| Sumario: | PURPOSE: To review the evidence on benefits and harms of (1) screening children and adolescents for prediabetes and type 2 diabetes and (2) interventions for prediabetes or type 2 diabetes that was screen detected or recently diagnosed for populations and settings relevant to primary care in the United States. DATA SOURCES: PubMed/MEDLINE, the Cochrane Library, and trial registries through May 3, 2021; reference lists of retrieved articles; outside experts; and reviewers, with surveillance of the literature through July 22, 2022. STUDY SELECTION: English-language controlled studies evaluating screening for prediabetes or type 2 diabetes or evaluating interventions for prediabetes or type 2 diabetes that was screen detected or recently diagnosed. DATA EXTRACTION: One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for all included studies using predefined criteria. DATA SYNTHESIS: This review included eight publications (856 participants). Of those, six were from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. No eligible studies directly evaluated the benefits or harms of screening. One included randomized, controlled trial (RCT) (TODAY, n=699 adolescents who were obese) reported that two youths with recently diagnosed type 2 diabetes developed renal impairment (0 vs. 1 vs. 1, p=1.00) and 11 developed diabetic ketoacidosis (5 vs. 3 vs. 3, p=0.70), finding no significant difference between metformin, metformin plus rosiglitazone, and metformin plus lifestyle, respectively. One trial of 75 adolescents who were obese with prediabetes compared an intensive lifestyle intervention versus standard care and reported that no participants in either group developed diabetes, although followup was only 6 months. Regarding harms of interventions, two RCTs assessing different comparisons enrolled youths with recently diagnosed diabetes. Major hypoglycemic events were reported by less than 1 percent of participants. Minor hypoglycemic events were more common among youths treated with metformin plus rosiglitazone than among those treated with metformin or metformin plus lifestyle. In one study, gastrointestinal adverse events were more commonly reported by those taking metformin than by those taking placebo. LIMITATIONS: The included trials generally focused on intermediate outcomes (e.g., glycemic control, body mass index) rather than health outcomes of interest. Duration of followup was too short to assess health outcomes in most studies. Evidence was limited by imprecision, unknown consistency (single study for most key questions), and risk of bias (with a single good-quality study). CONCLUSIONS: No eligible studies directly evaluated the benefits or harms of screening for prediabetes and type 2 diabetes in children and adolescents. For youths with prediabetes or recently diagnosed (not screen-detected) diabetes, the only eligible trials reported few health outcomes and found no difference between groups, although evidence was limited by substantial imprecision and a duration of followup likely insufficient to assess health outcomes. Limited data showed that the combination of rosiglitazone plus metformin was associated with hypoglycemic events (compared with metformin alone or metformin plus lifestyle) and that metformin was associated with gastrointestinal adverse events, consistent with studies conducted in adults.
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