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include reducing prandial insulin dos-\ning for the meal/snack preceding\n(and, if needed, following) exercise, re-\nducing basal insulin doses, increasing\ncarbohydrate intake, eating bedtime\nsnacks, and/or using CGM. Treatment\nfor hypoglycemia should be accessible\nbefore, during, and after engaging inactivity. C | [
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before, during, and after engaging inactivity. C\nPhysical activity and structured exercise\npositively impact metabolic and psycholog-\nical health in children with type 1 diabetes\n(29). While it affects insulin sensitivity,physical fitness, strength building, weight | [
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management, social interaction, mood,self-esteem building, and the creation ofhealthful habits for adulthood, it also hasthe potential to cause both hypoglycemia\nand hyperglycemia.\nSee below for strategies to mitigate\nhypoglycemia risk and minimize hyper- | [
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hypoglycemia risk and minimize hyper-\nglycemia associated with exercise. Foran in-depth discussion, see reviews andguidelines (30 –32).\nOverall, it is recommended that\nyouth participate in 60 min of moderate-\nintensity (e.g., brisk walking or dancing) to | [
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intensity (e.g., brisk walking or dancing) to\nvigorous-intensity (e.g., running or jump-ing rope) aerobic activity daily, includingresistance and flexibility training (33). Al-\nthough uncommon in the pediatric popula-tion, youth should be medically evaluatedfor comorbid conditions or diabetes com-\nplications that may... | [
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plications that may restrict participation in\nan exercise program. As hyperglycemiacan occur before, during, and after physi-cal activity, it is important to ensure thatthe elevated glucose level is not related toinsulin defi ciency that would lead to wors-\nening hyperglycemia with exercise and\nketosis risk. Intense ... | [
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ketosis risk. Intense activity should be\npostponed with marked hyperglycemia(glucose $350 mg/dL [ $19.4 mmol/L]),\nmoderate to large urine ketones, and/orb-hydroxybutyrate (B-OHB) >1.5 mmol/L.\nCaution may be needed when B-OHB lev-els are$0.6 mmol/L (11,30).\nThe prevention and treatment of hy- | [
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The prevention and treatment of hy-\npoglycemia associated with physical activ-ity include decreasing the prandial insulinfor the meal/snack before exercise and/orincreasing food intake. Youth on insulinpumps without automated insulin delivery(AID) can lower basal rates by /C2410–50%\nor more or suspend for 1 –2 h duri... | [
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or more or suspend for 1 –2 h during exer-\ncise (34). Decreasing basal rates or long-acting insulin doses by /C2420% after exer-\ncise may reduce delayed exercise-inducedhypoglycemia (35). Accessible rapid-acting\ncarbohydrates and frequent blood glu- | [
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carbohydrates and frequent blood glu-\ncose monitoring before, during, and afterexercise, with or without continuous glu-cose monitoring (CGM), maximize safetywith exercise. The use of AID systemsmay improve time in range (TIR) (70 –180\nmg/dL) during exercise, and youth canuse brand-speci fic settings that are more | [
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conservative or increase the glycemic\ngoal to prevent hypoglycemia (36).\nBlood glucose goals prior to physi-\ncal activity and exercise should be\n126– 180 mg/dL (7.0 –10.0 mmol/L) but | [
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126– 180 mg/dL (7.0 –10.0 mmol/L) but\nshould be individualized based on thetype, intensity, and duration of activity(30,32). Consider additional carbohydrateintake during and/or after exercise, de-pending on the duration and intensity ofphysical activity, to prevent hypoglyce-mia. For low- to moderate-intensity aero- | [
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bic activities (30 –60 min), and if the\nyouth is fasting, 10 –15 g of carbohydrate\nmay prevent hypoglycemia (32). After in-\nsulin boluses (relative hyperinsulinemia),consider 0.5 –1.0 g of carbohydrates/kg\nper hour of exercise ( /C2430–60 g), which is | [
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per hour of exercise ( /C2430–60 g), which is\nsimilar to carbohydrate requirements tooptimize performance in athletes withouttype 1 diabetes (37 –39).\nIn addition, obesity is as common in\nyouth with type 1 diabetes as in those\nwithout diabetes. It is associated with a | [
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without diabetes. It is associated with a\nhigher frequency of cardiovascular risk fac-tors, and it disproportionately affects ra-cial/ethnic minorities in the U.S. (40 –44). | [
