diabetestalk.net

Pediatric Diabetes Screening Guidelines

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 >>

Type 1 Diabetes In Children And Adolescents

Type 1 Diabetes In Children And Adolescents

Chapter Headings Introduction Hypoglycemia Immunization Key Messages Suspicion of diabetes in a child should lead to immediate confirmation of the diagnosis and initiation of treatment to reduce the likelihood of diabetic ketoacidosis (DKA). Management of pediatric DKA differs from DKA in adults because of the increased risk for cerebral edema. Pediatric protocols should be used. Children should be referred for diabetes education, ongoing care and psychosocial support to a diabetes team with pediatric expertise. Note: Unless otherwise specified, the term “child” or “children” is used for individuals 0 to 18 years of age, and the term “adolescent” for those 13 to 18 years of age. Introduction Diabetes mellitus is the most common endocrine disease and one of the most common chronic conditions in children. Type 2 diabetes and other types of diabetes, including genetic defects of beta cell function, such as maturity-onset diabetes of the young, are being increasingly recognized in children and should be considered when clinical presentation is atypical for type 1 diabetes. This section addresses those areas of type 1 diabetes management that are specific to children. Education Children with new-onset type 1 diabetes and their families require intensive diabetes education by an interdisciplinary pediatric diabetes healthcare (DHC) team to provide them with the necessary skills and knowledge to manage this disease. The complex physical, developmental and emotional needs of children and their families necessitate specialized care to ensure the best long-term outcomes (1,2). Education topics must include insulin action and administration, dosage adjustment, blood glucose (BG) and ketone testing, sick-day management and prevention of diabetic ketoacidosis (DKA), nutr Continue reading >>

My Site - Chapter 35: Type 2 Diabetes In Children And Adolescents

My Site - Chapter 35: Type 2 Diabetes In Children And Adolescents

If the decision is made to use an oral antihyperglycemic agent, metformin should be used over glimepiride [Grade D, Consensus]. Metformin may be used at diagnosis in those children presenting with A1C >7.0% [Grade B, Level 2 (4) ]. Children with type 2 diabetes should be screened annually for microvascular complications (nephropathy, neuropathy, retinopathy) beginning at diagnosis of diabetes [Grade D, Level 4 (6) ]. Children with type 2 diabetes should be screened for microalbuminuria with a first morning urine ACR (preferred) [Grade B, Level 2 (7) ] or a random ACR [Grade D, Consensus]. Abnormal results should be confirmed [Grade B, Level 2 (8) ] at least 1 month later with a first morning ACR and, if abnormal, followed by timed, overnight urine collection for albumin excretion rate [Grade D, Consensus]. Microalbuminuria [ACR > 2.5 mg/mmol (9) ] should not be diagnosed in adolescents unless it is persistent as demonstrated by 2 consecutive first morning ACR or timed collections obtained at 3- to 4-month intervals over a 6- to 12-month period [Grade D, Consensus]. Those with persistent albuminuria should be referred to a pediatric nephrologist for assessment of etiology and treatment [Grade D, Level 4 (10) ]. Children with type 2 diabetes should have a fasting lipid profile measured at diagnosis of diabetes and every 13 years thereafter, as clinically indicated [Grade D, Consensus]. Children with type 2 diabetes should be screened for hypertension beginning at diagnosis of diabetes and at every diabetes-related clinical encounter thereafter (at least biannually) [Grade D, Consensus]. Children with type 2 diabetes should be screened at diagnosis for comorbid conditions associated with insulin resistance, including NAFLD [Grade D, Level 4 (1,11) ] and PCOS in pubertal f Continue reading >>

