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free diet was benefi cial in asymptomaticdiabetesjournals.org/care Children and Adolescents S265\n©AmericanDiabetesAssociation | [
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adults with positive antibodies con firmed\nby biopsy (174).\nManagement of Cardiovascular Risk\nFactors\nHypertension Screening\nRecommendation\n14.33 Blood pressure should be mea-\nsured at every routine visit. In youth\nwith high blood pressure (blood pres-sure$90th percentile for age, sex, | [
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and height or, in adolescents aged$13 years, blood pressure $120/80\nmmHg) on three separate measure-\nments, ambulatory blood pressure\nmonitoring should be strongly consid-ered. B\nHypertension Treatment\nRecommendations\n14.34 Treatment of elevated blood\npressure (de fin e da s9 0 t ht o <95th\npercentile for age, s... | [
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percentile for age, sex, and height\nor, in adolescents aged $13 years,\n120–129/<80 mmHg) is lifestyle mod-\nific a t i o nf o c u s e do nh e a l t h yn u t r i t i o n ,\nphysical activity, sleep, and, if appro-priate, weight management. C\n14.35 In addition to lifestyle modi fica- | [
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14.35 In addition to lifestyle modi fica-\ntion, ACE inhibitors or angiotensin re-ceptor blockers should be started for\ntreatment of con firmed hypertension\n(defined as blood pressure consis-\ntently$95th percentile for age, sex,\nand height or, in adolescents aged\n$13 years, $130/80 mmHg). Due to | [
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and height or, in adolescents aged\n$13 years, $130/80 mmHg). Due to\nthe potential teratogenic effects, indi-viduals of childbearing age should re-ceive reproductive counseling, andACE inhibitors and angiotensin recep-\ntor blockers should be avoided in in-\ndividuals of childbearing age who arenot using reliable cont... | [
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14.36 The goal of treatment is blood\npressure <90th percentile for age,\nsex, and height or, in adolescents aged\n$13 years, <130/80 mmHg. C\nBlood pressure measurements should be\nperformed using the appropriate size cuffwith the youth seated and relaxed. Ele-vated blood pressure should be con firmed | [
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on at least three separate days, and ambu-latory blood pressure monitoring shouldbe considered. Evaluation should proceed\nas clinically indicated (175,176). Treatment\nis generally initiated with an ACE inhibitor,but an angiotensin receptor blocker can be\nused if the ACE inhibitor is not tolerated(e.g., due to cough)... | [
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Dyslipidemia Screening\nRecommendations\n14.37 Initial lipid pro file should be\nperformed soon after diagnosis, pref-\nerably after glycemia has improved\nand age is $2y e a r s .I fi n i t i a lL D Lc h o -\nlesterol is #100 mg/dL ( #2.6 mmol/L),\nsubsequent testing should be per-\nformed at 9 –11 years of age. BIniti... | [
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formed at 9 –11 years of age. BInitial\ntesting may be done with a nonfast-\ning lipid level with con firmatory test-\ning with a fasting lipid panel.\n14.38 If LDL cholesterol values are within\nthe accepted risk level (< 100 mg/dL\n[<2.6 mmol/L]), a lipid pro file repeated\nevery 3 years is reasonable. E\nDyslipidemia ... | [
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every 3 years is reasonable. E\nDyslipidemia Treatment\nRecommendations\n14.39 If lipids are abnormal, initial ther-\napy should consist of optimizing glyce-\nmia and medical nutrition therapy to\nlimit the amount of calories from fat to\n25–30% and saturated fat to <7%, limit\ncholesterol to <200 mg/day, avoid\ntrans ... | [
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trans fats, and aim for /C2410% calories\nfrom monounsaturated fats. A\n14.40 After the age of 10 years, addi-\ntion of a statin may be considered inyouth with type 1 diabetes who, de-\nspite medical nutrition therapy and life-\ns t y l ec h a n g e s ,c o n t i n u et oh a v eL D L\ncholesterol >160 mg/dL ( >4.1 mmol/... | [
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cholesterol >160 mg/dL ( >4.1 mmol/L)\nor LDL cholesterol >130 mg/dL\n(>3.4 mmol/L) and one or more car-\ndiovascular disease risk factors. EDue\nto the potential teratogenic effects, in-dividuals of childbearing age should re-\nceive reproductive counseling, and\nstatins should be avoided in individuals | [
