What to Know about Prediabetes and Type 2 Diabetes

As the prevalence of pediatric obesity has increased, so has the prevalence of prediabetes and type 2 diabetes in children. In the United States, one in five adolescents have prediabetes. Prediabetes can be a precursor to type 2 diabetes, but not every child with prediabetes will develop type 2 diabetes. In type 2 diabetes, blood glucose is high due to insulin resistance, meaning the body does not respond as well to the hormone insulin produced by the pancreas. 

What are symptoms and signs of prediabetes and type 2 diabetes?

Often, children do not have any symptoms with prediabetes. On exam, they may have obesity and acanthosis nigricans (darkening of skin folds around the neck and in the armpits). Their pediatrician may check blood tests due to these findings or if there is a strong family history of prediabetes or type 2 diabetes.

Youth with type 2 diabetes may not have any symptoms or they may have symptoms of increased urination, new bedwetting, increased thirst, or blurred vision. The exam may be similar to that of prediabetes, but may show unintentional weight loss. 

How are prediabetes and type 2 diabetes diagnosed?

These conditions are diagnosed through laboratory (blood) testing. Prediabetes is defined as blood glucose levels and hemoglobin A1c (HbA1c) which are higher than normal but not yet consistent with type 2 diabetes. For example, in prediabetes, HbA1c is between 5.7% and 6.4% and in type 2 diabetes, HbA1c is 6.5% or higher.

What is the treatment for prediabetes and type 2 diabetes?

A healthy, active lifestyle is the mainstay of treatment for both prediabetes and type 2 diabetes. This includes eliminating sugary beverages, minimizing fast food and increasing physical activity. However, this is often easier said than done, especially given other competing factors such as work or school schedules, neighborhood safety and high food expenses. A comprehensive, intensive weight management program can help provide structure and can help prevent prediabetes from developing into type 2 diabetes. Medications can also sometimes be used to help with weight management.

Once type 2 diabetes develops, medications are necessary to prevent complications. When type 2 diabetes develops in adolescence as compared to adulthood, the rates of complications such as kidney and eye problems are higher. A comprehensive diabetes clinic including endocrinologists, nutritionists and nephrologists can help prevent these complications. Oral medications such as metformin or SGLT-2 inhibitors and injectable medications such as insulin and GLP-1 receptor agonists, may be used for treatment.