This care process model was developed to help guide the general practitioner on outpatient screening and management of type 2 diabetes in patients within the University of Utah Health and Intermountain Healthcare systems. It was created by general pediatricians at the University of Utah School of Medicine and reviewed by pediatric endocrinologists at Primary Children’s Hospital. It is based on recommendations from the Intermountain Healthcare Pediatric Diabetes Care Process Model and the American Diabetes Association [American: 2021]. In 2023, it was updated to incorporate screening guidelines from the American Academy of Pediatrics Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity [Hampl: 2023].

Its purpose is to empower the general practitioner to screen for and manage pediatric type 2 diabetes while providing guidance about escalation of care and referral to diabetes specialists. Using the care process model will help primary care clinicians avoid delays in treatment while awaiting specialty consultation and reduce unnecessary referrals.

1. Patients with BMI ≥95th% percentile for age and sex who are ≥10 years old or pubertal should be screened for type 2 diabetes with a fasting plasma glucose or a HgbA1c.
2. Patients with BMI ≥85th% to <95th% percentile for age and sex with ≥1 diabetes risk factors who are ≥10 years old or pubertal should be screened for type 2 diabetes with a fasting plasma glucose or a HgbA1c.
3. Patients with obesity, pre-diabetes, and type 2 diabetes should be treated with lifestyle and dietary interventions.
4. Patients diagnosed with type 2 diabetes should be initiated on metformin therapy as long as no contraindications exist.
5. Patients with HgbA1c in the 6 - 6.4% range or with continued impaired glucose tolerance after 6 months of lifestyle interventions may be started on metformin.
6. If fasting plasma glucose or HgbA1c places the patient in the diabetic range, perform recommended lab work to help rule out diabetic ketoacidosis (DKA) and type 1 diabetes.
7. Patients with DKA should be emergently referred to a facility with pediatric resources for DKA management.
8. Consider adding a GLP-1 agonist in patients with continued HgbA1c elevation and impaired glucose tolerance after starting metformin.
9. If considering insulin therapy, consult or refer to pediatric endocrinology.

Click the Care Process Model image above to download a PDF with working links or use the links below.

Please note that on the algorithm phrases in bolded, red text link to Intermountain Healthcare’s Pediatric Clinical Program's "Diagnosis and Treatment of Pediatric Type 2 Diabetes" and "A Primary Care Guide to Lifestyle and Weight Management for Children and Adolescents" care process models and provide further guidance on each topic.