Despite increased prevalence of obesity and type 2 diabetes in pediatric age groups over the past 2 decades, there is little evidence for effective treatment and prevention (Liu et al., 2022). Andes et al. (2020) reported that approximately one in five children ages 12 to 19 had prediabetes with significant associations among sociodemographic groups. Liu et al. (2022) assessed trends in prediabetes among U.S. youth between 1999 and 2018 using data from the National Health and Nutrition Examination Survey (NHANES) from 6,598 youths ages 12 to 19. Sociodemographic variables examined included: sex, age, race and ethnicity, parental education levels, income level, household food-security status, and body mass index. Blood samples were collected to diagnose prediabetes. Mean age of study participants was 15.5 years and 51.2% were male. Prevalence of prediabetes increased from 11.6% in 1999-2002 to 28.2% in 2015-2018 across all sociodemographic groupings. Increases among population groups were most pronounced for males and overweight and obese youth. There was increase in prediabetes from 18.2% to 40.4% in children classified as obese according to body mass indices. Although the study had some limitations related to study power, the results signal a call for action for pediatric nurses.

The increased prevalence of obesity and its associated increase in type 2 diabetes, prediabetes, and insulin resistance was first reported by Haemer et al. (2014). The comorbidities of severe obesity and prediabetes are well documented and include for obesity: hypertension, dyslipidemia, fatty liver disease, musculoskeletal disorders, cardiovascular disease, type 2 diabetes and its complications that include a significantly shortened life span fraught with severe chronic complications (Andes et al., 2020).

Although the U.S. Preventive Services Task Force et al. (2021) recently released recommendations for screening prediabetes and type 2 diabetes in adults, no such recommendations have been made for children (Liu et al., 2022). However, Haemer et al. (2014) detailed specific recommendations for screening for diabetes that pediatric nurses can easily include in their assessment portfolios based on the 2007 recommendations made by an expert committee (Barlow & Expert Committee, 2007). Components of this screening protocol include a BMI greater than or equal to 99th percentile for all children and adolescents and for children at 10 years of age or puberty with a BMI in the 85th to 95th percentiles with one or more risk factors. Risk factors to be assessed include family history of type 2 diabetes, high-risk race or ethnicity such as African American, Latino, Native American, Asian American, and Pacific Islander, signs of insulin resistance, maternal history of diabetes or gestational diabetes, and use of second-generation antipsychotic medications.

Pediatric nurses play a pivotal role in prevention of diabetes including but not limited to medication administration and monitoring, nutrition and exercise education, and behavioral health interventions and referrals (Haemer et al., 2014). Screening for diabetes should be part of routine assessment. Pediatric nurse leaders have a responsibility to call for and participate in additional research on the association of obesity and other risk factors to prediabetes, and to advocate for further practice recommendations.

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