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For more information, see the ADA posi-\ntion statement “Management of Diabetes\nin Long-term Care and Skilled Nursing Fa-\ncilities” (125).Nutritional Considerations\nAn older adult residing in an LTC facility\nmay have irregular and unpredictable meal\nconsumption, undernutrition, anorexia, | [
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consumption, undernutrition, anorexia,\nand impaired swallowing. Furthermore,therapeutic diets may inadvertently lead\nto decreased food intake and contribute\nto unintentional weight loss and under-nutrition. Meals tailored to a person ’s\nculture, preferences, and personal goalsmay increase quality of life, satisfact... | [
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with meals, and nutrition status (127). It\nmay be helpful to give insulin after mealsto ensure that the dose is appropriate\nfor the amount of carbohydrate the indi-\nvidual consumed in the meal.\nHypoglycemia\nOlder adults with diabetes in LTC are es-\npecially vulnerable to hypoglycemia. They | [
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pecially vulnerable to hypoglycemia. They\nhave a disproportionately high number ofclinical complications and comorbidities\nthat can increase hypoglycemia risk: im-\npaired cognitive and renal function, slowed\nhormonal regulation and counterregula-\ntion, suboptimal hydration, variable appe-tite and nutritional intak... | [
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and slowed intestinal absorption (128).\nOral agents may achieve glycemic out-\ncomes similar to basal insulin in LTC pop-\nulations (93,129). CGM may be a usefulapproach to monitoring for hypoglycemia\namong individuals treated with insulin in\nLTC, but the data are limited.\nAnother consideration for the LTC set- | [
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LTC, but the data are limited.\nAnother consideration for the LTC set-\nting is that unlike in the hospital setting,health care professionals are not requiredto evaluate patients daily. According to fe-\nderal guidelines, assessments should be\ndone at least every 30 days for the first | [
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done at least every 30 days for the first\n90 days after admission and then at leastonce every 60 days. Although in practicepatients may actually be seen more fre-\nquently, the concern is that these individ-\nuals may have uncontrolled glucose levels\nor wide excursions without the practi-\ntioner being noti fied. Healt... | [
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tioner being noti fied. Health care profes-\nsionals may adjust treatment plans by\ntelephone, fax, or in person directly at the\nLTC facilities, provided they are given timelynotification of blood glucose management\nissues from a standardized alert system.\nThe following alert strategy could be\nconsidered:\n1.Call hea... | [
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considered:\n1.Call health care professional immedi-\nately in cases of low blood glucose\nlevels ( <70 mg/dL [ <3.9 mmol/L]).\nHowever, treatment of hypoglycemiashould not be delayed. A health carediabetesjournals.org/care Older Adults S253\n©AmericanDiabetesAssociation | [
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professional should also be called if\ntwo or more blood glucose values>250 mg/dL are observed within a\n24-h period and are accompanied byas i g n i ficant change in status.\n2. Call as soon as possible when\na)glucose values are 70 –100 mg/dL\n(3.9–5.6 mmol/L) (treatment plan\nmay need to be adjusted),\nb)glucose valu... | [
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may need to be adjusted),\nb)glucose values are consistently\n>250 mg/dL ( >13.9 mmol/L)\nwithin a 24-h period,\nc)glucose values are consistently\n>300 mg/dL ( >16.7 mmol/L)\nover 2 consecutive days,\nd)any reading is too high for the\nglucose monitoring device, or\ne)the person is sick, with vomiting,\nsymptomatic hy... | [
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symptomatic hyperglycemia, or\npoor oral intake.\nEND-OF-LIFE CARE\nRecommendations\n13.20 When palliative care is needed\nin older adults with diabetes, health\ncare professionals should initiate con-versations with people with diabetes\nand their care partners regarding the | [
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and their care partners regarding the\ngoals and intensity of care. Strict glu-cose and blood pressure managementare not necessary, and simpli fication\nof medication plans can be consid-ered. Similarly, the intensity of lipidmanagement can be relaxed, andwithdrawal of lipid-lowering therapy\nmay be appropriate. E\n13.2... | [
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may be appropriate. E\n13.21 Overall comfort, prevention\nof distressing symptoms, and pres-\nervation of quality of life and dig-\nnity are primary goals for diabetes\nmanagement at the end of life. C\nThe management of the older adult at\nthe end of life receiving palliative medi-\ncine or hospice care is a unique si... | [
