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Ada Pediatric Diabetes Guidelines

Diabetes Prevention And Control Program

Diabetes Prevention And Control Program

These guidelines were developed in conjunction with multiple primary and specialty care physicians, diabetes educators, and representatives of major managed care plans in the State of Nebraska and were based on the American Diabetes Association's (ADA) Standards of Care. On this page are links to the recommendations in the Guidelines sorted by topics, as well as links to printable versions of the Guidelines, a link to a one-sheet quick reference of the Guidelines' recommendations, to the individual links to the charts in the Guidelines, and other information.Authors: The authors of the Nebraska Diabetes Consensus Guidelines are dedicated individuals and organizations who are committed to improving diabetes care in Nebraska. View the list of authors. Printable Guidelines: In addition to the clickable links on this page, Our Office offers the Consensus Guidelines in two other forms: Continue reading >>

Aap Publishes First Guidelines To Manage Type 2 Diabetes In Children

Aap Publishes First Guidelines To Manage Type 2 Diabetes In Children

​​​​​​​​Over the past three decades, the prevalence of childhood obesity has increased dramatically in North America, ushering a host of health problems, including type 2 diabetes, that formerly afflicted only adults. To assist physicians in caring for this population, the American Academy of Pediatrics has issued a set of guidelines to provide evidence-based recommendations on managing type 2 diabetes in children ages 10 to 18. The guidelines are the first of their kind for this age group. The guidelines were written in consultation with the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics. The guidelines, and an accompanying technical report, are published in the February 2013 issue of Pediatrics and were released online Jan. 28. The guidelines recommend beginning treatment with insulin at the time of diagnosis in all patients who are ketotic or in ketoacidosis, markedly hyperglycemic, or in whom the distinction between type 1 and type 2 diabetes is not clear. In all others, metformin is recommended as first-line therapy, along with a lifestyle modification program including nutrition and physical activity. The guidelines include recommendations for monitoring pediatric patients’ glycemic control, implementing insulin regimens, and diet and physical activity recommendations. The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. (www.aap.org) Continue reading >>

Management Of Type 1 Diabetes Mellitus In Children And Adolescents

Management Of Type 1 Diabetes Mellitus In Children And Adolescents

INTRODUCTION Type 1 diabetes mellitus, one of the most common chronic diseases in childhood, is caused by insulin deficiency resulting from the destruction of insulin-producing pancreatic beta cells. (See "Pathogenesis of type 1 diabetes mellitus".) There are unique challenges in caring for children and adolescents with diabetes that differentiate pediatric from adult care. These include the obvious differences in the size of the patients, developmental issues such as the unpredictability of a toddler's dietary intake and activity level and inability to communicate symptoms of hypoglycemia, and medical issues such as the increased risk of hypoglycemia and diabetic ketoacidosis (DKA). Because of these considerations, the management of a child with type 1 diabetes must take into account the age and developmental maturity of the child. Although most children with type 1 diabetes present with the classic signs and symptoms of hyperglycemia without accompanying acidosis, approximately 30 percent of children in the United States present with DKA [1,2]. The management of these patients is discussed in detail separately. (See "Treatment and complications of diabetic ketoacidosis in children and adolescents".) The management of the child or adolescent with type 1 diabetes, who either did not present with ketoacidosis or who has recovered from ketoacidosis, will be reviewed here. The term parent will be used throughout the discussion, with recognition that the primary caregiver may not be a parent. Other aspects of childhood-onset type 1 diabetes are discussed in separate topic reviews: Continue reading >>

Ada Screening Guideline Change Could Under-diagnose T2dm In Children

Ada Screening Guideline Change Could Under-diagnose T2dm In Children

Home / Conditions / Prediabetes / ADA Screening Guideline Change Could Under-diagnose T2DM in Children ADA Screening Guideline Change Could Under-diagnose T2DM in Children Lower test performance of HbA1c in children raises concern. A new study conducted by the University of Michigan is warning that recent changes to the guidelines by the American Diabetes Association (ADA) may lead to missed diagnoses of type 2 diabetes in children. The ADA now recommends using HbA1c screening tests rather than glucose tests to identify children and adults with diabetes and pre-diabetes. This change has been very controversial because of lower test performance of HbA1c in children compared with adults. Lead author Joyce Lee, M.D., and colleagues found that 84% of physicians would switch from glucose screening tests to now using HbA1c screening tests in order to comply with the new ADA guidelines. Lee commented, "This potential for increased uptake of HbA1c could lead to missed cases of prediabetes and diabetes in children, and increased costs. A number of studies have shown that HbA1c has lower test performance in pediatric compared with adult populations, and as a result, increased uptake of HbA1c alone or in combination with non-fasting tests could lead to missed diagnoses of type 2 diabetes in the pediatric population. Also, a recent analysis of screening strategies found that HbA1c is much less cost-effective than other screening tests, which would result in higher overall costs for screening. Greater awareness of the 2010 ADA guidelines will likely lead to increased uptake of HbA1c and a shift to use of non-fasting tests to screen for adolescents with type 2 diabetes. This may have implications for detection rates for diabetes and overall costs of screening." The study was based o Continue reading >>

Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus

*Pediatric Endocrinology Clinical Fellow, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN. †Assistant Professor of Pediatrics, Assistant Professor of Pathology, Microbiology, and Immunology, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN. ‡Assistant Professor of Pediatrics, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN. Drs Gregory and Moore have disclosed no financial relationships relevant to this article. Dr Simmons has disclosed she has a research grant from Alexion Pharmaceuticals, Inc. This commentary does not contain discussion of unapproved/investigative use of a commercial product/device. Abbreviations ADA: American Diabetes Association DKA: diabetic ketoacidosis HbA1c: glycosylated hemoglobin I:C ratio: insulin-to-carbohydrate ratio IV: intravenous TDD: total daily dose T1DM: type 1 diabetes mellitus T2DM: type 2 diabetes mellitus Practice Gaps All children with type 1 diabetes mellitus (T1DM) should have their blood sugar managed with basal-bolus insulin treatment by either multiple daily injections or an insulin pump. All children with T1DM should have access to a pediatric endocrinologist with a diabetes management team with resources to support patients and families. All children with T1DM should be monitored for symptoms and/or screened for commonly associated conditions such as thyroid and celiac disease. Objectives After completing this article, readers should be able to: Recognize the presenting signs and symptoms of type 1 diabetes mellitus (T1DM). Know the key principles of effective diabetes self-management and the diabetes care team’s role in Continue reading >>

Treatment Of Type 1 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Treatment Of Type 1 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Abstract Description: The American Diabetes Association (ADA) annually updates Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. Methods: For the 2017 Standards of Care, the ADA Professional Practice Committee did MEDLINE searches from 1 January 2016 to November 2016 to add, clarify, or revise recommendations on the basis of new evidence. The committee rated the recommendations as A, B, or C, depending on the quality of evidence, or E for expert consensus or clinical experience. The Standards of Care were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions. Recommendation: This synopsis focuses on recommendations from the 2017 Standards of Care about monitoring and pharmacologic approaches to glycemic management for type 1 diabetes. The American Diabetes Association (ADA) first released its practice guidelines for health professionals in 1989. The Standards of Medical Care in Diabetes have since provided an extensive set of evidence-based recommendations that are updated annually for the diagnosis and management of patients with diabetes. The 2017 Standards of Care cover all aspects of patient care (1); this guideline synopsis focuses on monitoring and pharmacologic approaches for patients with type 1 diabetes. Guideline Development and Evidence Grading Monitoring Glycemia in Type 1 Diabetes Glycemic Goals: Recommendations Pharmacologic Therapy for Type 1 Diabetes: Recommendations Continue reading >>

Ispad Clinical Practice Consensus Guidelines 2014

Ispad Clinical Practice Consensus Guidelines 2014

Editor in Chief: Mark A. Sperling, Pittsburgh, USA. Guest Editors: Carlo Acerini, Maria E Craig, Carine de Beaufort, David M Maahs and Ragnar Hanas. Introduction Carlo Acerini, Maria E Craig, Carine de Beaufort, David M Maahs and Ragnar Hanas. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 1–3. Uploaded: 2. Sept 2014 Download Introduction Chapter 1: Definition, epidemiology, diagnosis and classification Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 4–17. Uploaded: 2. Sept 2014 Download Chapter 1 Chapter 2: Phases of Type 1 Diabetes Couper JJ, Haller MJ, Ziegler A-G, KnipM, Ludvigsson J, Craig ME. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 18–25. Download Chapter 2 Chapter 3: Type 2 diabetes Zeitler P, Fu J, Tandon N, Nadeau K, Urakami T, Bartlett T, Maahs D. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 26-46. Uploaded: 2. Sept 2014 Download Chapter 3 Chapter 4: The Diagnosis and Management of Monogenic diabetes Rubio-Cabezas O, Hattersley AT, Njølstad PR, Mlynarski W, Ellard S,White N, Chi DV, Craig ME. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 47-64. Uploaded: 2. Sept 2014 Download Chapter 4 Chapter 5: Management of cystic fibrosis-related diabetes Moran A, Pillay K, Becker DJ, Acerini CL. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 65-76. Uploaded: 2. Sept 2014 Download Chapter 5 Chapter 6: Diabetes education Lange K, Swift P, Pankowska E, Danne T. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 77-85. Uploaded: 2. Sept 2014 Download Chapter 6 Chapter 7: The delivery of ambulatory diabetes care Pihoker C, Forsander G, Fantahun B, Virmani A, Luo X, Hallman M, Wolfsdorf J, Maahs DM. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 86-101. Up Continue reading >>

