January 18, 2022
National Center for Health Research’s Comments on U.S. Preventive Services Task Force’s Draft Recommendation on Screening for for Prediabetes and Type 2 Diabetes in Children and Adolescents
We are writing to express our views on the U.S. Preventive Services Task Force’s (USPSTF) draft recommendation statement regarding screening for prediabetes and type 2 diabetes in children and adolescents.
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We support the “I” recommendation against screening for either prediabetes or type 2 diabetes in asymptomatic children aged 18 years or younger. We agree that there is not enough evidence on the effectiveness of available interventions to delay or prevent the progression of prediabetes to type 2 diabetes. We also agree that there is insufficient evidence of beneficial health outcomes resulting from early detection and treatment of type 2 diabetes in children and adolescents.
The recommendation against screening in asymptomatic children is of particular importance, because children who are considered prediabetic are often subject to unnecessary treatments or interventions that are similar or identical to those offered to children diagnosed with diabetes itself.1 Unnecessary screening could lead to several harmful outcomes, including stigmatizing labeling, overdiagnosis, and overtreatment. We agree with USPSTF that research has shown that many children considered prediabetic can revert to normal glucose tolerance without any pharmaceutical intervention. It would be harmful to introduce unnecessary pharmaceutical treatments to children who are likely to revert to normal glucose tolerance without such treatments, either due to normal developmental changes, changes in diet or exercise, or other improved habits.2,3
We share the concerns expressed in the draft recommendation that diabetes is the third most common chronic childhood disease, and the incidence of type 2 diabetes is rising. We strongly agree with the gaps USPSTF highlighted in their draft recommendation. Particularly, we agree with the fact that more research is needed to assess the effects of screening, lifestyle interventions, and pharmacotherapy options among Native American, American Indian, Black and Hispanic youth. These youth have much higher type 2 diabetes rates than non-Hispanic White children and adolescents, and they also have the greatest increase in incidence rates.
- Piller C. The war on ‘prediabetes’ could be a boon for pharma—but is it good medicine?. Science. https://www.science.org/content/article/war-prediabetes-could-be-boon-pharma-it-good-medicine. March 7, 2019.
- Kleber M, Lass N, Papcke S, Wabitsch M, Reinehr T. One‐year follow‐up of untreated obese white children and adolescents with impaired glucose tolerance: high conversion rate to normal glucose tolerance. Diabetic Medicine. 2010; 27(5):516-21.
- Love‐Osborne KA, Sheeder JL, Nadeau KJ, Zeitler P. Longitudinal follow up of dysglycemia in overweight and obese pediatric patients. Pediatric Diabetes. 2018; 19(2):199-204.