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Therefore, diabetes health care professio-nals should monitor weight status and en-courage a healthy eating pattern, physicalactivity, and healthy weight as key compo-nents of pediatric type 1 diabetes care.\nSchool and Child Care\nAs a large portion of a youth ’sd a yi s | [
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School and Child Care\nAs a large portion of a youth ’sd a yi s\nspent in school and/or day care, trainingof school or day care personnel to pro-vide care in accordance with the child ’s\nindividualized diabetes medical manage-ment plan is essential for optimal diabe-tes management and safe access to allschool or day c... | [
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nities (10,45,46). In addition, federaland state laws require schools, day care\nfacilities, and other entities to provide\nneeded diabetes care to enable thechild to safely access the school or daycare environment. Refer to the ADA po-sition statements “Diabetes Care in the | [
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School Setting ”(10) and “Care of YoungChildren With Diabetes in the Childcare\nand Community Setting ”(46) and the\nADA’ s Safe at School website (diabetes\n.org/resources/know-your-rights/safe-at-\nschool-state-laws) for additional details.\nPsychosocial Care\nRecommendations\n14.10 At diagnosis and during routine\nf... | [
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follow-up care, screen youth with\ntype 1 diabetes for psychosocial con-\ncerns (e.g., diabetes distress, depres-\nsive symptoms, and disordered eating),family factors, and behavioral health\nconcerns that could impact diabetes\nmanagement with age-appropriate stan-\ndardized and validated tools. Refer to a\nqualified b... | [
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qualified behavioral health professional,\npreferably experienced in childhood dia-betes, when indicated. B\n14.11 Behavioral health professio-\nnals should be considered integral\nmembers of the pediatric diabetes\ninterprofessional team. E\n14.12 Encourage developmentally ap- | [
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interprofessional team. E\n14.12 Encourage developmentally ap-\npropriate family involvement in diabe-tes management tasks for children andadolescents, recognizing that prema-\nture or unsupportive transfer of diabe-\ntes care responsibility to the youth\ncan contribute to diabetes distress,\nlower engagement in diabet... | [
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lower engagement in diabetes self-\nmanagement behaviors, and deterio-\nration in glycemia. A\n14.13 Health care professionals should\nscreen for food security, housing stabil-\nity/homelessness, health literacy, fi-\nnancial barriers, and social/communitysupport and apply that information to\ntreatment decisions. E\n14... | [
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treatment decisions. E\n14.14 Health care professionals should\nconsider asking youth and their pa-rents/caregivers about social adjust-ment (peer relationships) and school\nperformance to determine whether\nfurther intervention is needed. B\n14.15 Offer adolescents time by them- | [
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14.15 Offer adolescents time by them-\nselves with their health care professio-nal(s) starting at age 12 years or when\ndevelopmentally appropriate. E\n14.16 Starting at puberty, preconcep-\ntion counseling should be incorporated\ninto routine diabetes care for all indi-\nviduals of childbearing potential. A\nRapid and... | [
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Rapid and dynamic cognitive, develop-\nmental, and emotional changes occur dur-\ning childhood, adolescence, and emerging\nadulthood. Diabetes management duringS262 Children and Adolescents Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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childhood and adolescence places sub-\nstantial burdens on the youth and family,necessitating ongoing assessment of psy-chosocial status, social determinants of\nhealth, and diabetes distress in the youth\nand the parents/caregivers during routinediabetes visits (47 –55). It is important to\nconsider the impact of diab... | [
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consider the impact of diabetes on quality\nof life as well as the development of behav-\nioral health problems related to diabetesdistress, fear of hypoglycemia (and hyper-glycemia), symptoms of anxiety, disordered\neating behaviors and eating disorders, and\nsymptoms of depression (50,56). Considerscreening youth for... | [
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erally starting at 7 or 8 years of age (56), us-\ning validated tools for youth and theirparents/caregivers (57). Consider screeningfor depression and disordered eating be-\nhaviors using available screening tools\n(58,59). Early detection of depression, anx-iety, disordered eating, and learning dis-abilities can facil... | [
