Investigating for diabetes in children (Paediatric Guidelines)

If Type 1 Diabetes is suspected, please check a capillary blood glucose immediately and if elevated, phone the On Call Paediatric team for admission that day.  If that is normal, other tests for Diabetes are not required.  A fasting glucose, lab glucose or HbA1c are not suitable investigations, and delay diagnosis, increasing the chance of patients developing DKA while waiting for tests and results. 

Screening for Type 2 Diabetes in Young People under 16 years (based on ISPAD Guidelines)

Undiagnosed Type 2 Diabetes is rare in the adolescent population, even among high risk individuals.  Generalised population screening of obese youth is therefore unlikely to be cost effective in most populations.  Testing to identify clinical cases of diabetes should be considered in obese children and adolescents after the onset of puberty or after 10 years of age, whichever occurs earlier, who have risk factors for diabetes:

• Intrauterine growth retardation with rapid infant weight gain
• First degree family history of Type 2 diabetes
• Maternal history of diabetes or gestational diabetes during child’s gestation
• High risk ethnicity (South East Asian or Afro-Caribbean background)
• Polycystic Ovarian Syndrome
• Acanthosis Nigricans on examination

Other co-morbidities of obesity such as non-alcoholic fatty liver disease (NAFLD), dyslipidaemia, elevated BP and PCOS (polycystic ovary syndrome) are more prevalent than dysglycaemia. 

Type 2 Diabetes can be diagnosed using an HbA1c.  Please ensure the request form says 'suspected Type 2 diabetes’, not Type 1, otherwise the laboratory may not process it as it would be an inappropriate test for possible Type 1 diabetes.  If the HbA1c is ≥ 48mmol/mol in a patient suspected of Type 2 Diabetes, please contact the On Call Paediatric team who will admit the patient and arrange investigations to confirm diabetes type and the Paediatric Diabetes Team will review.

If you have any non urgent clinical questions, please do not hesitate to contact Victoria Franklin, Clinical Lead for the Highland Paediatric Diabetes Service on victoria.franklin@nhs.scot