Screening and Early Detection Strategies for Type 2 Diabetes in Obese Children: A Systematic Review

Abstract

Background: Type 2 diabetes mellitus (T2DM) has become a major pediatric health issue since the rising incidence of childhood obesity causes a marked increase in T2DM among children and adolescents. Early diagnosis and treatment are critical because T2DM in youngsters can be asymptomatic at first but can advance swiftly to severe consequences if not detected. Though there are known standards, best screening methods and diagnostic thresholds for T2DM in overweight youngsters continue to be controversial and call for a thorough analysis of current technologies.
Methodology: This systematic review followed PRISMA standards. To find studies published up to June 2025 that investigated screening or early detection approaches for T2DM in obese children and adolescents (aged 218 years), a thorough search was conducted across PubMed, Embase, Scopus, and Web of Science. Included were both observational and interventional studies reporting on screening techniques, diagnostic criteria, or early detection results. Two independent reviewers used validated instruments screened studies for eligibility, extracted data, and evaluated study quality.
Results: A total of nine studies were included, evaluating various screening strategies such as HbA1c, fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), and risk-based approaches. HbA1c demonstrated high sensitivity and specificity (up to 99% and 98.5%, respectively) for detecting T2DM and impaired glucose tolerance in obese children. The combination of FPG with fasting plasma insulin (FPI) improved diagnostic yield, while FPG alone was less sensitive. BMI-based screening was insufficient as a standalone tool; most pediatric T2DM cases occurred in children with obesity, but not all obese children developed diabetes. Prevalence of T2DM and impaired glucose tolerance among obese children ranged up to 27%, with over 75% of pediatric T2DM cases associated with obesity.
Conclusion: Screening and early detection of T2DM in overweight youngsters are most practically accomplished by multi-modal, risk-based methods combining biochemical markers and clinical risk variables. HbA1c and OGTT are the most tested and reliable instruments; nevertheless, their sensitivity is affected by variables including insulin resistance, age, and puberty. Alone, BMI is insufficient for screening, hence the importance of all-encompassing approaches.