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Overall, palliative medicine promotescomfort, symptom management andprevention (pain, hypoglycemia, hypergly-cemia, and dehydration), and preserva-tion of dignity and quality of life in olderadults with limited life expectancy(126,130). In the setting of palliative care,health care professionals should initiate | [
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conversations with people with diabetes\nand their care partners regarding thegoals and intensity of diabetes care; strictglucose and blood pressure managementmay not be consistent with achievingcomfort and quality of life. Avoidance of\nsevere hypertension and hyperglycemia | [
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severe hypertension and hyperglycemia\naligns with the goals of palliative care. Ina multicenter trial, withdrawal of statinsamong people with diabetes in palliativecare was found to improve quality of life\n(131–133). The evidence for the safety\nand ef ficacy of deintensi fication proto-\ncols in older adults is growin... | [
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cols in older adults is growing for both\nglucose and blood pressure management(97,134) and is clearly relevant for pallia-tive care. An individual has the right to\nrefuse testing and treatment, whereas | [
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refuse testing and treatment, whereas\nhealth care professionals may considerwithdrawing treatment and limiting diag-nostic testing, including a reduction inthe frequency of blood glucose monitor-\ning (135,136). Glycemic goals should aim | [
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ing (135,136). Glycemic goals should aim\nto prevent hypoglycemia and hyperglyce-mia. Treatment interventions need to bemindful of quality of life. Careful monitor-ing of oral intake is warranted. The deci-sion process may need to involve the\ni n d i v i d u a l ,f a m i l y ,a n dc a r e g i v e r s ,l e a d i n g | [
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to a care plan that is both convenientand effective for the goals of care (137).The pharmacologic therapy may includeoral agents as first line, followed by a sim-\nplified insulin plan. If needed, basal insulin | [
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plified insulin plan. If needed, basal insulin\ncan be implemented, accompanied by oralagents and without rapid-acting insulin.Agents that can cause gastrointestinalsymptoms such as nausea or excess weightloss may not be good choices in this set-\nting. As symptoms progress, some agents\nmay be slowly tapered and discon... | [
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may be slowly tapered and discontinued.\nDifferent categories have been pro-\nposed for diabetes management in thosewith advanced disease (68).\n1. A stable individual: Continue with\nthe person ’s previous medication\nplan, with a focus on 1) the preven-\ntion of hypoglycemia and 2) the\nmanagement of hyperglycemia us... | [
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tion of hypoglycemia and 2) the\nmanagement of hyperglycemia us-\ning blood glucose testing, keepinglevels below the renal threshold ofglucose, and hyperglycemia-mediated\ndehydration. There is no role for A1C\nmonitoring.\n2. An individual with organ failure: Prevent-\ning hypoglycemia is of greatest signifi - | [
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ing hypoglycemia is of greatest signifi -\ncance. Dehydration must be preventeda n dt r e a t e d .I np e o p l ew i t ht y p e1d i a -betes, insulin administration may bereduced as the oral intake of food de-\ncreases but should not be stopped. For | [
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creases but should not be stopped. For\nthose with type 2 diabetes, agents thatmay cause hypoglycemia should ber e d u c e di nd o s e .T h em a i ng o a li st o\navoid hypoglycemia, allowing for glucosevalues in the upper level of the desiredgoal range.\n3. A dying individual: For people with | [
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3. A dying individual: For people with\ntype 2 diabetes, the discontinuation ofall medications may be a reasonable ap-proach, as these individuals are unlikelyto have any oral intake. In people withtype 1 diabetes, there is no consensus,\nbut a small amount of basal insulin may\nmaintain glucose levels and preventacute... | [
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maintain glucose levels and preventacute hyperglycemic complications.\nReferences\n1. Laiteerapong N, Huang ES. Diabetes in older\nadults. In Diabetes in America. 3rd ed. Cowie CC, | [
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adults. In Diabetes in America. 3rd ed. Cowie CC,\nCasagrande SS, Menke A, et al., Eds. Bethesda,MD, National Institute of Diabetes and Digestiveand Kidney Diseases (US), 2018. Accessed 13October 2023. Available from https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/diabetes-in-america-3rd-edition | [
