Pediatric Diabetes Screening & Management Care Process Model

This care process model was developed to help guide the general practitioner on outpatient screening for diabetes and management of type 2 diabetes in patients within the University of Utah and Intermountain Healthcare systems. It was created by general pediatricians at the University of Utah in collaboration with Intermountain Health pediatric endocrinologists at Primary Children’s Hospital. 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. In accordance with the 2021 American Diabetes Standards of Care, the care process model reflects that screening should be performed on patients with only one type II diabetes risk factor rather than 2 in addition to being at least 10 years old or pubertal AND have BMI greater than or equal to 85th%. [American: 2021]

Adapted from a proposed algorithm in the Evaluation and Treatment of Prediabetes in Youth [Magge: 2020] and a Diagnosis and Treatment of Pediatric Type 2 Diabetes (Intermountain Healthcare) () care process model. Click the Care Process Model image above to download a PDF with working links or use the links below.

• Patients with BMI ≥85th percentile with ≥1 diabetes risk factors and age ≥10 years or pubertal should be screened for type 2 diabetes with a fasting plasma glucose or a HgbA1c.
• Patients with obesity, pre-diabetes, and type 2 diabetes should be treated with lifestyle and dietary intervention.
• Patients diagnosed with type 2 diabetes should be initiated on metformin therapy as long no contraindications exist.
• 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.
• 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.
• Patients with DKA should be emergently referred to a facility with pediatric resources for DKA management.
• Consider adding liraglutide in patients with continued HgbA1c elevation and impaired glucose tolerance after starting metformin.
• If considering insulin therapy, consult or refer to pediatric endocrinology.