Test Your Knowledge Answer #488

Answer and Critique (Correct Answer = A)

Because of increasing childhood obesity and a lack of physical activity, Type 2 diabetes is increasingly seen at younger ages. Obese children with a body mass index greater than the 85th percentile for age and sex who are of an ethnic group with a high prevalence of diabetes (e.g., African American, Hispanic, Pacific Islander); have family history of diabetes; have signs of insulin resistance (i.e., acanthosis nigricans); or have coexisting hypertension, hypercholesterolemia, or polycystic ovary syndrome are considered at high risk for developing diabetes. In these children, screening is recommended to start at age 10 years by measuring fasting blood glucose. If the fasting blood glucose level is 126 mg/dL (6.99 mmol/L) or greater, the test should be repeated on another day to confirm a diagnosis of diabetes. If the fasting blood glucose level is normal, then high-risk persons should undergo screening every 2 years

Key Point: The prevalence of Type 2 diabetes is increasing in children and young adults. Screening in high-risk children should be encouraged so that lifestyle modifications and treatment can be started early in the disease.

Measurement of islet cell antibodies has no role in screening or diagnosing diabetes. On physical examination, this patient has acanthosis nigricans, a sign of insulin resistance. However, no other signs or symptoms of Cushing's syndrome are present; thus a 24-hour urinary cortisol measurement is unnecessary. A 2-hour oral glucose tolerance test is not recommended for screening of diabetes at this time. Because this patient has several features that place him at high risk of diabetes, waiting until age 16 years to screen for diabetes is inappropriate.
Bibliography

1. Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care. 2000;23:381-9. [PMID: 10868870] [PubMed]