Ada Type 1 Diabetes Position Statement Changes A1c Recommendations For Pediatric Patients

Ada Type 1 Diabetes Position Statement Changes A1c Recommendations For Pediatric Patients

News Release BOSTON – (July 18, 2014) – The American Diabetes Association released a position statement outlining care protocols for persons with type 1 diabetes. The guidelines were officially released at the 2014 ADA Annual Conference in San Francisco this past June. The position statement covers care recommendations for all age ranges, from early childhood to adulthood and into the geriatric years. Lori Laffel, M.D., M.P.H., Chief of the Pediatric, Adolescent and Young Adult Programs and Senior Investigator in the Section on Genetics and Epidemiology at Joslin. This position statement arose from the type 1 Diabetes Sourcebook which was produced by the American Diabetes Association and the JDRF, and received funding from the Helmsley Charitable Trust. Over half a dozen authors from the Joslin Diabetes Center contributed to the Sourcebook and the position statement. Lori Laffel, M.D., M.P.H., Chief of the Pediatric, Adolescent and Young Adult Programs and Senior Investigator in the Section on Genetics and Epidemiology, was a lead author on guidelines. The new position statement is exclusively focused on those with type 1 diabetes rather than providing care recommendations for people with diabetes in general. “Previously, guidelines for the care of persons with diabetes didn’t necessarily distinguish between patients with type 1 and type 2 diabetes,” says Dr. Laffel. She says that the statement’s streamlined presentation should make for an easier read for busy care providers. “Often the guidelines that come out every January from the Diabetes Association are very long. They compile an entire journal,” says Dr. Laffel. “This particular guideline can be digested in a brief reading.” One of the biggest changes in care recommendations relates to A1C leve Continue reading >>

Diabetes Mellitus: Screening And Diagnosis

Diabetes Mellitus: Screening And Diagnosis

Diabetes mellitus is one of the most common diagnoses made by family physicians. Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure, and vascular and heart disease. Screening patients before signs and symptoms develop leads to earlier diagnosis and treatment, but may not reduce rates of end-organ damage. Randomized trials show that screening for type 2 diabetes does not reduce mortality after 10 years, although some data suggest mortality benefits after 23 to 30 years. Lifestyle and pharmacologic interventions decrease progression to diabetes in patients with impaired fasting glucose or impaired glucose tolerance. Screening for type 1 diabetes is not recommended. The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and type 2 diabetes in adults 40 to 70 years of age who are overweight or obese, and repeating testing every three years if results are normal. Individuals at higher risk should be considered for earlier and more frequent screening. The American Diabetes Association recommends screening for type 2 diabetes annually in patients 45 years and older, or in patients younger than 45 years with major risk factors. The diagnosis can be made with a fasting plasma glucose level of 126 mg per dL or greater; an A1C level of 6.5% or greater; a random plasma glucose level of 200 mg per dL or greater; or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg per dL or greater. Results should be confirmed with repeat testing on a subsequent day; however, a single random plasma glucose level of 200 mg per dL or greater with typical signs and symptoms of hyperglycemia likely indicates diabetes. Additional testing to determine the etiology of diabetes is not routinely recommended. Clinical r Continue reading >>