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statins should be avoided in individuals\nof childbearing age who are not usingreliable contraception. B\n14.41 The goal of therapy is an\nLDL cholesterol value <100 mg/dL\n(<2.6 mmol/L). E\nPopulation-based studies estimate that\n14–4 5 %o fc h i l d r e nw i t ht y p e1d i a b e t e s\nhave two or more atheroscleroti... | [
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have two or more atherosclerotic cardio-\nvascular disease (ASCVD) risk factors\n(178–180), and the prevalence of cardio-\nvascular disease (CVD) risk factors increasewith age (180) and among racial/ethnic mi-\nnorities (40), with girls having a higher riskburden than boys (179).\nPathophysiology. The atherosclerotic p... | [
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Pathophysiology. The atherosclerotic pro-\ncess begins in childhood, and althoughASCVD events are not expected to occur\nduring childhood, observations using a va-\nriety of methodologies show that youthwith type 1 diabetes may have subclinicalCVD within the first decade of diagnosis\n(181–183). Studies of carotid intim... | [
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(181–183). Studies of carotid intima media\nthickness have yielded inconsistent results(176,177).\nScreening. Diabetes predisposes to the\ndevelopment of accelerated arterioscle-rosis. Lipid evaluation for these individu-\nals contributes to risk assessment and\nidenti fies an important proportion of | [
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identi fies an important proportion of\nthose with dyslipidemia. Therefore, ini-tial screening should be done soon afterdiagnosis. If the initial screen is normal,\nsubsequent screening may be done at\n9–11 years of age, which is a stable time | [
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9–11 years of age, which is a stable time\nfor lipid assessment in children (184).Children with a primary lipid disorder(e.g., familial hyperlipidemia) should\nbe referred to a lipid specialist. Non-HDL\ncholesterol level has been identi fied as a\nsignifi cant predictor of the presence of ath-\nerosclerosis —as powerful... | [
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erosclerosis —as powerful as any other li-\npoprotein cholesterol measure in children\nand adolescents. For both children and\nadults, non-HDL cholesterol level seemsto be more predictive of persistent dyslipi-demia and, therefore, atherosclerosis andfuture events than total cholesterol, LDL\ncholesterol, or HDL choles... | [
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cholesterol, or HDL cholesterol levels\nalone. A major advantage (185) of non-HDL cholesterol is that it can be accuratelycalculated in a nonfasting state and there-fore is practical to obtain in clinical practice\nas a screening test (186). Youth with type 1\nd i a b e t e sh a v eah i g hp r e v a l e n c eo fl i p i... | [
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Even if normal, screening should be re-\npeated within 3 years, as A1C and other\ncardiovascular risk factors can change\ndramatically during adolescence (187).\nTreatment. Pediatric lipid guidelines pro-\nvide some guidance relevant to children\nwith type 1 diabetes and secondary dys- | [
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with type 1 diabetes and secondary dys-\nlipidemia (176,184,188,189); however,there are few studies on modifying lipidlevels in children with type 1 diabetes. A6-month trial of dietary counseling pro-\nduced a signi ficant improvement in lipid | [
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duced a signi ficant improvement in lipid\nlevels (190); likewise, a lifestyle interventionS266 Children and Adolescents Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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trial with 6 months of exercise in adoles-\ncents demonstrated improvement in lipidlevels (191). Data from the SEARCH for Dia-betes in Youth (SEARCH) study show that\nimproved glucose over a 2-year period is\nassociated with a more favorable lipid pro-file; however, improved glycemia alone will\nnot normalize lipids in ... | [
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not normalize lipids in youth with type 1 di-\nabetes and dyslipidemia (187).\nAlthough intervention data are sparse,\nthe American Heart Association catego-\nrizes children with type 1 diabetes in thehighest tier for cardiovascular risk and rec-\nommends both lifestyle and pharmaco- | [