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2. Centers for Disease Control and Prevention.\nNational Diabetes Statistics Report, 2020:Estimates of Diabetes and its Burden in theUnited States. 2020. Accessed 13 October 2023.Available from https://www.cdc.gov/diabetes/\npdfs/data/statistics/national-diabetes-statistics-\nreport.pdf\n3. Kirkman MS, Briscoe VJ, Clar... | [
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report.pdf\n3. Kirkman MS, Briscoe VJ, Clark N, et al.\nDiabetes in older adults. Diabetes Care 2012;35:2650– 2664\n4. Young-Hyman D, de Groot M, Hill-Briggs F,Gonzalez JS, Hood K, Peyrot M. Psychosocial carefor people with diabetes: a position statement ofthe American Diabetes Association. Diabetes Care2016;39:2126 –2... | [
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5 . I n s t i t u t eo fM e d i c i n eo ft h eN a t i o n a lA c a d e m i e s .Cognitive aging: progress in understanding andopportunities for action. Accessed 13 October 2023.Available from https://nationalacademies.org/hmd/Reports/2015/Cognitive-Aging.aspx\n6. Sudore RL, Karter AJ, Huang ES, et al.\nSymptom burden ... | [
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Symptom burden of adults with type 2 diabetes\nacross the disease course: diabetes & aging study.\nJ Gen Intern Med 2012;27:1674– 1681\n7. Laiteerapong N, Karter AJ, Liu JY , et al.Correlates of quality of life in older adults withdiabetes: the diabetes & aging study. DiabetesCare 2011;34:1749– 1753 | [
0.04952011629939079,
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-0.04113788902759552,
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0.027655258774757385,
-0.05357053130865097,
-0.023543... |
8. McClintock MK, Dale W, Laumann EO, WaiteL. Empirical rede finition of comprehensive health\nand well-being in the older adults of the UnitedStates. Proc Natl Acad Sci USA 2016;113:E3071–E3080\n9. Laiteerapong N, Iveniuk J, John PM, Laumann\nEO, Huang ES. Classi fication of older adults who | [
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0.0014541298151016235,
-0.112... |
EO, Huang ES. Classi fication of older adults who\nhave diabetes by comorbid conditions, UnitedStates, 2005-2006. Prev Chronic Dis 2012;9:E100\n10. Blaum C, Cigolle CT, Boyd C, et al. Clinical\ncomplexity in middle-aged and older adults withdiabetes: the Health and Retirement Study. Med\nCare 2010;48:327– 334 | [
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Care 2010;48:327– 334\n11. Tinetti ME, Costello DM, Naik AD, et al.Outcome Goals and health care preferences\nof older adults with multiple chronic conditions.JAMA Netw Open 2021;4:e211271S254 Older Adults Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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14. Children and Adolescents:\nStandards of Care in Diabetes—\n2024\nDiabetes Care 2024;47(Suppl. 1):S258 –S281 |https://doi.org/10.2337/dc24-S014American Diabetes Association\nProfessional Practice Committee *\nThe American Diabetes Association (ADA) “Standards of Care in Diabetes ”includes | [
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the ADA ’s current clinical practice recommendations and is intended to provide the\ncomponents of diabetes care, general treatment goals and guidelines, and tools to\nevaluate quality of care. Members of the ADA Professional Practice Committee, an\ninterprofessional expert committee, are responsible for updating the S... | [
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Care annually, or more frequently as warranted. For a detailed description of ADAstandards, statements, and reports, as well as the evidence-grading system for ADA ’s | [
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... |
clinical practice recommendations and a full list of Professional Practice Committeemembers, please refer to Introduction and Methodology. Readers who wish to com-ment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.\nThe management of diabetes in children and adolescents (individuals <18... | [
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age) cannot simply be derived from care routinely provided to adults with diabetes.\nThe epidemiology, pathophysiology, developmental considerations, and response to\ntherapy in pediatric diabetes are often different from those of adult diabetes. Thereare also differences in recommended care for children and adolescent... | [
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abetes, type 2 diabetes, and other forms of pediatric diabetes. This section is divided\ninto two major parts: the first part addresses care for children and adolescents with\ntype 1 diabetes, and the second part addresses care for children and adolescents\nwith type 2 diabetes. Monogenic diabetes (neonatal diabetes and... | [
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-0.0012... |