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options and help minimize adverse effects\non diabetes management and diseaseoutcomes (50,56). When psychologicalsymptoms are identifi ed, referral to a be-\nhavioral health professional, ideally withexperience in pediatric diabetes, may bewarranted. Such professionals can provideindividualized, evidence-based behaviora... | [
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health care services, including cognitive-\nbehavioral, mindfulness-based, and otherinterventions (60), to improve psychosocial\nfunctioning in youth with type 1 diabetes\n(61–63).\nThe complexities of diabetes manage-\nment require ongoing parental involve-ment in care throughout childhood and\nadolescence. Developmen... | [
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adolescence. Developmentally appropri-\nate, supportive family teamwork betweenthe growing youth and parent can helpmaintain engagement in self-management\nbehaviors and reduce deterioration in gly-\ncemia (64,65). It is appropriate to inquireabout diabetes-specifi c family relation-\nships, including family teamwork an... | [
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ships, including family teamwork and con-\nflict, during visits; health care professionals\nc a nb o t hh e l pf a m i l i e sn e g o t i a t eap l a n\nand refer to an appropriate behavioralhealth professional for more in-depth sup-\nport (66). Such professionals can conduct | [
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-0.02077590860426426,
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0.04409470... |
port (66). Such professionals can conduct\nfurther assessment and deliver evidence-based behavioral interventions to supportdevelopmentally appropriate, collabora-\ntive family involvement in diabetes self-\nmanagement (61,63). Monitoring of socialadjustment (peer relationships) and school\nperformance can facilitate b... | [
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performance can facilitate both well-being\nand academic achievement (67). Diabetesmanagement and glycemic levels may berelated to academic progress and stu-dents ’functioning in the school setting,\nwhich highlights the need for appropriateaccommodations and access to diabetes-\nrelated support in school (68).\nShared... | [
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-... |
related support in school (68).\nShared decision-making with youth\nregarding the adoption of management\nplan components and self-management\nbehaviors can improve diabetes self-\nefficacy, participation in diabetes care, and\nmetabolic outcomes (41,69). Although cog-nitive abilities vary, the ethical position of-ten a... | [
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whereby children after age 12 or 13 yearswho appear to be “mature ”have the right\nto consent or withhold consent to generalmedical treatment, except in cases in\nwhich refusal would signi ficantly endanger\nhealth (70).\nBeginning at the onset of puberty or\nat diagnosis of diabetes, all individuals\nwith childbearing ... | [
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with childbearing potential should re-\nceive education about the risks of fetal\nmalformations associated with elevatedA1C and the use of effective contracep-tion to prevent unplanned pregnancy.\nPreconception counseling using devel- | [
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Preconception counseling using devel-\nopmentally appropriate educational andbehavioral strategies enables individualsof childbearing potential to make well-\ninformed decisions (71). Preconception\ncounseling resources tailored for ado-lescents are available at no costthrough the ADA (72). Refer to theADA position sta... | [
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Care for People With Diabetes ”for fur-\nther details (56).\nYouth with type 1 diabetes have an in-\ncreased risk of disordered eating behavior\nas well as clinical eating disorders, with | [
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as well as clinical eating disorders, with\nserious short-term and long-term nega-t i v ee f f e c t so nd i a b e t e so u t c o m e sa n dhealth in general. It is important to recog-nize the unique and dangerous disor-\ndered eating behavior of insulin omission | [
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dered eating behavior of insulin omission\nfor weight management in type 1 diabe-tes (73) using tools such as the DiabetesEating Problems Survey-Revised (DEPS-R)\nto allow for early diagnosis and interven-\ntion (59,74 –76). Given the complexity of\ntreating disordered eating behaviors, col-laboration between the diabe... | [
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care team and a behavioral health pro-\nfessional, ideally with expertise in disor-dered eating behaviors and diabetes, isrecommended.\nThe presence of a behavioral health\nprofessional on pediatric interprofessional\nteams highlights the importance of attendingto the psychosocial issues of diabetes.\nThese psychosocia... | [
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0.051752... |