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ommends both lifestyle and pharmaco-\nlogic treatment for those with elevatedLDL cholesterol levels (189,192). Initial\ntherapy should include a nutrition plan that\nrestricts saturated fat to 7% of total caloriesand dietary cholesterol to 200 mg/day(184). Data from randomized clinical trials\nin children as young as 7... | [
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in children as young as 7 months of age\nindicate that this diet is safe and does notinterfere with normal growth and develop-ment (193).\nNeither long-term safety nor cardio-\nvascular outcome effi cacy of statin ther-\napy has been established for children;however, studies have shown short-termsafety equivalent to tha... | [
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and ef ficacy in lowering LDL cholesterol\nlevels in familial hypercholesterolemia or\nsevere hyperlipidemia, improving endo-\nthelial function and causing regression of\ncarotid intimal thickening (194,195). Sta-tins are not approved for children aged<10 years, and statin treatment should | [
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generally not be used in children withtype 1 diabetes before this age. Statinsare contraindicated in pregnancy; there-fore, the prevention of unplanned preg-\nnancies is of paramount importance.\nStatins should be avoided in individualsof childbearing age who are not usingreliable contraception (see Section 15, | [
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“Management of Diabetes in Pregnancy, ”\nfor more information). The multicenter,\nrandomized, placebo-controlled Adoles-cent Type 1 Diabetes Cardio-Renal Inter-\nvention Trial (AdDIT) provides safety data\non pharmacologic treatment with an ACEinhibitor and statin in adolescents withtype 1 diabetes (176).\nMicrovascula... | [
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Microvascular Complications\nNephropathy Screening\nRecommendation\n14.42 Annual screening for albumin-\nuria with a random (morning sample\npreferred to avoid effects of exercise)spot urine sample for albumin-to-creatinine ratio should be consideredat puberty or at age >10 years, which-\never is earlier, once the yout... | [
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0.0... |
ever is earlier, once the youth has haddiabetes for 5 years. B\nNephropathy Treatment\nRecommendation\n14.43 An ACE inhibitor or an angioten-\nsin receptor blocker, titrated to normal-\nization of albumin excretion, may be\nconsidered when elevated urinary\nalbumin-to-creatinine ratio ( >30 mg/g) | [
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0.06787360459566116,
0.06947591155767441,
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-0.03777463361620903,
0.028791304677724838,
0.030513834208250046,
-0.0558185949921608,
0.084... |
albumin-to-creatinine ratio ( >30 mg/g)\nis documented (two of three urinesamples obtained over a 6-month in-\nterval following efforts to improve gly-\ncemia and normalize blood pressure). E\nDue to the potential teratogenic ef-\nfects, individuals of childbearing age\nshould receive reproductive counsel-\ning, and AC... | [
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0.019402632489800453,
-0.05653800070285797,
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0.016936395317316055,
0.010819698683917522,
0.03063189424574375,
0.1247529685497284,
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0.0017338893376290798,
0.017939819023013115,
-0.04758591204881668,
-0.07859533280134201,
0.02... |
ing, and ACE inhibitors and angiotensin\nreceptor blockers should be avoided in\nindividuals of childbearing age who\nare not using reliable contraception. B\nData from 7,549 participants <20 years of\nage in the T1D Exchange clinic registry em- | [
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0.049440402537584305,
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0.03862836956977844,
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0.06472867727279663,
-0.07539358735084534,
-0.01051534... |
phasize the importance of meeting glyce-mic and blood pressure goals, particularlyas diabetes duration increases, in order toreduce the risk of diabetic kidney disease.T h ed a t aa l s ou n d e r s c o r et h ei m p o r t a n c eof routine screening to ensure early diag-nosis and timely treatment of albuminuria(196). ... | [
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0.017029713839292526,
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-... |
and timely treatment of albuminuria(196). An estimation of glomerular filtra- | [