betes of the young [MODY]) and cystic fibrosis –related diabetes, which are often pre-\nsent in youth, are discussed in Section 2, “Diagnosis and Classi fication of Diabetes. ”\nTable 14.1A and Table 14.1 Bprovide an overview of the recommendations for | [
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0.052... |
screening and treatment of complications and related conditions in pediatric type 1diabetes and type 2 diabetes, respectively. In addition to comprehensive diabetes\ncare, youth with diabetes should receive age-appropriate and developmentally appro- | [
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priate pediatric care, including immunizations as recommended by the Centers forDisease Control and Prevention (CDC) (1). To ensure continuity of care as an adoles-\ncent with diabetes becomes an adult, guidance is provided at the end of this section\non the transition from pediatric to adult diabetes care. | [
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on the transition from pediatric to adult diabetes care.\nDue to the nature of pediatric clinical research, the recommendations for children\nand adolescents with diabetes are less likely to be based on clinical trial evidence. How-ever, expert opinion and a review of available and relevant experimental data are sum- | [
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marized in the American Diabetes Association (ADA) position statements “Type 1\nDiabetes in Children and Adolescents ”(2) and “Evaluation and Management of Youth-\nOnset Type 2 Diabetes ”(3). Finally, other sections in the Standards of Care may have\nrecommendations that apply to youth with diabetes and are referenced ... | [
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of this section.*A complete list of members of the American\nDiabetes Association Professional PracticeCommittee can be found at https://doi.org/10.2337/dc24-SINT.\nDuality of interest information for each author is\navailable at https://doi.org/10.2337/dc24-SDIS.\nSuggested citation: American Diabetes Association | [
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Suggested citation: American Diabetes Association\nProfessional Practice Committee. 14. Children andadolescents: Standards of Care in Diabetes —2024 .\nDiabetes Care 2024;47(Suppl. 1):S258 –S281 | [
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Diabetes Care 2024;47(Suppl. 1):S258 –S281\n© 2023 by the American Diabetes Association.Readers may use this article as long as thework is properly cited, the use is educationaland not for pro fit, and the work is not altered. | [
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More information is available at https://www.diabetesjournals.org/journals/pages/license.14. CHILDREN AND ADOLESCENTSS258 Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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Table 14.1 A—Recommendations for screening and treatment of complications and related conditions in pediatric type 1 diabetes\nThyroid disease Celiac disease Hypertension Nephropathy Retinopathy Neuropathy Dyslipidemia\nCorresponding\nrecommendations14.28 and 14.29 14.30–14.32 14.33–14.36 14.42 and 14.43 14.44–14.46 14... | [
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0.04033393785357475,
0.10476627945899963,
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0.0072298916056752205,
0.07437469065189362,
0.034200165420770645,
-0.07226655632257462,
0.057... |
Method Thyroid-stimulating\nhormone; consider\nantithyroglobulinand antithyroid\nperoxidase\nantibodiesIgA tTG if total IgA\nnormal; IgG tTG anddeamidated gliadinantibodies if IgA\ndeficientBlood pressure\nmonitoringAlbumin-to-creatinine\nratio; random sample\nacceptable initiallyDilated fundoscopy or\nretinal photograp... | [
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0.00017418361676391214,
0.07886292040348053,
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0.03726740553975105,
0.02321387454867363,
-0.013338638469576836,
-0.05133415386080742,
0.04... |
retinal photographyFoot exam with foot\npulses, pinprick, 10-gmono filament sensation\ntests, vibration, and\nankle re flexesLipid pro file, nonfasting\nacceptable initially\nWhen to start Soon after diagnosis Soon after diagnosis At diagnosis Puberty or $10 years\nold, whichever is\nearlier, and diabetesduration of 5 yea... | [
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0.03405911102890968,
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-0.039925627410411835,
0.063935786485672,
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-0.07220752537250519,
0.067165... |
earlier, and diabetesduration of 5 yearsPuberty or $11 years\nold, whichever isearlier, and diabetesduration of\n3–5 yearsPuberty or $10 years old,\nwhichever is earlier,\nand diabetes durationof 5 yearsSoon after diagnosis;\npreferably afterglycemia hasimproved and\n$2 years old\nFollow-up frequency Every 1 –2 years i... | [
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0.... |