These psychosocial factors are signi ficantly\nrelated to self-management dif ficulties,\nelevated A1C, reduced quality of life, and\nhigher rates of acute and chronic diabetes\ncomplications.\nGlycemic Monitoring, Insulin\nDelivery, and Goals\nRecommendations\n14.17 All youth with type 1 diabetes\nshould monitor glucose... | [
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0.03... |
should monitor glucose levels multiple\ntimes daily (up to 6 –10 times/day by\nblood glucose meter or CGM), includ-ing prior to meals and snacks, at bed-\ntime, and as needed for safety in\nspecifi cs i t u a t i o n ss u c ha sp h y s i c a la c -\ntivity, driving, or the presence of symp-toms of hypoglycemia. B\n14.18... | [
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0.0669839084148407,
0.0972486287355423,
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0.04880... |
14.18 Real-time CGM Aor intermit-\ntently scanned CGM Eshould be of- | [
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0.00... |
fered for diabetes management atd i a g n o s i so ra ss o o na sp o s s i b l ei ny o u t hwith diabetes on multiple daily injec-tions or insulin pump therapy who arecapable of using the device safely (ei-ther by themselves or with caregivers).The choice of device should be madebased on the individual ’s and family ’s | [
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-0.047063592821359634,
-0.0164... |
circumstances, desires, and needs.\n14.19 Automated insulin delivery\n(AID) systems should be offered for\ndiabetes management to youth withtype 1 diabetes who are capable ofusing the device safely (either by\nthemselves or with caregivers). The\nchoice of device should be madebased on the individual ’s and family ’s | [
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0.0660480186343193,
0.03858393803238869,
-0.042701199650764465,
0.07085429... |
circumstances, desires, and needs. A\n14.20 Insulin pump therapy alone | [
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0.07922447472810745,
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0.03948744386434555,
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0.007429664954543114,
0.043065547943115234,
-0.06107035651803017,
0.0614605... |
14.20 Insulin pump therapy alone\nshould be offered for diabetes man-agement to youth on multiple dailyinjections with type 1 diabetes whoare capable of using the device safely(either by themselves or with care-givers) if unable to use AID systems.T h ec h o i c eo fd e v i c es h o u l db em a d ebased on the individu... | [
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0.08604811877012253,
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circumstances, desires, and needs. A\n14.21 Students must be supported at\nschool in the use of diabetes technol-ogy, including continuous glucose mon-itors, insulin pumps, connected insulinpens, and AID systems as prescribed bytheir diabetes care team. E\n14.22 A1C goals must be individualized\nand reassessed over tim... | [
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0.07242904603481293,
0.062160663306713104,
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0.01067048404365778,
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-... |
and reassessed over time. An A1C of\n<7% (<53 mmol/mol) is appropriate\nfor many children and adolescents. Bdiabetesjournals.org/care Children and Adolescents S263\n©AmericanDiabetesAssociation | [
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0.04534801095724106,
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0.0... |
14.23 Less stringent A1C goals (such\nas<7.5% [<58 mmol/mol]) may be\nappropriate for youth who cannot ar-\nticulate symptoms of hypoglycemia;have hypoglycemia unawareness; lackaccess to analog insulins, advanced in-sulin delivery technology, and/or CGM;cannot check blood glucose regularly;\nor have nonglycemic factors... | [
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0.11393892019987106,
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0.... |
or have nonglycemic factors that in-\ncrease A1C (e.g., high glycators). B\n14.24 Even less stringent A1C goals\n(such as <8% [<64 mmol/mol]) may\nbe appropriate for individuals with ahistory of severe hypoglycemia, lim-ited life expectancy, or where theharms of treatment are greater thanthe bene fits.B\n14.25 Health ca... | [
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0.013015604577958584,
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14.25 Health care professionals may\nreasonably suggest more stringent A1C\ngoals (such as <6.5% [<48 mmol/mol])\nfor selected individuals if they can be\nachieved without signi ficant hypogly- | [
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0.02... |
achieved without signi ficant hypogly-\ncemia, negative impacts on well-being,or undue burden of care or in thosewho have nonglycemic factors thatdecrease A1C (e.g., lower erythrocytelife span). Lower goals may also be ap-propriate during the honeymoonphase. B\n14.26 CGM metrics derived from con- | [
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-0.... |
