Section 14:

Children and Adolescents

Children and adolescents with diabetes and their parents/caregivers should receive culturally sensitive and
developmentally appropriate individualized diabetes self-management education and support according to
national standards at diagnosis and routinely thereafter. Recommendations for managing Type 1 diabetes are
comprehensively addressed in the ADA Standards of Care in Diabetes—2024 document.

School and Child Care

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Federal and state laws require
Youth spend significant time in Proper care ensures optimal schools, day care facilities, and
school/day care, necessitating diabetes management and safe other entities to provide needed
personnel training for optimal access to all school- or day care– diabetes care to enable the
diabetes care. sponsored opportunities. children to safely access the
school or day care environment.

Type 2 Diabetes in Youth and Adolescents

• Risk-based screening should be considered after the onset of puberty or ≥10 years of age,
whichever occurs earlier, in youth with overweight (BMI ≥85th percentile) or obesity (BMI ≥95th
percentile) and who have one or more additional risk factors for diabetes.
Screening

• Fasting plasma glucose, 2-h plasma glucose during a 75-g oral glucose tolerance test, and A1C can
be used to diagnose prediabetes or diabetes in children and adolescents.
• In those in whom a diagnosis of type 2 diabetes is being considered, a panel of pancreatic
Diagnosis autoantibodies should be tested to exclude the possibility of autoimmune type 1 diabetes.

• Treatment of type 2 diabetes in youth may include: metformin, insulin, a glucaogon-like peptide 1
(GLP-1) receptor agonist approved for use in youth with type 2 diabetes, and/or the sodium–glucose
cotransporter 2 (SGLT2) inhibitor empagliflozin. (See figure on the next page.)
Treatment

• Blood pressure should be measured at every clinic visit and treated if found to be elevated on three
separate measurements.
Complications • Urine albumin-to-creatinine ratio and estimated glomerular filtration rate should be obtained at the time
of diagnosis then annually.
• Neuropathy screening by foot exam should be done at diagnosis and then annually.
• Retinopathy screening by dilated fundoscopy should be done at diagnosis and then annually.
• Evaluation for nonalcoholic fatty liver disease (by measuring AST and ALT) should be done at
diagnosis and then annually.
• Screening for symptoms of obstructive sleep apnea should be done at each visit.
• Evaluate for polycystic ovary syndrome in female adolescents when indicated.
• Lipid screening should be done after optimizing glycemia and then annually.

Suggested citation: American Diabetes Association Primary Care Advisory Group. 14. Children and adolescents: Standards of Care in Diabetes—2024 abridged for
primary care professionals. Clin Diabetes 2024;42:218–219 (doi: 10.2337/cd24-a014). ©2024 by the American Diabetes Association.

218 DIABETESJOURNALS.ORG/CLINICAL
 AMERICAN DIABETES ASSOCIATION

Addressing Probable New Cases of Type 2 Diabetes in Youth

New-Onset Diabetes in Youth With Overweight or Obesity With Clinical Suspicion of Type 2 Diabetes
Initiate lifestyle management and diabetes education

A1C <8.5% A1C ≥8.5%

Acidosis and/or DKA and/or HHNK
No acidosis or ketosis No acidosis with or without ketosis

• Metformin • Metformin • Manage DKA or HHNK

» Titrate up to 2,000 mg per day » Titrate up to 2,000 mg per day • IV insulin until acidosis resolves,
as tolerated as tolerated then subcutaneous (as for type
1 diabetes) until antibodies are

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• Long-acting insulin: start at 0.5
known
units/kg/day and titrate every 2–3
days based on BGM

Pancreatic autoantibodies

NEGATIVE POSITIVE

• Continue or start metformin • Continue or initiate MDI insulin or pump therapy, as for
type 1 diabetes
• If on insulin, titrate guided by glucose values
• Discontinue metformin

A1C goals not met

• Continue metformin

• Consider adding a GLP-1 receptor agonist or an SGLT2

inhibitor approved for youth with type 2 diabetes

• Initiate/titrate insulin therapy; if using long-acting

insulin only and glycemic target not met with escalating
doses, then add prandial insulin; total daily insulin dose
may exceed 1 unit/kg/day

Management of new-onset diabetes in you with overweight or obesity with clinical suspicion of type 2 diabetes. A1C 8.5% = 69 mmol/
mol. Adapted from Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and management of youth-onset type 2
diabetes: a position statement by the American Diabetes Association. Diabetes Care 2018;41:2648–2668. BGM, blood glucose monitoring;
DKA, diabetic ketoacidosis: HHNK, hyperosmolar hyperglycemic nonketotic syndrome; IV, intravenous; MDI, multiple daily injection.

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