Canadian Diabetes Association Clinical Guidelines Type 2 Diabetes in Children

Question 1

What can reduce the risk of youth-onset type 2 DM?

Answer 1

Breastfeeding

Question 2

What screening test should be performed for type 2 diabetes?

Answer 2

Fasting plasma glucose q2y

Question 3

Who should be screened for type 2 diabetes?

Answer 3

1. > /=3 risk factor in non-pubertal or >/=2 risk factors in pubertal children:
   a) Obesity (BMI>95th)
   b) High risk ethnic group (Aboriginal, African, Asian, Hispanic, South Asian descent)
   c) Family history of type 2 DM and/or exposure to hyperglycemia in utero
   d) Signs or symptoms of insulin resistance (incld. acanthosis nigricans, hypertension, dyslipidemia, NAFLD (ALT>3x UL of normal or fatty liver on US), PCOS)
2. Impaired fasting glucose or impaired glucose tolerance
3. Use of atypical antipsychotic medication

Question 4

In which populations may an OGTT (1.75g/kg, max 75g) be used as a screening test?

Answer 4

1. Very obese children (BMI >99th)

2. Multiple risk factors who meet criteria for regular screening

Question 5

What testing can be considered if there is diagnostic uncertainty between type 1 and 2 diabetes?

Answer 5

Islet autoantibodies

Genetic testing for defects in beta cell function

Question 6

When should children with type 2 diabetes be screened for dyslipidemia?

Answer 6

At diagnosis and q1-3y after as clinically indicated

Question 7

How should children with type 2 diabetes be screened for dyslipidemia?

Answer 7

Fasting TC, HDL-C, TG, calculated LDL-C

Question 8

When should children with type 2 diabetes be screened for hypertension?

Answer 8

At diagnosis and at least twice yearly after

Question 9

When should children with type 2 diabetes be screened for NAFLD?

Answer 9

q1y at diagnosis

Question 10

How should children with type 2 diabetes be screened for NAFLD?

Answer 10

ALT

Question 11

When should children with type 2 diabetes be screened for nephropathy?

Answer 11

q1y at diagnosis

Question 12

How should children with type 2 diabetes be screened for nephropathy?

Answer 12

First am (preferred) or random ACR

Abnormal ACR requires confirmation at least 1m later with first am or time overnight urine collection for ACR

Repeated sampling should be done q3-4m over 6-12m to demonstrate persistence

Question 13

When should children with type 2 diabetes be screened for neuropathy?

Answer 13

q1y at diagnosis

Question 14

How should children with type 2 diabetes be screened for neuropathy?

Answer 14

Questioned and examined for:

1. Symptoms of numbness, pain, cramps and paresthesia
2. Vibration sense
3. Light touch and ankle reflexes

Question 15

When should children with type 2 diabetes be screened for PCOS?

Answer 15

q1y at diagnosis in pubertal females

Question 16

How should children with type 2 diabetes be screened for PCOS?

Answer 16

Clinical assessment on history and physical exam for oligo/amenorrhea, acne, and/or hirsutism

Question 17

When should children with type 2 diabetes be screened for retinopathy?

Answer 17

q1y at diagnosis

Question 18

How should children with type 2 diabetes be screened for retinopathy?

Answer 18

Seven standard field, stereoscopic colour fundus photography with interpretation by a trained reader (gold standard) OR
Direct ophthalmoscopy or indirect slit lamp fundoscopy through dilated pupil OR
Digital fundus photography

Question 19

What percentage of Canadian youth present with DKA at time of diagnosis?

Answer 19

10%

Question 20

What are short-term complications of type 2 diabetes in children?

Answer 20

1. DKA

2. Hyperglycemic hyperosmolar state (HHS)

Question 21

What is the target A1C for most children with type 2 diabetest?

Answer 21

<7.0%

Question 22

When should insulin therapy be initiated right away?

Answer 22

1. A1C >/= 9/0%

2. Severe metabolic decompensation (e.g. DKA)

Question 23

What medications should be started in glycemic targets are not achieved within 3-6m using lifestyle modifications alone?

Answer 23

1. Metformin
2. Glimepiride
3. Insulin

Metoformin is preferred to Glimepiride