14.26 CGM metrics derived from con-\ntinuous glucose monitor use over themost recent 14 days (or longer foryouth with more glycemic variability),including time in range (70 –180 mg/dL\n[3.9–10.0 mmol/L]), time below range\n(<70 mg/dL [ <3.9 mmol/L] and\n<54 mg/dL [ <3.0 mmol/L]), and\ntime above range ( >180 mg/dL\n[>1... | [
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0.0... |
time above range ( >180 mg/dL\n[>10.0 mmol/L] and >250 mg/dL\n[>13.9 mmol/L]), are recommended\nto be used in conjunction with A1C\nwhenever possible. E\nCurrent standards for diabetes manage-\nment re flect the need to minimize hy-\nperglycemia as safely as possible. The\nDiabetes Control and Complications Trial(DCCT),... | [
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0.025601... |
<13 years of age, demonstrated that near\nnormalization of blood glucose levels was\nmore dif ficult to achieve in adolescents\nthan in adults. Nevertheless, the increased\nuse of basal-bolus plans, insulin pumps,\nfrequent blood glucose monitoring, CGM,AID systems, goal setting, and improvedpatient education has been a... | [
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0.032... |
with more children and adolescents reach-\ning the blood glucose goals recommendedby the ADA (77 –79), particularly in familiesin which both the parents/caregivers and\nthe child with diabetes participate jointlyto perform the required diabetes-relatedtasks.\nLower A1C in adolescence and young | [
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Lower A1C in adolescence and young\nadulthood is associated with a lower riskand rate of microvascular and macrovas-cular complications (80 –83) and demon-\nstrates the effects of metabolic memory\n(84–87).\nIn addition, type 1 diabetes can be as-\nsociated with adverse effects on cogni- | [
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sociated with adverse effects on cogni-\ntion during childhood and adolescence(6,88 –90), and neurocognitive imaging\ndifferences related to hyperglycemia inchildren provide another motivation for\nachieving glycemic goals (6). DKA has\nbeen shown to cause adverse effects on\nbrain development and function. Addi- | [
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brain development and function. Addi-\ntional factors (91 –94) that contribute to\nadverse effects on brain development\nand function include young age, severe\nhypoglycemia at <6 years of age, and\nchronic hyperglycemia (95,96). However,meticulous use of therapeutic modalities\nsuch as rapid- and long-acting insulin a... | [
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such as rapid- and long-acting insulin ana-\nlogs, technological advances (e.g., CGM,\nsensor-augmented pump therapy, and AID\nsystems), and intensive self-management\neducation now make it more feasible to\nachieve glycemic goals while reducing the\nincidence of severe hypoglycemia (97 –120).\nPlease refer to Section ... | [
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Please refer to Section 7, “Diabetes\nTechnology, ”for more information on\ntechnology to support people with diabetes.\nIn selecting individualized glycemic\ngoals, the long-term health bene fits of\nachieving a lower A1C should be bal-\nanced against the risks of hypoglycemia\nand the developmental burdens of in-\nten... | [
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tensive treatment plans in youth (121).\nRecent data with newer devices and insu-\nlins indicate that the risk of hypoglycemia\nwith lower A1C is less than it was before\n(122–131). Some data suggest that there\nc o u l db eat h r e s h o l dw h e r el o w e rA 1 C\nis associated with more hypoglycemia\n(132,133); howe... | [
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0.0593123659491539,
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0.026254596188664436,
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0.05561039224267006,
0.0088889691978693,
-0.00490852... |
(132,133); however, the con fidence inter-\nvals were large, suggesting great variability.In addition, achieving lower A1C levels is\nlikely facilitated by setting lower A1C goals\n(134,135). Lower goals may be possible\nduring the honeymoon phase of type 1 di-\nabetes. Special consideration should be\ngiven to the risk... | [
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0.003707918105646968,
0.03847262263298035,
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0.13269878923892975,
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-0.02... |
given to the risk of hypoglycemia in young\nchildren (aged <6 years) who are often\nunable to recognize, articulate, and/or\nmanage hypoglycemia. However, registry\ndata indicate that A1C goals can be achieved\nin children, including those aged <6y e a r s ,without increased risk of severe hypogly- | [
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0.03609997779130936,
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0.024286294355988503,
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0.08322722464799881,
0.07035157084465027,
0.08213983476161957,
