A Call to Replace Race- and Ethnicity-Based Screening with Health-Related Social Needs Evaluation When Assessing Risk of Type 2 Diabetes in Youth.

Youth-onset type 2 diabetes (T2D), an “awakening epidemic,” has doubled in prevalence in the past two decades and represents a growing threat to adolescent health equity [ [1] Perng W. Conway R. Mayer-Davis E. et al. Youth-onset type 2 diabetes: The epidemiology of an awakening epidemic. Diabetes Care. 2023; 46: 490-499 Crossref Scopus (1) Google Scholar ]. Compared to their white peers, youth from minoritized racioethnic backgrounds face a higher prevalence and steeper rise in incidence of T2D and a higher risk of severe complications in early adulthood [ [1] Perng W. Conway R. Mayer-Davis E. et al. Youth-onset type 2 diabetes: The epidemiology of an awakening epidemic. Diabetes Care. 2023; 46: 490-499 Crossref Scopus (1) Google Scholar ]. To facilitate early identification and treatment, the American Diabetes Association (ADA) and International Society for Pediatric and Adolescent Diabetes (ISPAD) T2D screening guidelines use race and ethnicity to risk-stratify children and adolescents [ [2] ElSayed N.A. Aleppo G. Aroda V.R. et al. 2. Classification and diagnosis of diabetes: Standards of care in diabetes-2023. Diabetes Care. 2023; 46: S19-S40 Crossref PubMed Scopus (96) Google Scholar , [3] Shah A.S. Zeitler P.S. Wong J. et al. ISPAD clinical practice consensus guidelines 2022: Type 2 diabetes in children and adolescents. Pediatr Diabetes. 2022; 23: 872-902 Crossref PubMed Scopus (13) Google Scholar ]. Based on the observed racioethnic disparities in T2D prevalence, the guidelines state that racial or ethnic identity as Black, Asian, Native American/Alaskan Native, Pacific Islander, or Latino, alone, is adequate justification to screen youth meeting developmental (age ≥10 years or pubertal) and body mass index (BMI) (≥85th percentile) criteria. Therefore, even in the absence of additional individual-level risk factors that could more directly indicate genetic or epigenetic risk (e.g., family history of T2D, maternal gestational diabetes) or clinical evidence (e.g., acanthosis nigricans), clinicians are encouraged to screen adolescents for T2D based solely on race and ethnicity.