New Diabetes Guidelines Fail To Guide

New Diabetes Guidelines Fail To Guide

2018 ADA Standards of Care Incorporate CV Risk At the beginning of each year, the American Diabetes Association (ADA) releases their new standards of care. In their 2018 Standards of Medical Care in Diabetes,[ 1 ] the real headline is how they have incorporated the cardiovascular (CV) outcome trials data[ 2 , 3 , 4 ] into the guidelines. To summarize, these standards integrate a person's known CV disease status at step two in the treatment algorithm. The first-line therapy for type 2 diabetes is still lifestyle and metformin, but when you go to that second step of adding second-line therapythe dual-therapy stepthe standards of care divide the world into people who have atherosclerotic CV disease and those who do not. Those who do not have CV disease have a whole world of choice in terms of a second-line agent, but for those who have CV disease, the ADA recommends adding an agent that has been shown to have CV disease benefit, or to reduce CV mortality, or both. The guidelines discuss drugs that improve CV outcomes and reduce mortality, and they include empagliflozin and liraglutide as two agents that do that. Then they describe agents that are known to reduce CV events; canagliflozin is listed as the agent that does that. In that second step, the ADA recommends that practitioners choose an agent that has CV benefits for patients with known CV disease. This is also included in the treatment algorithm figure, which has been changed from past years. The figure itself does not actually list the medications. Rather, it refers the reader back to a table, Table 8.1, which lists all of the medications for the treatment of diabetes and a whole bunch of characteristics about them. The table has 11 columns and eight rows. That is the basic guidance for a practitioner when choosin Continue reading >>

Ada Diabetes Management Guidelines For Children And Adolescents | Ndei

Ada Diabetes Management Guidelines For Children And Adolescents | Ndei

A lower A1C target (<7.0%) is reasonable if it can be achieved without excessive hypoglycemia Plasma glucose before meals (preprandial) Glucose goals should be modified in children with frequent hypoglycemiaor hypoglycemia unawareness If the child is taking basal-bolus therapy, measure postprandial glucose when there is a discrepancy between preprandial glucose values and A1C levels, and to assess preprandial insulin doses Managing Microvascular Complications in Children and Adolescents With Type 1 Diabetes Annual albuminuria screen with a random spot urine sample for ACR with 5-yr diabetes diabetes duration Measure eGFR at initial evaluation and then based on age, diabetes duration, and treatment ACEI* titrated to normalization of albumin excretion if elevated ACR (>30 mg/g) confirmed with 2 of 3 urine samples Obtain samples over 6-month interval after efforts to improve glycemic control and normalize BP Initial dilated and comprehensive eye exam at age 10 yrs or post-puberty onset (whichever occurs first) in children with diabetes duration of 3-5 years Consider annual comprehensive foot exam at age 10 yrs or post-puberty onset (whichever occurs first) in children with diabetes duration of 3-5 years *ACEIs are not approved by the U.S. Food and Drug Administration (FDA) for treatment of nephropathy. Not all ACEIs are indicated for use in children/adolescents by the FDA. Refer to full prescribing information for indications and uses in pediatric populations. Managing High Blood Pressure in Children and Adolescents With Type 1 Diabetes High-normal BP* or hypertension: confirm BP on 3 separate days Lifestyle changes (diet & physical activity) aimed at weight control If target BP is not achieved within 3-6 months, initiate pharmacologic therapy Initial pharmacologic therap Continue reading >>

New Ada Position Statement: Lower Target A1c For Type 1 Diabetes

New Ada Position Statement: Lower Target A1c For Type 1 Diabetes

During the American Diabetes Association (ADA) 74th Scientific Sessions, held at the Moscone Center in San Francisco, June 13-17, 2014, David Maahs, MD, a pediatric endocrinologist at the Barbara David Center for Childhood Diabetes, Children’s Hospital Colorado, and the University of Colorado Denver, moderated a panel discussion about the ADA’s position statement on its recommendation to lower its target blood glucose levels for children with Type 1 Diabetes (T1D). Panel members: Anne Peters, MD, FACP, Professor, Keck School of Medicine, University of Southern California, Los Angeles, CA Lori Laffel, MD, Chief, Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center and Associate Professor of Pediatrics, Harvard Medical School, Boston, MA Sue Kirkman, MD, Professor of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, SC Jane L. Chiang, MD, Senior Vice President, Medical and Community Affairs, American Diabetes Association, Alexandria, VA Identify Type 1 Diabetes Treatment Needs “This process didn’t actually begin with wanting to change a pediatric target,” rather “the interest was to create a separate position statement for the treatment of type 1 diabetes, because type 1 and type 2 diabetes are not the same disease,” stated Dr. Peters. The ADA’s position statement evolved from the creation of the Type 1 Diabetes Sourcebook, which was written by the panel members and many other authors. Dr. Peters explained the goal of the position statement is to cover the needs of people of all ages with T1D. She pointed out that “we don’t even know how many people have T1D” because many patients receive treatment through a primary care provider. Dr. Peters broadly estimated the number to be “on the ord Continue reading >>

