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Screening for Prediabetes and Type 2 Diabetes Mellitus in Children and Adolescents: An Evidence Review for the U.S. Preventive Services Task Force
Evidence Synthesis, No. 216
Investigators: Daniel E. Jonas, MD, MPH, Emily B. Vander Schaaf, MD, MPH, Sean Riley, MA, MSc, Bianca Allison, MD, MPH, Jennifer Cook Middleton, PhD, Claire Baker, Rania Ali, MPH, Christiane E. Voisin, MSLS, and Erin LeBlanc, MD, MPH.
Structured Abstract
Purpose:
To review the evidence on benefits and harms of (1) screening children and adolescents for prediabetes and type 2 diabetes and (2) interventions for prediabetes or type 2 diabetes that was screen detected or recently diagnosed for populations and settings relevant to primary care in the United States.
Data Sources:
PubMed/MEDLINE, the Cochrane Library, and trial registries through May 3, 2021; reference lists of retrieved articles; outside experts; and reviewers, with surveillance of the literature through July 22, 2022.
Study Selection:
English-language controlled studies evaluating screening for prediabetes or type 2 diabetes or evaluating interventions for prediabetes or type 2 diabetes that was screen detected or recently diagnosed.
Data Extraction:
One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for all included studies using predefined criteria.
Data Synthesis:
This review included eight publications (856 participants). Of those, six 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 included randomized, controlled trial (RCT) (TODAY, n=699 adolescents who were obese) reported that two youths with recently diagnosed type 2 diabetes developed renal impairment (0 vs. 1 vs. 1, p=1.00) and 11 developed diabetic ketoacidosis (5 vs. 3 vs. 3, p=0.70), finding no significant difference between metformin, metformin plus rosiglitazone, and metformin plus lifestyle, respectively. One trial of 75 adolescents who were obese with prediabetes compared an intensive lifestyle intervention versus standard care and reported that no participants in either group developed diabetes, although followup was only 6 months. Regarding harms of interventions, two RCTs assessing different comparisons enrolled youths with recently diagnosed diabetes. Major hypoglycemic events were reported by less than 1 percent 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. In one study, gastrointestinal adverse events were more commonly reported by those taking metformin than by those taking placebo.
Limitations:
The included trials generally focused on intermediate outcomes (e.g., glycemic control, body mass index) rather than health outcomes of interest. Duration of followup was too short to assess health outcomes in most studies. Evidence was limited by imprecision, unknown consistency (single study for most key questions), and risk of bias (with a single good-quality study).
Conclusions:
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 followup likely insufficient to assess health outcomes. Limited data showed that the combination of rosiglitazone plus metformin was associated with hypoglycemic events (compared with metformin alone or metformin plus lifestyle) and that metformin was associated with gastrointestinal adverse events, consistent with studies conducted in adults.
Contents
Suggested citation:
Jonas DE, Vander Schaaf EB, Riley S, Allison B, Middleton JC, Baker C, Ali R, Voisin CE, LeBlanc E. Screening for Prediabetes and Type 2 Diabetes Mellitus in Children and Adolescents: An Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 216. AHRQ Publication No. 21-05288-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2022.
This report is based on research conducted by the RTI International–University of North Carolina Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (HHSA-290-2015-00007-I, Task Order No. 9). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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