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0.011156179010868073,
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0.... |
cemia (123,134). Recent data have dem-onstrated that the use of real-time CGMlowered A1C and increased TIR in adoles-cents and young adults and, in childrenaged<8 years old, was associated with\na lower risk of hypoglycemia (136,137).\nPlease refer to Section 6, “Glycemic Goals\nand Hypoglycemia, ”for more information\... | [
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0.040753044188022614,
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-0.... |
and Hypoglycemia, ”for more information\non glycemic assessment.\nA strong relationship exists between\nthe frequency of blood glucose monitor-\ning and glycemic management (118 –120,\n138–144). Glucose levels for all children | [
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0.08364739269018173,
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0.01231508981436491,
-0.07304215431213379,
0.0105... |
138–144). Glucose levels for all children\nand adolescents with type 1 diabetesshould be monitored multiple times dailyby blood glucose monitoring and/or CGM.Recent data on children and adults sug-gest that use of CGM soon after type 1\ndiabetes diagnosis is associated with im- | [
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0.005646893754601479,
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0.040... |
diabetes diagnosis is associated with im-\nproved A1C (104,105,145). In the U.S.,real-time CGM is approved for nonadjunc-tive use in children aged 2 years and olderand intermittently scanned CGM is ap-proved for nonadjunctive use in childrenaged 4 years and older. Parents/caregivers\nand youth should be offered initial... | [
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0.0... |
and youth should be offered initial and\nongoing education and support for CGMuse. Behavioral support may further im-prove ongoing CGM use (137). Metrics de-rived from CGM include percent time intarget range, below target range, and\nabove target range (146). While studies in-\ndicate a relationship between TIR and | [
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0.08136977255344391,
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0.10289321839809418,
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0.009395353496074677,
0.08190160989761353,
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0.019886067137122154,
0.09899... |
dicate a relationship between TIR and\nA1C (147,148), it is still uncertain whatthe ideal goal TIR should be for children,and further studies are needed. Please re-fer to Section 7, “Diabetes Technology, ”\nfor more information on the use of bloodglucose meters, CGM, and insulin pumps.\nMore information on insulin inje... | [
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0.073... |
More information on insulin injection\ntechnique can be found in Section 9,“Pharmacologic Approaches to Glycemic\nTreatment. ”\nKey Concepts in Setting Glycemic Goals\n\x81Glycemic goals should be individu-\nalized, and lower goals may be rea-\nsonable based on a bene fit–risk\nassessment. | [
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0.08295116573572159,
0.10546629875898361,
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sonable based on a bene fit–risk\nassessment.\n\x81Blood glucose goals should be modi-fied in children with frequent hypogly-\ncemia or hypoglycemia unawareness.\n\x81Postprandial blood glucose values\nshould be measured when there is a | [
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0.07... |
\x81Postprandial blood glucose values\nshould be measured when there is a\ndiscrepancy between preprandial bloodglucose values and A1C levels and toS264 Children and Adolescents Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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0.03373697027564049,
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0.0019464343786239624,
-0.026242097839713097,
-0.025754516944289207,
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0.01... |
assess preprandial insulin doses in\nthose on basal-bolus or pump plans.\nAutoimmune Conditions\nRecommendation\n14.27 Assess for additional autoim-\nmune conditions soon after the di-agnosis of type 1 diabetes and ifsymptoms develop. B\nBecause of the increased frequency of\nother autoimmune diseases in type 1 dia- | [
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0.016142208129167557,
-0.03621559962630272,
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0.1137261763215065,
0.07929626852273941,
-0.1043526828289032,
0.002112935995683074,
-0.02559753507375717,
-0.053325362503528595,
-0.09902140498161316,
0.0505... |
other autoimmune diseases in type 1 dia-\nbetes, screening for thyroid dysfunction\nand celiac disease should be considered(149–153). Periodic screening in asymp-\ntomatic individuals has been recom-\nmended, but the optimal frequency of\nscreening is unclear.\nAlthough much less common than thy- | [
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0.00984816811978817,
