KEYSTONE, COLO. — Making the diagnosis of type 2 diabetes in adolescents is a trickier matter than many physicians realize, Dr. Philip Scott Zeitler cautioned at a conference on the management of diabetes in youth.
“Testing for islet cell antibodies is critical. You cannot make the diagnosis of type 2 diabetes in kids clinically,” according to Dr. Zeitler of the University of Colorado, Denver.
Yet physicians often attempt to do so anyway.
“In our national study,” he recalled, “we screened more than 600 adolescents, all of whom were considered to have type 2 diabetes by a pediatric endocrinologist. Fifteen percent of these patients had islet cell antibodies.”
Islet cell antibodies indicate type 1 diabetes and rule out type 2 disease. “I would argue in favor of doing antibody tests as soon as possible because it'll take a while to get the results back,” said Dr. Zeitler.
“The important thing is, don't get sucked into clinical phenotype as your diagnostic criteria.
“There are many, many overweight patients who are Hispanic or Native American who have type 1 diabetes,” the physician explained at the conference which was sponsored by the University and the Children's Diabetes Foundation, Denver.
Dr. Zeitler said that patients with type 2 diabetes should not perfom frequent daily self-monitoring of blood glucose levels if they are not on insulin. Twice-a-day fingerstick measurements 3–5 days per week and when ill are fine. Asking kids to check their blood glucose level four times daily when they're not going to change anything based on the results—assuming they're not on insulin—is “a recipe for burnout,” he said.