Pediatric Diabetes Screening & Management Care Process Model
University of Utah/Intermountain Healthcare
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.
Authors & Reviewers
Initial publication: December 2021; last update/revision: April 2022
American Diabetes Association Professional Practice Committee. 13. Children and Adolescents: Standards of Medical Care in Diabetes-2021. Diabetes Care.
2021;44(Suppl 1):S180-S199.
PubMed abstract The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice
recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools
to evaluate quality of care.
Magge SN, Silverstein J, Elder D, Nadeau K, Hannon TS. Evaluation and Treatment of Prediabetes in Youth. J Pediatr.
2020;219:11-22.
PubMed abstract / Full Text