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0.015909835696220398,
0.05846706032752991,
0.07024463266134262,
-0.10451515018939972,
-0.008101421408355236,
0.01626528427004814,
0.020996710285544395,
-0.0598771795630455,
0.... |
screening is unclear.\nAlthough much less common than thy-\nroid dysfunction and celiac disease, otherautoimmune conditions, such as Addison\ndisease (primary adrenal insuf ficiency),\nautoimmune hepatitis, autoimmune gas-\ntritis, dermatomyositis, and myasthenia\ngravis, occur more commonly in the popu- | [
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0.008556927554309368,
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0.009711460210382938,
0.03219108656048775,
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0.006237815134227276,
0.07661701738834381,
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0.08359990268945694,
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-0.05387561023235321,
0.00183... |
gravis, occur more commonly in the popu-\nlation with type 1 diabetes than in thegeneral pediatric population and shouldbe assessed and monitored as clinically in-\ndicated. In addition, relatives of youth\nwith type 1 diabetes should be offeredtesting for islet autoantibodies through re-\nsearch studies (e.g., TrialNe... | [
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-0.04706823453307152,
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0.11133793741464615,
0.057845160365104675,
0.01766842231154442,
-0.023569446057081223,
0.030671151354908943,
0.0306386835873127,
-0.092886783182621,
0.0591... |
search studies (e.g., TrialNet) and national\nprograms for early diagnosis of preclinicaltype 1 diabetes (stages 1 and 2).\nThyroid Disease\nRecommendations\n14.28 Consider testing children with\ntype 1 diabetes for antithyroid per-\noxidase and antithyroglobulin anti-bodies soon after diagnosis. B\n14.29 Measure thyro... | [
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0.0020877851638942957,
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0.048477064818143845,
0.06888584047555923,
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0.020672185346484184,
0.020575176924467087,
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0.... |
14.29 Measure thyroid-stimulating hor-\nmone concentrations at diagnosis whenclinically stable or soon after optimizingglycemia. If normal, suggest recheckingevery 1 –2 years or sooner if the youth\nhas positive thyroid antibodies or devel-ops symptoms or signs suggestive ofthyroid dysfunction, thyromegaly, anabnormal ... | [
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0.05121248587965965,
0.06605595350265503,
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0.020... |
glycemic variability. B\nAutoimmune thyroid disease is the most\ncommon autoimmune disorder associ-ated with diabetes, occurring in 17 –30%\nof individuals with type 1 diabetes (150,\n154,155). At the time of diagnosis, /C2425%\nof children with type 1 diabetes havethyroid autoantibodies (156), the pres-ence of which i... | [
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0.006200447678565979,
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0.03220228850841522,
0.11038806289434433,
0.06347529590129852,
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dysfunction —most commonly hypothy-\nroidism, although hyperthyroidism oc-curs in /C240.5% of people with type 1\ndiabetes (157,158). For thyroid autoanti-bodies, a study from Sweden indicated\nthat antithyroid peroxidase antibodies\nwere more predictive than antithyroglo-\nbulin antibodies in multivariate analysis | [
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0.03251436725258827,
0.10601141303777695,
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-0.022986125200986862,
-0.05110692232847214,
0.006302612833678722,
-0.048122506588697433,
-0.00... |
bulin antibodies in multivariate analysis\n(159). Thyroid function tests may be mis-\nleading (euthyroid sick syndrome) if per-\nformed at the time of diagnosis owing\nto the effect of previous hyperglycemia,\nketosis or ketoacidosis, weight loss, etc.\nTherefore, if performed at diagnosis and\nslightly abnormal, thyro... | [
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0.04626354202628136,
0.08309033513069153,
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-0... |
slightly abnormal, thyroid function tests\nshould be repeated soon after a period of\nmetabolic stability and achievement of gly-\ncemic goals. Subclinical hypothyroidism\nmay be associated with an increased risk\nof symptomatic hypoglycemia (160) and a\nreduced linear growth rate. Hyperthyroid-\nism alters glucose met... | [
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0.04930690675973892,
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0.009221554733812809,
0.05007588490843773,
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ism alters glucose metabolism and usually\ncauses deterioration of glycemia.\nCeliac Disease\nRecommendations\n14.30 Screen youth with type 1 dia-\nbetes for celiac disease by measuring\nIgA tissue transglutaminase (tTG) anti-bodies, with documentation of nor-\nmal total serum IgA levels, soon after | [