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tion rate (GFR), calculated using GFRestimating equations from the serum cre-atinine, height, age, and sex (197), shouldbe considered at baseline and repeated asindicated based on clinical status, age, dia-betes duration, and therapies. Improvedmethods are needed to screen for earlyGFR loss since estimated GFR is inacc... | [
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2(197,198).\nThe AdDIT study in adolescents with type 1diabetes demonstrated the safety of ACE\ninhibitor treatment, but the treatment did\nnot change the albumin-to-creatinine ratioover the course of the study (176).\nRetinopathy\nRecommendations\n14.44 An initial dilated and compre- | [
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... |
Retinopathy\nRecommendations\n14.44 An initial dilated and compre-\nhensive eye examination is recom-mended once youth have had type 1diabetes for 3 –5y e a r s ,p r o v i d e dt h e yare aged $11 years or puberty has\nstarted, whichever is earlier. B\n14.45 After the initial examination,\nrepeat dilated and comprehens... | [
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-0.014162201434373856,
-0.07882241159677505,
0.07323618... |
14.45 After the initial examination,\nrepeat dilated and comprehensive\neye examination every 2 years. Less\nfrequent examinations, every 4 years,may be acceptable on the advice of\nan eye care professional and based\non risk factor assessment, including ahistory of A1C <8%.B\n14.46 Programs that use retinal pho- | [
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0.05... |
14.46 Programs that use retinal pho-\ntography (with remote reading or useof a validated assessment tool) to im-prove access to diabetic retinopathyscreening can be appropriate screening\nstrategies for diabetic retinopathy. Such\nprograms need to provide pathways fortimely referral for a comprehensive eye\nexamination... | [
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0.025796422734856606,
-0.014342919923365116,
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0... |
examination when indicated. E\nRetinopathy (like albuminuria) most com-\nmonly occurs after the onset of puberty\nand after 5 –10 years of diabetes duration | [
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0.0915... |
and after 5 –10 years of diabetes duration\n(199). It is currently recognized that thereis a low risk of development of vision-threatening retinal lesions prior to 12 yearsof age (200,201). A 2019 publication basedon the follow-up of the DCCT adolescent\ncohort supports a lower frequency of eye | [
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cohort supports a lower frequency of eye\nexaminations than previously recom-mended, particularly in adolescents withA1C closer to the goal range (202,203).Referrals should be made to eye careprofessionals with expertise in diabeticretinopathy and experience in counsel-ing pediatric patients and families on the | [
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importance of prevention, early detec-\ntion, and intervention.\nNeuropathy\nRecommendation\n14.47 Consider an annual comprehen-\nsive foot exam at the start of puberty or\nat age$10 years, whichever is earlier,\nonce the youth has had type 1 diabetesfor 5 years. The examination should in-\nclude inspection, assessment... | [
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0.080845408141613,
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-0.05251249298453331,
0.064842313528... |
clude inspection, assessment of foot\npulses, pinprick, and 10-g monofi la-\nment sensation tests, testing of vibra-tion sensation using a 128-Hz tuning\nfork, and ankle re flex tests. B\nDiabetic neuropathy rarely occurs in pre-\npubertal children or after only 1 –2y e a r s | [
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0.03514016792178154,
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0.04680239409208298,
0.061570752412080765,
-0.05103854089975357,
0.04980294778943062,
0.04198956489562988,
-0.00638040853664279,
-0.07729452848434448,
0.069036... |
pubertal children or after only 1 –2y e a r s\nof diabetes (199), although data suggest aprevalence of distal peripheral neuropathyof 7% in 1,734 youth with type 1 diabetesand association with the presence of CVDdiabetesjournals.org/care Children and Adolescents S267\n©AmericanDiabetesAssociation | [
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0.01897507533431053,
0.07027813047170639,
0.06456217169761658,
-0.021729854866862297,
0.05... |
risk factors (204,205). A comprehensive\nfoot exam, including inspection, palpation\nof dorsalis pedis and posterior tibialpulses, and determination of propriocep-tion, vibration, and mono filament sensa-\ntion, should be performed annually along\nwith an assessment of symptoms of neu- | [