Follow-up frequency Every 1 –2 years if\nthyroid antibodies\nnegative; more often\nif symptoms develop\nor presence ofthyroid antibodiesWithin 2 years and\nthen at 5 yearsafter diagnosis;\nsooner if symptoms\ndevelopEvery visit If normal, annually; if\nabnormal, repeatwith con firmation in\ntwo of three samplesover 6 mo... | [
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0.05629214644432068,
0.09... |
two of three samplesover 6 monthsIf normal, every\n2 years; considerless frequently\n(every 4 years)\nif A1C<8% and\neye professional\nagreesIf normal, annually If LDL <100 mg/dL,\nrepeat at 9 –11 years\nold; then, if <100\nmg/dL, every\n3 years\nGoal NA NA <90th percentile for\nage, sex, and height;if$13 years old,\n<... | [
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<120/80 mmHgAlbumin-to-creatinine\nratio<30 mg/gNo retinopathy No neuropathy LDL<100 mg/dL\nTreatment Appropriate treatment\nof underlying thyroid\ndisorderAfter con firmation,\nstart gluten-freedietLifestyle modi fication\nfor elevated bloodpressure (90th to\n<95th percentile for\nage, sex, and heightor, if$13 years old... | [
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age, sex, and heightor, if$13 years old,\n120–129/<80 mmHg);\nlifestyle modi fication\nand ACE inhibitor or\nARB* for hypertension\n($95th percentile for\nage, sex, and heightor, if$13 years old,\n$130/80 mmHg)Optimize glycemia and\nblood pressure; ACE\ninhibitor* if albumin-\nto-creatinine ratio iselevated in two ofthr... | [
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to-creatinine ratio iselevated in two ofthree samples over\n6 monthsOptimize glycemia;\ntreatment perophthalmologyOptimize glycemia;\nreferral to neurologyIf abnormal, optimize\nglycemia andmedical nutrition\ntherapy; if after6 months LDL>160 mg/dL or\n>130 mg/dL with\ncardiovascular riskfactor(s), initiate\nstatin the... | [
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... |
ARB, angiotensin receptor blocker; NA, not applicable; tTG, tissue transglutaminase. *Due to the potential teratogenic effects, individuals of childbearing age should receive reproductive counseling,and medication should be avoided in individuals of childbearing age who are not using reliable contraception.diabetesjour... | [
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using reliable contraception.diabetesjournals.org/care Children and Adolescents S259 | [
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©AmericanDiabetesAssociation | [
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Table 14.1 B—Recommendations for screening and treatment of complications and related conditions in pediatric type 2 diabetes\nHypertension Nephropathy Neuropathy Retinopathy DyslipidemiaNonalcoholic fatty\nliver diseaseObstructive\nsleep apneaPolycystic ovarian\nsyndrome (for\nadolescent\nfemaleindividuals)\nCorrespon... | [
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-0.0028270429465919733,
0.048282843083143234,
-0.06722917407751083,
-0.026287727057933807,
0.05409517511725426,
0.08830674737691879,
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0.0014499288517981768,
0.015654543414711952,
0.04106670618057251,
-0.08713819086551666,
0.0... |
syndrome (for\nadolescent\nfemaleindividuals)\nCorresponding\nrecommendations14.74 –14.77 14.78 –14.83 14.84 and 14.85 14.86–14.89 14.96–14.100 14.90 and 14.91 14.92 14.93 and 14.94\nMethod Blood pressure\nmonitoringAlbumin-to-\ncreatinine ratio;\nrandom sample\nacceptable\ninitiallyFoot exam with foot\npulses, pinpric... | [
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-0.019240213558077812,
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-0.057925995439291,
0.02296... |
initiallyFoot exam with foot\npulses, pinprick,10-g mono filament\nsensation tests,vibration, andankle re flexesDilated fundoscopy Lipid pro file AST and ALT\nmeasurementScreening for\nsymptomsScreening for\nsymptoms;laboratory\nevaluation if\npositive symptoms\nWhen to start At diagnosis At diagnosis At diagnosis At/soon... | [
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0.08640... |
diagnosisSoon after diagnosis,\npreferably afterglycemia hasimprovedAt diagnosis At diagnosis At diagnosis\nFollow-up frequency Every visit If normal, annually;\nif abnormal,repeat with\nconfirmation\nin two of three\nsamples over6 monthsIf normal, annually If normal, annually Annually Annually Every visit Every visit\n... | [
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-0.... |
Goal <90th percentile for\nage, sex, and height;if$13 years old,\n<130/80 mmHg<30 mg/g No neuropathy No retinopathy LDL <100 mg/dL,\nHDL>35 mg/dL,\ntriglycerides\n<150 mg/dLNA NA NA\nTreatment Lifestyle modi fication\nfor elevated bloodpressure (90th to\n<95th percentile for\nage, sex, and heightor, if$13 years old,\n12... | [
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0.0295... |
120–129/<80 mmHg);\nlifestyle modi fication\nand ACE inhibitor orARB* for hypertension\n($95th percentile for\nage, sex, and height\nor, if$13 years,\n$130/80 mmHg)Optimize glycemia\nand blood\npressure; ACE\ninhibitor*if albumin-to-creatinine ratio\nis elevated in\ntwo of threesamples over6 monthsOptimize glycemia;\nre... | [
