Presence of Type 2 Diabetes Risk Factors in Children

Leslie K. Scott, PhD, PNP-BC, CDE


Pediatr Nurs. 2013;39(4):190-196. 

In This Article

Abstract and Introduction


This study aimed to identify the prevalence of type 2 diabetes risk factors among elementary school-age children and determine eligibility for type 2 diabetes screening. A cross-sectional review of 971 school-based health clinic medical records of children in grades 1 through 5 was conducted. Relationships of risk factors associated with type 2 diabetes mellitus were examined to determine the prevalence of these risk factors in elementary school-age children. Screening guidelines for type 2 diabetes were applied to determine the prevalence of students meeting criteria for further screening. Almost 40% of the students had a body mass index (BMI) above the 85th percentile for age and gender. Forty-nine percent of the students belonged to a high-risk ethnic group. Acanthosis nigricans, an indicator of insulin resistance, was identified in nearly 27% of the student records. Forty-eight percent of the records identified the student as having a family history of diabetes. Significant correlations were found between the presence of acanthosis nigricans, high BMI, and a family history of diabetes. According to screening guidelines for type 2 diabetes in children, 39.3% of the elementary school children 10 years of age and older were eligible for type 2 diabetes screening. Almost 40% of children younger than 10 years of age had risk factors associated with screening criteria. These findings support the need for early detection of high-risk children and intervention strategies to decrease modifiable risk factors in elementary school-age children. The school nurse is in a pivotal role of identifying such at-risk students during annual, routine health screening practices.


Diabetes mellitus is a very serious and costly disease. Unfortunately, children are not immune to this health problem. There are 215,000 children younger than 20 years of age in the United States with diabetes (Centers for Disease Control and Prevention [CDC], 2011a); two million children 12 to 19 years of age have pre-diabetes (CDC, 2008b). One in three children born in 2000 will develop diabetes in their lifetime (CDC, 2009). Diabetes is the sixth leading cause of death, the leading cause of blindness, and the leading cause of end-stage renal disease, and is responsible for numerous individuals with nerve disease/amputations and cardiovascular disease (American Diabetes Association [ADA], 2010). Direct and indirect costs of diabetes and its related complications in the U.S. total $174 billion annually (CDC, 2008b). His torically, most children with diabetes develop type 1 diabetes; however, since 1996, there has been an increase in the incidence of type 2 diabetes in children, particularly in high-risk ethnic groups (for example, African-American, Hispanic, Asian-American, Pacific Islander, and American Indian). Identifying children at high risk for the development of type 2 diabetes is important because it has been well documented in adults that the onset of type 2 diabetes can be prevented or at least delayed (Bo-Abbas et al., 2002; Knowler et al., 2002).