Remote Screening For Pediatric Diabetes Gets Closer

Remote Screening For Pediatric Diabetes Gets Closer

For Professionals Research Updates Type 2 Diabetes Remote Screening for Pediatric Diabetes Gets Closer Researchers sought to determine if the use of a computerized support system would allow for improved identification of pediatric patients at high risk for prediabetes and type 2 diabetes, and its implications to initiate earlier treatment. With Tamara S. Hannon, MD, MS, and Elena Christofides, MD Given the rising prevalence of diabetes in the pediatric population, the value of a remote screening method to foster an earlier, more consistent diagnosis, was pursued with the aim of improving clinical outcomes. Tamara S. Hannon, MD, MS, associate professor of pediatrics at Indiana University School of Medicine in Indianapolis, Indiana, and her colleagues, sought to employ the Child Health Improvement Through Computer Automation (CHICA), a computerized clinical decision support system, to decrease screening barriers and improve rates of diagnosis and follow-up for prediabetes and type 2 diabetes (T2D) in children;1 the study was published in JAMA Pediatrics . The findings indicated that the proportion of youths meeting the outcomes criteria for T2Dbody mass index (BMI) and at least 2 other risk factors was an astonishing 41.3%.1 Based on the authors literature review, they had expected greater than 20% of their patients 10 years or older would have a BMI at or above the 85thpercentile and at least 2 risk factors for T2D.2 While the CHICA analysis did not increase the proportion of youths identified with diabetes risk factors, it more than quadrupled the rate of screenings and demonstrated greater compliance in follow-up visits. Can Digital Tools Reduce Barriers to Screening With Better Rates of Diagnosis? Computer decision support is going to be utilized for screening in th Continue reading >>

Type 2 Diabetes Mellitus In Children And Adolescents

Type 2 Diabetes Mellitus In Children And Adolescents

Background The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is increasing, mirroring the epidemic of paediatric obesity. Early-onset T2DM is associated with poor long-term outcomes. Objective/s In this article, we describe the growing problem of early-onset T2DM in Australia, explore the difference between early-onset and adult-onset T2DM, and review the management of T2DM in children and adolescents. Discussion T2DM is difficult to differentiate from the more common type 1 diabetes mellitus (T1DM) in the paediatric population. Risk factors for T2DM include obesity, ethnicity and family history, and adolescence is a predisposing time for the development of T2DM due to physiological insulin resistance. Early-onset T2DM is more associated with shorter duration to insulin requirement, development of diabetic complications and cardiovascular disease than adult-onset T2DM and T1DM. The main goals in management include normalising hyperglycaemia, facilitating lifestyle modifications and managing diabetes-related and obesity-related comorbidities. 26,30 Box 1. Diagnosis of diabetes defined by the International Society of Paediatric and Adolescent Diabetes (ISPAD) and American Diabetes Association (ADA) guidelines The diagnosis of diabetes is made by the measurement of hyperglycaemia in the absence of any acute physiological stress and the presence of symptoms of hyperglycaemia: fasting plasma glucose of ≥7.0 mmol/L plasma glucose of ≥11.1 mmol/L post-oral glucose tolerance test, with 1.75 g/kg (max 75g) of anhydrous glucose dissolved in water symptoms of diabetes, such as polyuria, polydipsia, nocturia, unexplained weight loss and a random plasma glucose of ≥11.1 mmol/L glycated haemaglobin (HbA1c) of >6.5%* *The test should be performed in a 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 >>

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 >>

Cost-effectiveness Of Screening Strategies For Identifying Pediatric Diabetes Mellitus And Dysglycemia

Cost-effectiveness Of Screening Strategies For Identifying Pediatric Diabetes Mellitus And Dysglycemia