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0.07770134508609772,
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0.07460501790046692,
0.10814858227968216,
-0.059610869735479355,
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0.082... |
with an assessment of symptoms of neu-\nropathic pain (205). Foot inspection canbe performed at each visit to educate youthregarding the importance of foot care (seeSection 12, “Retinopathy, Neuropathy, and\nFoot Care” ).\nTYPE 2 DIABETES\nFor information on risk-based screening for | [
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TYPE 2 DIABETES\nFor information on risk-based screening for\ntype 2 diabetes and prediabetes in youth,please refer to Section 2, “Diagnosis and\nClassi fication of Diabetes. ”For additional\nsupport for these recommendations, see\nthe ADA position statement “Evaluation\nand Management of Youth-Onset Type 2\nDiabetes ”(... | [
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0.04749... |
and Management of Youth-Onset Type 2\nDiabetes ”(3).\nT h ep r e v a l e n c eo ft y p e2d i a b e t e si n\nyouth has continued to increase over the\npast 20 years (4). The CDC published pro-jections for type 2 diabetes prevalence\nusing the SEARCH database; assuming a | [
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0.0009911864763125777,
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0.033735647797584534,
0.07074278593063354,
-0.10155189037322998,
0.027011... |
using the SEARCH database; assuming a\n2.3% annual increase, the prevalence inthose under 20 years of age will quadru-ple in 40 years (206,207).\nEvidence suggests that type 2 diabetes\nin youth is different not only from type 1diabetes but also from type 2 diabetes in\nadults and has unique features, such as a | [
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-0.00864493940025568,
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0.059... |
adults and has unique features, such as a\nmore rapidly progressive decline in b-cell\nfunction and accelerated development of\ndiabetes complications (3,208). Long-termfollow-up data from the Treatment Op-\ntions for Type 2 Diabetes in Adolescents | [
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0.059338606894016266,
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0.00095... |
tions for Type 2 Diabetes in Adolescents\nand Youth (TODAY) study showed that amajority of individuals with type 2 diabe-tes diagnosed as youth had microvascularcomplications by young adulthood (209).\nType 2 diabetes disproportionately im- | [
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0.076... |
Type 2 diabetes disproportionately im-\npacts youth of ethnic and racial minoritiesand can occur in complex psychosocialand cultural environments, which maymake it dif ficult to sustain healthy lifestyle\nchanges and self-management behaviors\n(41,210– 213). Additional risk factors asso-\nciated with type 2 diabetes in ... | [
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0.04723631218075752,
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0.0253... |
ciated with type 2 diabetes in youth in-\nclude adiposity, family history of diabetes,female sex, and low socioeconomic status(208).\nAs with type 1 diabetes, youth with\ntype 2 diabetes spend much of the day in\nschool. Therefore, close communication | [
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0.09977319091558456,
0.010954284109175205,
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0.018... |
school. Therefore, close communication\nwith and the cooperation of school per-sonnel are essential for optimal diabetesmanagement, safety, and maximal aca-\ndemic opportunities.\nScreening and Diagnosis\nRecommendations\n14.48 Risk-based screening for predia-\nbetes and/or type 2 diabetes should\nbe considered after t... | [
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0.06783214211463928,
-0.0503910593688488,
0.01655237004160881,
-0.060810636729002,
0.03730208799242973,
0.07104020565748215,
0.05974060669541359,
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0.004732461180537939,
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-0.09154340624809265,
0.0082005606... |
be considered after the onset of pu-\nberty or $10 years of age, whichever\noccurs earlier, in youth with over-\nweight (BMI $85th percentile) or\nobesity (BMI $95th percentile) and\nwho have one or more additional\nrisk factors for diabetes (see Table 2.5\nfor evidence grading of other riskfactors).\n14.49 If screenin... | [
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0.053788479417562485,
