Categories Care Process Models , Reprinted from Medical Home Portal

Pediatric Type 2 Diabetes Screening & Management Care Process Model

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Published: Posted on
DOI: 10.26075/d-fz8s-5wxf

This care process model helps 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.

Key Points

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.

Pediatric Type 2 Diabetes Care Process Model

Click the Care Process Model image above to enlarge. 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.

Lifestyle and Weight Management for Children and Adolescents (Intermountain Healthcare) care process model

Diagnosis and Treatment of Pediatric Type 2 Diabetes (Intermountain Healthcare) care process model

Referrals

  • Pediatric Endocrinology 
  • Diabetes Clinics 

Tools

Pediatric Diabetes Algorithm

Page Bibliography

American Diabetes Association. (2021). 13. Children and Adolescents: Standards of Medical Care in Diabetes-2021. Diabetes Care, 44(Suppl 1), S180–S199. https://doi.org/10.2337/dc21-S013

Hampl, S. E., Hassink, S. G., Skinner, A. C., Armstrong, S. C., Barlow, S. E., Bolling, C. F., Avila Edwards, K. C., Eneli, I., Hamre, R., Joseph, M. M., Lunsford, D., Mendonca, E., Michalsky, M. P., Mirza, N., Ochoa, E. R., Sharifi, M., Staiano, A. E., Weedn, A. E., Flinn, S. K., … Okechukwu, K. (2023). Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics, 151(2), e2022060640. https://doi.org/10.1542/peds.2022-060640

Article History

The Medical Home Portal last published this article in June 2023. Topical Reviews in Pediatrics (TRIP) reprinted it in November 2024. The Medical Home Portal, retired in July 2024, provided diagnosis and management information for pediatric conditions, guidance for immediate steps after a positive newborn screen result, and in-depth family education to improve outcomes for children with complex medical care needs.

The full archive can be found at the Medical Home Portal Archive. 

Topical Reviews in Pediatrics (TRIP) includes archival and updated content from the Medical Home Portal and features new, contemporary topics in pediatrics.  

Initial publication: December 2021; last update/revision: June 2023

  • 2023 revision: Jose Morales Moreno, MDA, Carole H. Stipelman, MD, MPHA, Allison Smego, MDA
  • 2022 revision: Jose Morales Moreno, MDA, Carole H. Stipelman, MD, MPHA, Allison Smego, MDA
  • 2021 revision: Jose Morales Moreno, MDA, Carole H. Stipelman, MD, MPHA, Allison Smego, MDA

AAuthor; CAContributing Author; SASenior Author; RReviewer

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Jose Morales Moreno, MD

Dr. Morales Moreno’s career as a physician, educator, and academician began in 2013 at the University of Nebraska where he completed his undergraduate training. Here, he received a 4 year National Hispanic Merit Scholarship and obtained his BA in biology. He completed his medical training at the University of Nebraska Medical Center in 2017 and his pediatric residency at the University of St. Louis, Cardinal Glennon Children’s Hospital in 2020. Currently, he is a general pediatrician working in the University of Utah outpatient pediatric clinics, including the South Main Pediatric Clinic, University Pediatric Clinic, Sugarhouse Pediatric Clinic, as well as the well-baby nursery.

Dr. Morales Moreno’s interests include resident education, curriculum development, quality improvement, and working with Salt Lake City’s underserved population.

No conflicts of interest to report

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Rachel Tanz, MD

Dr. Tanz completed her medical degree at Chicago Medical School at Rosalind Franklin University. She then completed her residency at Lurie Children’s Hospital at Northwestern University in Chicago. She worked in private practice for 3 years and is now an Assistant Professor of Pediatrics in the Division of General Pediatrics at the University of Utah. Dr. Tanz is board-certified in Pediatrics.

No conflicts of interest to report

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Carole H. Stipelman, MD, MPH

Carole Stipelman, MD, MPH, is a Professor in the Division of General Pediatrics at the University of Utah School of Medicine. She is the Medical Director of University Pediatric Clinic and the pediatric clinic at Sugar House Health Center, where she directs the provision of pediatric primary care to infants and children for 28,000 clinic visits annually by 19 faculty and 25 residents, with an emphasis on care for children with medical complexity, innovative quality improvement research, and clinical education initiatives.

Dr. Stipelman serves as the provider informaticist for the Women and Children’s Service Line of University of Utah Health, including pediatrics, obstetrics and gynecology, neonatology, and the newborn nursery. In this role, she leads and facilitates diverse and innovative projects in electronic health record optimization and data-driven clinical care, such as the pediatric well-child visit Smart Forms and Pediatric Data Mart of the University Enterprise Data Warehouse.

Dr. Stipelman’s advocacy activities in access to care have included service on the national Children's Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program Expert Panel of the United States government Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare and Medicaid Services (CMS).

Dr. Stipelman was the Principal Investigator for Community Access to Child Health (CATCH) and CHIPRA grants that led to the formation of Take Care Utah, a nonprofit that employs 90 insurance navigators across Utah to connect patients to health care. For this work, she was awarded the F. Edwards Rushton Award from the American Academy of Pediatrics.

As CATCH District Facilitator for the American Academy of Pediatrics, Dr. Stipelman provides advocacy and grant-writing mentorship for pediatricians throughout 13 states from Hawaii to Wyoming and 2 Canadian provinces.

No conflicts of interest to declare

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