M A N A G E M E N T A N D T R E A T M E N T O F

M A N A G E M E N T A N D T R E A T M E N T O F

This care process model (CPM) was developed by Intermountain Healthcare’s Pediatric Clinical Specialties Program. It provides guidance for identifying and managing type 1 diabetes in children, educating and supporting patients and their families in every phase of development and treatment, and preparing our pediatric patients to transition successfully to adulthood and adult diabetes self-management. This CPM is based on guidelines from the American Diabetes Association (ADA), particularly the 2014 position statement Type 1 Diabetes Through the Life Span, as well as the opinion of local clinical experts in pediatric diabetes.ADA1,CHI Pediatric Type 1 Diabetes C a r e P r o c e s s M o d e l F E B R U A R Y 2 0 1 7 2 0 17 U p d a t e Why Focus on PEDIATRIC TYPE 1 DIABETES? Diabetes in childhood carries an enormous burden for patients and their families and represents significant cost to our healthcare system. In 2008, Intermountain Healthcare published the first CPM on the management of pediatric diabetes with the overall goal of helping providers deliver the best clinical care in a consistent and integrated way. What’s new: • Separate CPMs for type 1 and type 2 pediatric diabetes to promote more- accurate diagnosis and more-focused education and treatment. • Updated recommendations for diagnostic testing, blood glucose control, and follow-up care specifically related to pediatric type 1 diabetes. • A more comprehensive view of treatment for pediatric type 1 diabetes — one that emphasizes psychosocial wellness for patient and family and lays a foundation for better health over the lifespan. • Information and tools to support pediatric type 1 diabetes care by nonspecialist providers — important for coping with the ongoin Continue reading >>

Clinical Practice Guidelines Clinical Guidelines For The Management Of Type 1 Diabetes In Children In Saudi Arabia Endorsed By The Saudi Society Of Endocrinology And Metabolism, (ssem)

Clinical Practice Guidelines Clinical Guidelines For The Management Of Type 1 Diabetes In Children In Saudi Arabia Endorsed By The Saudi Society Of Endocrinology And Metabolism, (ssem)

Abstract Several guidelines have been set by the American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD); however, there are no specific guidelines for our region. The following are the clinical management guidelines that were developed and are endorsed by the Saudi Society of Endocrinology and Metabolism (SSEM) for assisting patients and providers in choosing appropriate health care plans. While these guidelines are useful aids that help providers to determine appropriate practices for children with diabetes, they are not meant to replace the clinical judgment of the individual provider or to establish a standard of care. This article covers several insulin therapy regimens in children with diabetes in Saudi Arabia, including the management of acute complications, sick day management and follow-ups. Copyright © 2014 King Faisal Specialist Hospital & Research Centre (General Organization), Saudi Arabia. Production and hosting by Elsevier B.V. Continue reading >>

Outpatient Management Of Pediatric Type 1 Diabetes

Outpatient Management Of Pediatric Type 1 Diabetes

Outpatient Management of Pediatric Type 1 Diabetes 1Pediatric Diabetes and Endocrinology, Health Sciences Center and Harold Hamm Diabetes Center, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma 1Pediatric Diabetes and Endocrinology, Health Sciences Center and Harold Hamm Diabetes Center, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma 2Department of Endocrinology and Diabetes, Children's National Medical Center, Washington, District of Columbia Copyright 2015 Pediatric Pharmacy Advocacy Group This article has been cited by other articles in PMC. The incidence of both type 1 and type 2 diabetes (T1DM and T2DM) continues to rise within the pediatric population. However, T1DM remains the most prevalent form diagnosed in children. It is critical that health-care professionals understand the types of diabetes diagnosed in pediatrics, especially the distinguishing features between T1DM and T2DM, to ensure proper treatment. Similar to all individuals with T1DM, lifelong administration of exogenous insulin is necessary for survival. However, children have very distinct needs and challenges compared to those in the adult diabetes population. Accordingly, treatment, goals, and age-appropriate requirements must be individually addressed. The main objectives for the treatment of pediatric T1DM include maintaining glucose levels as close to normal as possible, avoiding acute complications, and preventing long-term complications. In addition, unique to pediatrics, facilitating normal growth and development is important to comprehensive care. To achieve these goals, a careful balance of insulin therapy, medical nutrition therapy, and exercise or activity is necessary. Pharmacological treatment options consist of various insulin products aimed Continue reading >>

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