Cost-effectiveness of Screening Strategies for Identifying Pediatric Diabetes Mellitus and Dysglycemia ObjectiveTo conduct a cost-effectiveness analysis of screening strategies for identifying children with type 2 diabetes mellitus and dysglycemia (prediabetes/diabetes). Study ParticipantsA total of 2.5 million children aged 10 to 17 years. InterventionScreening strategies for identifying diabetes and dysglycemia. Main Outcome MeasuresEffectiveness (proportion of cases identified), total costs (direct and indirect), and efficiency (cost per case identified) of each screening strategy based on test performance data from a pediatric cohort and cost data from Medicare and the US Bureau of Labor Statistics. ResultsIn the base-case model, 500 and 400000 US adolescents had diabetes and dysglycemia, respectively. For diabetes, the cost per case was extremely high ($312000-$831000 per case identified) because of the low prevalence of disease. For dysglycemia, the cost per case was in a more reasonable range. For dysglycemia, preferred strategies were the 2-hour oral glucose tolerance test (100% effectiveness; $390 per case), 1-hour glucose challenge test (63% effectiveness; $571), random glucose test (55% effectiveness; $498), or a hemoglobin A1c threshold of 5.5% (45% effectiveness; $763). Hemoglobin A1c thresholds of 5.7% and 6.5% were the least effective and least efficient (ranges, 7%-32% and $938-$3370) of all strategies evaluated. Sensitivity analyses for diabetes revealed that disease prevalence was a major driver of cost-effectiveness. Sensitivity analyses for dysglycemia did not lead to appreciable changes in overall rankings among tests. ConclusionsFor diabetes, the cost per case is extremely high because of the low prevalence of the disease in the pediatric populati 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 >>

Diabetes Screening, Diagnosis, And Therapy In Pediatric Patients With Type 2 Diabetes

Diabetes Screening, Diagnosis, And Therapy In Pediatric Patients With Type 2 Diabetes

Diabetes Screening, Diagnosis, and Therapy in Pediatric Patients With Type 2 Diabetes Helena W. Rodbard , MD, FACP, MACE, Chair Helena W. Rodbard, AACE Diabetes Mellitus Clinical Practice Guidelines Task Force; Past President, American College of Endocrinology; Past President, American Association of Clinical Endocrinologists; Private Practice of Endocrinology, Endocrine and Metabolic Consultants, Rockville, Maryland; Disclosure: Helena W. Rodbard, MD, FACP, MACE, has disclosed that she has received research support from sanofi-aventis U.S. and Biodel, Inc. Dr. Rodbard has also disclosed that she has served as a consultant and lecturer for Abbott Laboratories, AstraZeneca, GlaxoSmithKline, Merck & Co., Inc., Novo Nordisk Pharmaceuticals, Inc., Ortho-McNeill Diagnostics, Pfizer Inc, and sanofi-aventis U.S. Dr. Rodbard has also disclosed that she has received no remuneration for the preparation of this manuscript. This article has been cited by other articles in PMC. The dramatic rise in the incidence and prevalence of type 2 diabetes mellitus in the pediatric and adolescent populations has been associated with the ongoing epidemic of overweight, obesity, insulin resistance, and metabolic syndrome seen in these age groups. Although the majority of pediatric patients diagnosed with diabetes are still classified as having type 1 diabetes, almost 50% of patients with diabetes in the pediatric age range (under 18 years) may have type 2 diabetes. Screening of high-risk patients for diabetes and prediabetes is important. Prompt diagnosis and accurate diabetes classification facilitate appropriate and timely treatment and may reduce the risk for complications. This is especially important in children because lifestyle interventions may be successful and the lifelong risk for co 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 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 >>

Diabetes Screening, Diagnosis, And Therapy In Pediatric Patients With Type 2 Diabetes

Diabetes Screening, Diagnosis, And Therapy In Pediatric Patients With Type 2 Diabetes

"At risk for overweight" (body mass index > 85th percentile for age and sex; or weight for age, sex, and height > 85th percentile; or weight > 120% of ideal for height) Family history of type 2 diabetes in first- or second-degree relative Race/ethnicity (Native American, African American, Hispanic American, Asian American, Pacific Islander) Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome) Age for initiation of screening: 10 years or at onset of puberty if puberty occurs at a younger age Measurement: fasting plasma glucose preferred Recommendations for Screening for Type 2 Diabetes in Children *Clinical judgment should be used to screen for diabetes in high-risk patients who do not meet these criteria. Copyright 2000 American Diabetes Association. From Diabetes Care, Vol. 23, 2000; 381-389. Adapted with permission from The American Diabetes Association. Currently Available Insulin Formulations [31,68] *May require 2 daily injections in patients with type 1 diabetes mellitus Assumes 0.1-0.2 U/kg per injection. Onset and duration may vary by injection site; in addition, for insulin detemir the duration of action has been reported to be dose-dependent (ranging from 6 hours at 0.1 U/kg to 23 hours at 1.6 U/kg). Contrary to popular belief, the premixed insulin formulations do not result in 2 discrete peaks of insulin activity separated by a nadir; there is only a single skewed, asymmetric peak located between that of the peaks that would be expected for rapid-acting insulin analogs and intermediate-acting insulin. The peak is asymmetric, with a skewing toward the longer time. [63,64] A mixture of 50% insulin lispro and 50% lispro protamine suspension is also available. Continue reading >>

