Recognizing Children at Risk Given the serious complications of diabetes, which include heart disease, kidney damage, and blindness, early detection of diabetes in children is crucial. However, in children and adults, type 2 diabetes often causes mild or no symptoms, and many cases are thought to go undiagnosed. Pharmacists can improve the early detection of diabetes by recognizing risk factors in children and advising parents, when appropriate, to consult a physician about testing. ADA recommends a fasting plasma glucose test for overweight children who have any two of the following risk factors: 3 n A family history of type 2 diabetes. n Being a member of a racial or ethnic group that has increased risk. n Signs of insulin resistance or conditions associated with it. As in adults, type 2 diabetes in children appears to be preceded by pre-diabetes, a precursor stage marked by impaired glucose tolerance and insulin resistance. A recent study detected impaired glucose tolerance in 25% of obese children (4 to 10 years of age) and 21% of obese adolescents (11 to 18 years of age).5 The researchers diagnosed silent type 2 diabetes in 4% of the obese adolescents studied. In addition to being overweight or obese, children with insulin resistance or type 2 diabetes typically have a skin condition called acanthosis nigricans, in which the skin around the neck or in the armpits appears dark, thick, and velvety. In adolescent and teenage girls with insulin resistance, polycystic ovarian syndrome, which causes chronic anovulation and hyperandrogenism, is common. Affected girls often have acne and excess facial hair, in addition to experiencing irregular or absent menstrual periods.