years.
• The incidence of type 2 diabetes has increased among youth in the U.S., with cases rising from 9 per 100,000 in 2002 to 2003 to 13.8 per 100,000 in 2014 to 2015.

The U.S. Preventive Services Task Force has published a final recommendation in JAMA, stating there is insufficient evidence to assess the benefits and harms of prediabetes and type 2 diabetes screening in asymptomatic children and adolescents.

The recommendation statement was based on a review of eight publications that reported on three randomized clinical trials, consisting of 856 participants aged 10 to 17 years (median age, 14 years).

The USPSTF concluded that the studies did not provide enough evidence on the effect of screening as well as early detection and treatment of type 2 diabetes in this population.

Additionally, the only eligible studies evaluating interventions for youth with prediabetes or recently diagnosed diabetes “reported few health outcomes and found no differences between groups,” Daniel E. Jonas, MD, MPH, a professor of clinical medicine in the department of internal medicine at the Ohio State University, and colleagues wrote in the evidence report.

The final recommendation aligns with the USPSTF’s draft recommendation that was released last December. For years, the task force has made screening recommendations for prediabetes and type 2 diabetes in adults, but this was the first time the USPSTF made a recommendation on prediabetes and type 2 diabetes screening in adolescents and children.

Citing CDC data, the USPSTF reported that 210,000 children and adolescents aged younger than 20 years in the U.S. had diabetes in 2018. Among them, 23,000 had type 2 diabetes. The incidence of type 2 diabetes has increased among youth, rising from 9 cases per 100,000 children and adolescents in 2002 to 2003 to 13.8 cases per 100,000 children and adolescents in 2014 to 2015.

The task force noted that future research in this area should examine screening outcomes of youth reflective of diabetes prevalence in the U.S., specifically within underrepresented groups, and examine outcomes of screening on youth who are considered higher risk.

In a related editorial, Elvira Isganaitis, MD, MPH, an assistant professor of pediatrics at Harvard Medical School, and Lori Laffel, MD, MPH, a professor of pediatrics at Harvard Medical School, acknowledged the gravity that the risk for type 2 diabetes presents, citing “mounting” evidence of its association with higher morbidity and premature mortality.

The authors also wrote that the USPSTF evidence report highlights “important gaps in literature,” while emphasizing the need for further research on youth at risk for prediabetes and diabetes.

“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,” they wrote.

References:

• Isganaitis E, Laffel L. JAMA. 2022;doi:10.1001/jama.2022.13759
• Jonas DE, et al. JAMA. 2022;doi:10.1001/jama.2022.7957.
• Mangione CM, et al. JAMA. 2022;doi:10.1001/jama.2022.14543.