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referral to\nneurologyOptimize glycemia;\ntreatment perophthalmologyIf abnormal, optimize\nglycemia andmedical nutrition\ntherapy; if LDL>130 mg/dL after\n6 months, initiate\nstatin therapy (for\nthose aged>10 years)*; if\ntriglycerides\n>400 mg/dL\nfasting or >1,000\nmg/dL nonfasting,begin fibrateRefer to\ngastroentero... | [
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-0... |
gastroenterologyfor persistently\nelevated orworseningtransaminasesIf positive\nsymptoms,\nrefer to sleep\nspecialist andpolysomnogramIf no contraindications,\noral contraceptive\npills; medical\nnutrition therapy;metformin | [
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ARB, angiotensin receptor blocker; NA, not applicable; tTG, tissue transglutaminase. *Due to the potential teratogenic effects, individuals of childbearing age should receive reproductive counseling, andmedication should be avoided in individuals of childbearing age who are not using reliable contraception.S260 Childre... | [
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0.07617077231407166,
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0.0251... |
using reliable contraception.S260 Children and Adolescents Diabetes Care Volume 47, Supplement 1, January 2024 | [
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-0.0... |
©AmericanDiabetesAssociation | [
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0.0... |
TYPE 1 DIABETES\nType 1 diabetes is the most common form | [
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0.0... |
of diabetes in youth (4), although data sug-gest that it accounts for a large proportionof cases diagnosed in adult life (5). Thehealth care professional must consider theunique aspects of care and managementof children and adolescents with type 1diabetes, such as changes in insulin sensi-tivity related to physical gro... | [
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0.0498... |
insulin sensi-tivity related to physical growth and sexualmaturation, ability to provide self-care,supervision in the childcare and school en-vironment, neurological vulnerability to hy- | [
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poglycemia and hyperglycemia in young\nchildren, and possible adverse neurocog-nitive effects of diabetic ketoacidosis(DKA) (6,7). Attention to family dynamics,developmental stages, and physiologicdifferences related to sexual maturity isessential in developing and implementingan optimal diabetes treatment plan (8). | [
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0.0381... |
An interprofessional team trained in\npediatric diabetes management and sensi-tive to the challenges of children and ado-lescents with type 1 diabetes and theirfamilies should provide diabetes-specifi c | [
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0.069... |
care for this population. It is essential thatdiabetes self-management education andsupport, medical nutrition therapy, andpsychosocial/behavioral support be pro-vided at diagnosis and regularly thereafterin a developmentally appropriate formatthat builds on prior knowledge by a teamof health care professionals experie... | [
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-0.12750084698200226,
0.005929... |
by a teamof health care professionals experiencedwith the biological, educational, nutritional,behavioral, and emotional needs of thegrowing child and family. The diabetesteam, taking into consideration the youth ’s | [
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0.02144711... |
developmental and psychosocial needs,should ask about and discuss diabetes man-agement responsibilities with youth and pa-rents/caregivers on an ongoing basis.\nDiabetes Self-Management Education\nand Support\nRecommendation\n14.1 Youth with type 1 diabetes and\ntheir parents/caregivers (for individu-\nals aged <18 yea... | [
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0.... |
als aged <18 years) should receive\nculturally sensitive and developmen-tally appropriate individualized diabe-\ntes self-management education and\nsupport according to national stand-ards at diagnosis and routinely there-after. B\nSelf-management in pediatric diabetes in-\nvolves both the youth and their parents/adult... | [
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0.016... |
the medical plan is, it can only be effec-tive if the family and/or affected individu-\nals are able to implement it. Family\ninvolvement is a vital component of opti-\nmal diabetes management throughout\nchildhood and adolescence. As parents/\ncaregivers are critical to diabetes self- | [
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0.012789... |
caregivers are critical to diabetes self-\nmanagement in youth, diabetes care re-quires an approach that places the youth\nand their parents/caregivers at the center\nof the care model. The pediatric diabetes\ncare team must be capable of evaluating\nthe educational, behavioral, emotional,\nand psychosocial factors tha... | [