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0.08556283265352249,
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0.01268812082707882,
0.13352428376674652,
-0.09087134152650833,
0.06754498928785324,
0.009349416941404343,
0.01117500476539135,
-0.10375387221574783,
0.0421... |
mal total serum IgA levels, soon after\nthe diagnosis of diabetes, or IgG tTGand deamidated gliadin antibodies ifIgA is defi cient. B\n14.31 Repeat screening for celiac dis-\nease within 2 years of diabetes diagno-\nsis and then again after 5 years and\nconsider more frequent screening inyouth who have symptoms or a firs... | [
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0.03630768... |
consider more frequent screening inyouth who have symptoms or a first-\ndegree relative with celiac disease. B\n14.32 Individuals with confi rmed ce-\nliac disease should be placed on a\ngluten-free diet for treatment and to | [
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0... |
gluten-free diet for treatment and to\navoid complications. Youth and theircaregivers should also have a consul-tation with a registered dietitian nu-tritionist experienced in managingboth diabetes and celiac disease. B\nCeliac disease is an immune-mediated\ndisorder that occurs with increased fre-\nquency in people wi... | [
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0.07086833566427231,
0.023327834904193878,
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-0.026... |
quency in people with type 1 diabetes\n(1.6–16.4% of individuals compared with\n0.3–1% in the general population) (149,\n152,153,161 –165). Screening people with\ntype 1 diabetes for celiac disease is furtherjustified by its association with osteoporosis,iron de ficiency, growth failure, and potential\nincreased risk of ... | [
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0.021956076845526695,
0.053757112473249435,
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increased risk of retinopathy and albumin-\nuria (166– 169).\nScreening for celiac disease includes\nmeasuring serum levels of IgA and tis-sue transglutaminase (tTG) IgA antibod-ies, or, with IgA de ficiency, screening\ncan include measuring tTG IgG antibod-ies or deamidated gliadin peptide IgG\nantibodies. Because most... | [
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0.04551161080598831,
0.05160728096961975,
0.02442212589085102,
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-0.0... |
antibodies. Because most cases of celiac\ndisease are diagnosed within the first\n5 years after the diagnosis of type 1 dia-betes, screening should be consideredat the time of diagnosis and repeated at2 and then 5 years (163) or if clinicalsymptoms indicate, such as poor growthor increased hypoglycemia (164,166).\nAltho... | [
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0.05121238902211189,
0.029597772285342216,
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0.... |
Although celiac disease can be diag-\nnosed more than 10 years after diabetes\ndiagnosis, there are insuf ficient data after\n5 years to determine the optimal screen- | [
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5 years to determine the optimal screen-\ning frequency. Measurement of tTG anti-body should be considered at other timesin individuals with symptoms suggestive ofceliac disease (163). Monitoring for symp-toms should include an assessment of lin-ear growth and weight gain (164,166). Asmall bowel biopsy in antibody-posi... | [
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children is recommended to con firm the\ndiagnosis (170). European guidelines on\nscreening for celiac disease in children (notspecifi c to children with type 1 diabetes)\nsuggest that biopsy may not be necessaryin symptomatic children with high anti-body titers (i.e., greater than 10 times theupper limit of normal) prov... | [
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ther testing is performed (veri fication of\nendomysial antibody positivity on a sepa-\nrate blood sample) (171). Whether thisapproach may be appropriate for asymp-tomatic children in high-risk groups re-mains an open question, though evidenceis emerging (172). It is also advisable tocheck for celiac disease –associated... | [
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types in individuals who are diagnosedwithout a small intestinal biopsy. In symp-tomatic children with type 1 diabetes andconfirmed celiac disease, gluten-free diets\nreduce symptoms and rates of hypoglyce-mia (173). The challenging dietary restric-tions associated with having both type 1diabetes and celiac disease plac... | [
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cant burden on individuals. Therefore, a\nbiopsy to confi rm the diagnosis of celiac dis-\nease is recommended, especially in asymp-\ntomatic children, before establishing adiagnosis of celiac disease (171) and endors-ing signifi cant dietary changes. A gluten- | [
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