Pediatric Psoriasis Guidelines

Pediatric Psoriasis Guidelines

PeDRA and NSP issue new C-level recommendations based on 26 studies A multi-specialty panel of physician experts has released the first comorbidity screening guidelines for pediatric psoriasis. The consensus statement, released last July, comes out amid increasing evidence that -- like adults with psoriasis -- children with the disease are at elevated risk for systemic and behavioral comorbidities. "There is increasing evidence that psoriasis is an inflammatory skin condition where other organs are affected. Data has shown higher rates of heart attacks, strokes in adults with psoriasis and evidence of vascular inflammation. Psoriatic arthritis, hepatic disease, obesity, depression, and anxiety are also associated with psoriasis," said Lawrence F. Eichenfield, MD, chief of pediatric and adolescent dermatology at University of California, San Diego and Rady Children's Hospital, San Diego. "Recognizing that children and teenagers with psoriasis have higher risk of these comorbidities over a lifetime, we should try to minimize their development and impact." Despite statistics that suggest psoriasis starts in childhood in almost one-third of cases, there were no prior guidelines for screening children for comorbidities. However, there are screening recommendations for adults by the National Psoriasis Foundation and other organizations. "By increasing awareness and providing a tool to help address these important health issues, we hope to optimize the comprehensive care of patients with pediatric psoriasis," the authors write. The Pediatric Dermatology Research Alliance (PeDRA), a consortium of pediatric dermatology researchers and National Psoriasis Foundation developed the statement. The panel included experts in pediatric and adult psoriasis, epidemiology and relevant ped Continue reading >>

Screening For Retinopathy In The Pediatric Patient With Type 1 Diabetes Mellitus - Reaffirmed 2014

Screening For Retinopathy In The Pediatric Patient With Type 1 Diabetes Mellitus - Reaffirmed 2014

Screening for Retinopathy in the Pediatric Patient with Type 1 Diabetes Mellitus - Reaffirmed 2014 Diabetic retinopathy (DR) is the leading cause of blindness in young adults in the United States. Early identification and treatment of DR can decrease the risk of vision loss in affected patients. This clinical report reviews the risk factors for the development of DR and screening guidance for pediatric patients with type 1 diabetes mellitus. Type 1 diabetes mellitus is one of the most common metabolic disorders in children, with a prevalence of approximately 2 per 1000 school-aged children in the United States. The prevalence of type 1 diabetes mellitus increases with age, and the overall incidence of the disease may be increasing. Although the incidence of type 2 diabetes in children is increasing, there are no data or guidelines regarding ophthalmic screening in children with this disorder. Diabetic retinopathy (DR) is one of the most important complications of type 1 diabetes mellitus, representing the leading cause of blindness in young adults. There are 3 main components of a strategy to minimize the risk of visual loss attributable to DR: provide the most effective treatment of the underlying metabolic disorder and its comorbidities; develop optimal treatment modalities for patients with ocular disease; identify risk factors for the development of ocular disease and implement effective screening programs to identify at-risk patients. The first 2 have been evaluated in well-conducted, large, prospective trials. The efficacy of providing intensive treatment of the underlying metabolic disorder was evaluated by the Diabetes Control and Complications Trial (DCCT),1 which clearly demonstrated the benefits of improving glycemic control and decreasing hemoglobin A1c con Continue reading >>

More in diabetes