PEDIATRICS UPDATES: TID and T2D

PEDIATRICS UPDATES

Q#01

What laboratory features are helpful to distinguish T1D from T2D?

Although classification can usually be made on the basis of clinical characteristics, measurement of levels of fasting insulin and C-peptide (low in T1D; normal or elevated in T2D) or islet cell autoantibodies (positive in T1D; absent in T2D) may be useful to distinguish T1D from T2D. Be mindful that there can be overlap in the laboratory evaluation.

Q#02

What is acanthosis nigricans?

Acanthosis nigricans is hyperpigmented and often highly rugated patches that are foundmost prominently in intertriginous areas, especially on the nape of the neck. This is a marker of insulin resistance.

Q#03

How is T2D diagnosed?

The diagnosis of diabetes is based on blood glucose level cutoffs and the levels used are the same for T1D and T2D. The diagnosis is made when any of the following criteria are met:

• Random glucose concentration of 200 mg/dL or higher (if accompanied by classic symptoms: polyuria, polydipsia, weight loss)

• Fasting (>8 hours) glucose concentration of more than 125 mg/dL

• Abnormal oral glucose tolerance test defined as a glucose concentration of more than 200 mg/dL measured 2 hours after drinking 1.75 g/kg of glucose (with a maximum dose of 75 g)

• Hemoglobin A1C≥6.5%

Q#04

Which pediatric patients should be screened for T2D?

The American Diabetes Association recommends screening beginning at 10 years of age (or earlier if puberty initiates before age 10 years). Screening should be performed using a fasting plasma glucose, oral glucose tolerance test, or hemoglobin A1C for patients with the following risk factors:

• Body mass index more than 85th percentile for age and sex, plus

• Any two of following risk factors: positive family history in first- or second-degree relative; high-risk race/ethnicity; presence of associated conditions (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovarian syndrome)

• Maternal history of diabetes or gestational diabetes during the child’s gestation

Q#05

What hemoglobin A1C level is sufficient to diagnose diabetes?

A level≥6.5% on two occasions using a laboratory method is sufficient for the diagnosis. Levels between 5.7 and 6.4 place a person at increased risk for diabetes.