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0.03883... |
and psychosocial factors that impact the\nimplementation of a treatment plan andmust work with the youth and family to\novercome barriers or redefi ne goals as\nappropriate. Diabetes self-managementeducation and support requires periodic\nreassessment, especially as the youth\ngrows, develops, and acquires the need | [
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0.027... |
grows, develops, and acquires the need\nand desire for greater independent self-\ncare skills. The pediatric diabetes team\nshould work with the youth and their pa-rents/caregivers to ensure there is not a\npremature transfer of self-management\ntasks to the youth during this time. In addi-\ntion, it is necessary to as... | [
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tion, it is necessary to assess the educa-\ntional needs and skills of, and provide\ntraining to, daycare workers, school nurses,\nand school personnel who are responsiblefor the care and supervision of the child\nwith diabetes (2,9,10).\nNutrition Therapy\nRecommendations\n14.2 Individualized medical nutrition\ntherap... | [
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therapy is recommended for youth\nwith type 1 diabetes as an essential\ncomponent of the overall treatmentplan. A\n14.3 Monitoring carbohydrate intake,\nwhether by carbohydrate counting or\nexperience-based estimation, is a\nkey component to optimizing glyce-mic management. B\n14.4 Meal composition impacts\npostprandia... | [
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0.027024... |
14.4 Meal composition impacts\npostprandial glucose excursions. Ed-\nucation on the impact of high-fat\nand high-protein meals and the ad-justment of insulin dosing is neces-sary. A\n14.5 Comprehensive nutrition edu-\ncation at diagnosis, with at leastannual updates and as needed, byan experienced registered dietitiann... | [
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sess caloric and nutrition intake inrelation to weight status and car-\ndiovascular disease risk factors andto inform macronutrient choices. E\nNutrition management should be individ-ualized: family habits, food preferences,religious or cultural needs, finances, sched-\nules, physical activity, and the youth ’sa n d | [
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ules, physical activity, and the youth ’sa n d\nfamily ’s abilities in numeracy, literacy, and | [
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self-management should be considered.Visits with a registered dietitian nutritionistshould include assessment for changes infood preferences over time, access tofood, growth, and development, weightstatus, cardiovascular risk, and potentialfor disordered eating. Following recom-mended nutrition plans is associated with... | [
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nutrition plans is associated withbetter glycemic outcomes in youth withtype 1 diabetes (11). | [
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Although carbohydrate content is the | [
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primary variable for calculation of mealinsulin dose, it is well known that mealswith higher content of fat and proteincan cause early hypoglycemia and de-layed postprandial excursion. Some ad-justments in insulin dosing, including anincrease in the calculated dose as wellas a split dose, will improve postpran-dial glu... | [
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Physical Activity and Exercise\nRecommendations\n14.6 Physical activity is recommended\nfor all youth with type 1 diabetes with\nthe goal of 60 min of moderate- tovigorous-intensity aerobic activity daily,\nwith vigorous muscle-strengthening and\nbone-strengthening activities at least3 days per week. C\n14.7 Frequent g... | [
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... |
14.7 Frequent glucose monitoring\nbefore, during, and after exercise,via blood glucose meter or continu-ous glucose monitoring (CGM), is\nimportant to prevent, detect, and\ntreat hypoglycemia and hyperglyce-mia associated with exercise. C\n14.8 Youth and their parents/care- | [
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14.8 Youth and their parents/care-\ngivers should receive education ongoals and management of glycemiabefore, during, and after physical ac-\ntivity, individualized according to the\ntype and intensity of the plannedphysical activity. E\n14.9 Youth and their parents/care- | [
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14.9 Youth and their parents/care-\ngivers should be educated on strate-gies to prevent hypoglycemia during,after, and overnight following physical\nactivity and exercise, which maydiabetesjournals.org/care Children and Adolescents S261\n©AmericanDiabetesAssociation | [
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