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



The medical records of children in grades 1 through 5 enrolled in school-based health clinics in Kentucky public schools during the 2001–2002 academic years were eligible for review. Fayette County currently has 32 elementary schools supporting a community with a population of 270,000 individuals (Fayette County Public School System [FCPS], 2002). Fayette County consists of 81% non-Hispanic Caucasian, 13.5% African-American, and 5.5% Other (U.S. Census Bureau, 2009).

Health record data from four schools with 1,312 total student enrollment were extracted for this study. This represented 12% of the elementary school-age population in Fayette County (FCPS, 2002). It is a requirement that each school-based health clinic medical record includes a completed health history form (English or Spanish versions available) and be updated annually. State education guidelines recommend that elementary school-age children have their height and weight assessed annually as part of yearly school health screenings (Kentucky Department of Education, 2009). Due to the serendipitous finding of acanthosis nigricans on the neck of numerous students, the medical director of the four school-based clinics added acanthosis nigricans screening to the annual school health screening protocols at each elementary school. Student records that had height, weight, acanthosis nigricans documentation, and a completed heath history form on file were included in this study.

Study Design

A cross-sectional study of existing clinic medical records from the 2001–2002 academic year were used to evaluate the presence of risk factors associated with type 2 diabetes among elementary school-age children in grades 1 through 5 following four, schoolwide height/weight screenings. Data were used to determine the prevalence of risk factors associated with type 2 diabetes mellitus as described by the AAP/ADA screening criteria (see Figure 1).

Research Procedure

The University of Kentucky Medical Institutional Review Board and the Medical Director of the Fayette County, Kentucky's schoolbased health clinics, approved the study. Each school-wide height/weight screening was scheduled independently based on school schedule and availability of students. Prior to each of the school-wide screenings, school-based clinic nurses and nurse practitioners participated in a 30-minute education session that focused on the assessment of acanthosis nigricans as provided by a certified diabetes educator. Key areas of these training sessions included the detection and grading of acanthosis nigricans on the posterior area of the neck. Photos depicting the different degrees of acanthosis nigricans as it occurs in children of various ethnic groups were used during the training session. Descriptions of acanthosis nigricans severity similar to a screening tool developed by Burke et al. (1999) were also discussed.

The school nurse conducted height and weight measurements according to recommendations set by the County Board of Education and the local health department (Kentucky Department of Education, 2000). Heights were obtained with a stadiometer and measured in inches to the nearest one-fourth inch. Weight was obtained with a standard balance scale and measured in pounds to the nearest one-fourth pound. Students were screened for the presence of acanthosis nigricans on the back of the neck during the height/weight screening. All measurements obtained during the screening were recorded in each student's clinic medical record.

Absolute BMI was calculated for each student using the standard English measurement formula: weight (lb)/height (in)2 x 703 (CDC, 2011b). The BMI for each student was then plotted on gender-appropriate, BMI for-age percentiles chart to determine each child's BMI percentile, then placed in each child's clinic medical record, which was then reviewed by the clinic nurse or nurse practitioner. Students with a BMI between the 85th and 95th percentiles for age and gender were considered overweight, and students whose BMI exceeded the 95th percentile for age and gender were considered obese according to CDC guidelines (CDC, 2011b).

An existing diagnosis of diabetes in the student and the presence of a family history of diabetes were obtained by the clinic nurse from the health history form located in each student's clinic medical record. The health history form is completed by the parent at the beginning of each school year and identifies any current or previous health issues in the student as well as any family history of common chronic diseases. All health history forms are reviewed by the school nurse as part of the routine health screening/maintenance protocols for students enrolled in the school-based health clinics.