13. Children and Adolescents: Standards of Medical Care in Diabetes−2020

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. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidencegrading system for ADA's clinical practice recommendations, please refer to the Standards ofCare Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. The management of diabetes in children and adolescents cannot simply be derived from care routinely provided to adults with diabetes. The epidemiology, pathophysiology, developmental considerations, and response to therapy in pediatric-onset diabetes are different from adult diabetes. There are also differences in recommended care for children and adolescents with type 1 as opposed to type 2 diabetes. This section first addresses care for children and adolescents with type 1 diabetes and next addresses care for children and adolescents with type 2 diabetes. Figure 13.1 provides guidance on managing new-onset diabetes in youth with overweight or obesity before type 1 or type 2 diabetes is diagnosed and so applies to all youth with overweight or obesity. Lastly, guidance is provided in this section on transition of care from pediatric to adult providers to ensure that the continuum of care is appropriate as the child with diabetes develops into adulthood. Due to the nature of clinical research in children, the recommendations for children and adolescents with diabetes are less likely to be based on clinical trial evidence. However, expert opinion and a review of available and relevant experimental data are summarized in the American Diabetes Association (ADA) position statements "Type 1 Diabetes in Children and Adolescents" (1) and "Evaluation and Management of Youth-Onset Type 2 Diabetes" (2). The ADA consensus report "Youth-Onset Type 2 Diabetes Consensus Report: Current Status, Challenges, and Priorities" (3) characterizes type 2 diabetes in children and evaluates treatment options but also discusses knowledge gaps and recruitment challenges in clinical and translational research in youth-onset type 2 diabetes. Monogenic diabetes (neonatal diabetes and maturity-onset diabetes in the young [MODY]), which often present in youth, are discussed in section 2 "Classification and Diagnosis of Diabetes" (

Lipid Biomarkers as Predictors of Diastolic Dysfunction in Diabetes with Poor Glycemic Control

“…Using sphygmomanometry, we found that systolic blood pressure (SBP) was 112.16 mmHg in girls and 119.16 mmHg in boys, whereas diastolic blood pressure (DBP) was 76.08 mmHg for the former, and 76.06 mmHg for the later ( Table 2 and Table S1). These data indicate that vascular pressure was not altered [19]. However, cardiac performance could have been affected.…”

“…Similarly, 86.7% of males showed poor glycemic control (HbA1c ≥ 7.5 mg/dL) [19]. Their HbA1c levels were 9.58% (8.98% in the last three years) and FBG was 127.0 mg/dL ( Table 1).…”

“…Both girls and boys presented a T1DM duration (and treatment) of 6.0 years. However, the insulin therapy they received may have not been appropriated for their level of glycemic control [19]. Uncontrolled hyperglycemia (glycated haemoglobin (HbA1c) ≥ 7.5%) was present in 85.4% of girls showed, with a mean HbA1c level of 10.12% in the last year (9.55% as mean for the previous three years) and their fasting blood glucose (FBG) was 138.0 mg/dL (Table 1).…”

The impact of the COVID-19 lockdown on disordered eating behaviors in youths with type 1 diabetes: Analysis of cross-sectional survey data.

“…The potential increased parental emphasis on the importance of diabetes control, along with the related pressure to engage in healthy eating behaviors and to take control of their weight, seems to be con rmed by the zBMI values (which were found to be lower than those measured in the latest diabetes visit) and by the HbA1c values remaining unchanged. It is worth noting that glycemic control-even though higher than the American Diabetes Association's recommended target value of 7.5% for good metabolic control [58]-is substantially analogous to population data in similar age groups [59,60].…”

“…In conclusion, our ndings suggest that, as recommended by international guidelines [12,58,73], continuous medical and psychological care is needed in order to periodically monitor physical and psychological conditions, especially during critical developmental phases, as teens age and/or face troubling circumstances such as those imposed by quarantine.…”