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-0.06937460601329803,
0.041... |
14.49 If screening is normal, repeat\nscreening at a minimum of 3-year in-\ntervals, Eor more frequently if BMI is\nincreasing. C\n14.50 Fasting plasma glucose, 2-h\nplasma glucose during a 75-g oral glu-\ncose tolerance test, and A1C can be\nused to test for prediabetes or diabe-\ntes in children and adolescents. B\n1... | [
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0.014454127289354801,
0.023351969197392464,
-0.02927846647799015,
-0.11579093337059021,
... |
14.51 Children and adolescents with\noverweight or obesity in whom thediagnosis of type 2 diabetes is being\nconsidered should have a panel of\npancreatic autoantibodies tested to\nexclude the possibility of autoimmune\ntype 1 diabetes. B\nIn the last decade, the incidence and prev- | [
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0.019370432943105698,
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0.07061... |
type 1 diabetes. B\nIn the last decade, the incidence and prev-\nalence of type 2 diabetes in adolescentshas increased dramatically, especially in\nracial and ethnic minority populations\n(184,214). A few studies suggest oral glu-cose tolerance tests or fasting plasma glu-\ncose values as more suitable diagnostic | [
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0.0... |
cose values as more suitable diagnostic\ntests than A1C in the pediatric population,especially among certain ethnicities (215),\nalthough fasting glucose alone may over-\ndiagnose diabetes in children (216,217).In addition, many of these studies do notrecognize that diabetes diagnostic criteria\nare based on long-term ... | [
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0.02... |
are based on long-term health outcomes,\nand validations are not currently availablein the pediatric population (218). An anal-\nysis of National Health and Nutrition Ex-\namination Survey (NHANES) data suggestsusing A1C for screening of high-risk youth\n(219).\nThe ADA acknowledges the limited\ndata supporting A1C for... | [
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data supporting A1C for diagnosing type 2\ndiabetes in children and adolescents.Although A1C is not recommended for\ndiagnosis of diabetes in children with\ncystic fibrosis or symptoms suggestiveof acute onset of type 1 diabetes, and | [
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0.007364844903349876,
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0.059221163392066956,
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0.... |
only A1C assays without interferenceare appropriate for children with hemo-globinopathies, the ADA continues torecommend A1C for diagnosis of type 2diabetes in this population (214,215).\nDiagnostic Challenges\nGiven the current obesity epidemic, dis-tinguishing between type 1 and type 2diabetes in children can be dif ... | [
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Overweight and obesity are common inchildren with type 1 diabetes (42), anddiabetes-associated autoantibodies andketosis may be present in pediatric indi-viduals with clinical features of type 2diabetes (including obesity and acanthosisnigricans) (216). The presence of isletautoantibodies has been associated withfaster... | [
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... |
has been associated withfaster progression to insulin defi ciency | [
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(216). At the onset, DKA occurs in /C246% of\nyouth aged 10 –19 years with type 2 diabe- | [
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tes (220). Although uncommon, type 2 di-abetes has been observed in prepubertalchildren under the age of 10 years, andthus it should be part of the differential inchildren with suggestive symptoms (221).Finally, obesity contributes to the develop-ment of type 1 diabetes in some individu-als (222), which further blurs t... | [
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individu-als (222), which further blurs the linesbetween diabetes types. However, accu-rate diagnosis is critical, as treatmentplans, educational approaches, dietary ad-vice, and outcomes differ markedly be-tween individuals with the two diagnoses.The signi ficant diagnostic dif ficulties posed | [
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by MODY are discussed in Section 2,“Diagnosis and Classi fication of Diabetes. ”\nIn addition, there are rare and atypical dia-betes cases that represent a challenge forclinicians and researchers.\nManagement\nLifestyle Management\nRecommendations\n14.52 All youth with type 2 diabetes\nand their families should receive ... | [
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0.0... |
and their families should receive com-\nprehensive diabetes self-managementeducation and support that is speci fic\nto youth with type 2 diabetes and isculturally appropriate. B\n14.53 Youth with overweight/obesity\nand type 2 diabetes and their families\nshould be provided with developmen-\ntally and culturally appropr... | [
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0.0583... |
tally and culturally appropriate com-\nprehensive lifestyle programs that areintegrated with diabetes managementto achieve at least a 7 –10% decrease\nin excess weight. CS268 Children and Adolescents Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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14.54 Given the necessity of long-\nterm weight management for youth\nwith type 2 diabetes, lifestyle inter-\nvention should be based on a chronic\ncare model and offered in the context\nof diabetes care. E\n14.55 Youth with prediabetes and\ntype 2 diabetes, like all children andadolescents, should be encouraged\nto pa... | [
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0.02388... |
to participate in at least 60 min of\nmoderate to vigorous physical ac-\ntivity daily (with muscle and bone\nstrength training at least 3 days/\nweek) Band to decrease sedentary\nbehavior. C\n14.56 Nutrition for youth with predia-\nbetes and type 2 diabetes, like for all\nchildren and adolescents, should focus\non heal... | [
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on healthy eating patterns that empha-\nsize consumption of nutrient-dense,\nhigh-quality foods and decreased con-\nsumption of calorie-dense, nutrient-\npoor foods, particularly sugar-added\nbeverages. B\nGlycemic Goals\nRecommendations\n14.57 Blood glucose monitoring | [
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Glycemic Goals\nRecommendations\n14.57 Blood glucose monitoring\nshould be individualized, taking intoconsideration the pharmacologic treat-ment of the youth with type 2 diabe-tes.E\n14.58 Real-time CGM or intermittently | [
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0.0130... |
14.58 Real-time CGM or intermittently\nscanned CGM should be offered fordiabetes management in youth withtype 2 diabetes on multiple daily injec-tions or insulin pumps who are capableof using the device safely (either bythemselves or with a caregiver). Thechoice of device should be made basedon an individual ’s and fam... | [
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0.03851141780614853,
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0.0565... |
stances, desires, and needs. E\n14.59 Glycemic status should be as-\nsessed at least every 3 months. E\n14.60 A reasonable A1C goal for most\nchildren and adolescents with type 2 di-abetes is <7% (<53 mmol/mol). More\nstringent A1C goals (such as <6.5%\n[<48 mmol/mol]) may be appropriate\nfor selected individuals if th... | [
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for selected individuals if they can be\nachieved without signi ficant hypoglyce-\nmia or other adverse effects of treat-\nment. Appropriate individuals mighti n c l u d et h o s ew i t has h o r td u r a t i o no fdiabetes and lesser degrees of b-cell | [
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0.007231... |
dysfunction and individuals treatedwith lifestyle or metformin only whoachieve signi ficant weight improve-\nment. E\n14.61 Less stringent A1C goals (such\nas 7.5% [58 mmol/mol]) may be ap-\npropriate if there is an increased risk\nof hypoglycemia. E\n14.62 A1C goals for individuals on in-\nsulin should be individualize... | [
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... |
sulin should be individualized, taking\ninto account the relatively low rates of\nhypoglycemia in youth-onset type 2\ndiabetes. E\nPharmacologic Management\nRecommendations\n14.63 Initiate pharmacologic therapy,\nin addition to behavioral counseling\nfor healthful nutrition and physical ac-\ntivity changes, at diagnosi... | [
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0.084... |
tivity changes, at diagnosis of type 2\ndiabetes. A\n14.64 In individuals with incidentally\ndiagnosed or metabolically stable dia-\nbetes (A1C <8.5% [<69 mmol/mol]\nand asymptomatic), metformin is the\ninitial pharmacologic treatment of\nchoice if renal function is normal. A\n14.65 Y o u t hw i t hm a r k e dh y p e r... | [
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0.0... |
14.65 Y o u t hw i t hm a r k e dh y p e r g l y c e -\nmia (blood glucose $250 mg/dL\n[$13.9 mmol/L], A1C $8.5% [ $69\nmmol/mol]) without acidosis at diag-\nnosis who are symptomatic with\npolyuria, polydipsia, nocturia, and/or\nweight loss should be treated initially\nwith long-acting insulin while metfor-\nmin is in... | [
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min is initiated and titrated. B\n14.66 In individuals with ketosis/ketoa-\ncidosis, treatment with subcutaneousor intravenous insulin should be initi-\nated to rapidly correct the hyperglyce-\nmia and the metabolic derangement.\nOnce acidosis is resolved, metformin\nshould be initiated while subcutaneous\ninsulin ther... | [
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insulin therapy is continued. A\n14.67 In individuals presenting with\nsevere hyperglycemia (blood glucose$600 mg/dL [ $33.3 mmol/L]), con-\nsider assessment for hyperglycemichyperosmolar nonketotic syndrome. A\n14.68 If glycemic goals are no longer\nmet with metformin (with or withoutlong-acting insulin), glucagon-lik... | [
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tide 1 (GLP-1) receptor agonist therapy\nand/or empagli flozin should be consid-\nered in children 10 years of age orolder. A\n14.69 When choosing glucose-lowering\nor other medications for youth withoverweight or obesity and type 2diabetes, consider medication-taking\nbehavior and the medications ’effect\non weight. E | [
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behavior and the medications ’effect\non weight. E\n14.70 For youth not meeting glycemic\ngoals, maximize noninsulin therapies(metformin, a GLP-1 receptor agonist,\nand empagli flozin) before initiating\nand/or intensifying insulin therapy plan. E\n14.71 In individuals initially treated\nwith insulin and metformin and/o... | [
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0.028... |
with insulin and metformin and/or\nother glucose lowering medications\nwho are meeting glucose goals based\non blood glucose monitoring or CGM,insulin can be tapered over 2 –6 weeks\nby decreasing the insulin dose 10 –30%\nevery few days. B\nTreatment of youth-onset type 2 diabetes | [
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0.0675... |
every few days. B\nTreatment of youth-onset type 2 diabetes\nshould include lifestyle management, dia-betes self-management education and\nsupport, and pharmacologic treatment.\nInitial treatment of youth with obesity\nand diabetes must take into account that\ndiabetes type is often uncertain in the\nfirst few weeks of ... | [
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0.04... |
first few weeks of treatment due to\noverlap in presentation and that a sub-\nstantial percentage of youth with type 2\ndiabetes will present with clinically signif-\nicant ketoacidosis (223). Therefore, initial\ntherapy should address the hyperglyce-\nmia and associated metabolic derange-\nments irrespective of ultimat... | [
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0.0081281... |
ments irrespective of ultimate diabetes\ntype, with adjustment of therapy once\nmetabolic compensation has been estab-\nlished and subsequent information, such\nas islet autoantibody results, becomes\navailable. Figure 14.1 provides an ap-\nproach to the initial treatment of new-\nonset diabetes in youth with overweigh... | [
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0.04294649884104729,
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0.002895... |
onset diabetes in youth with overweight\nor obesity with clinical suspicion of type 2\ndiabetes.\nGlycemic goals should be individual-\nized, taking into consideration the long-\nterm health bene fits of more stringent\ngoals and risk for adverse effects, such as\nhypoglycemia. A lower A1C goal in youth\nwith type 2 dia... | [
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0.01779220812022686,
0.0011448513250797987,
-0.08923594653606415,
0.017852... |
with type 2 diabetes when compared\nwith those recommended in type 1 diabe-\nt e si sj u s t i fied by a lower risk of hypoglyce-\nmia and higher risk of complications\n(209,224– 227).\nSelf-management in pediatric diabetes\ninvolves both the youth and their parents/\nadult caregivers. Individuals and their fam-\nilies ... | [
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ilies should receive education and support\nfor healthful nutrition and physical activity,\nsuch as a balanced meal plan, achieving\nand maintaining a healthy weight, and reg-\nular physical activity. Youth with type 2diabetesjournals.org/care Children and Adolescents S269\n©AmericanDiabetesAssociation | [
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diabetes and comorbidities, including ne-\nphropathy, should continue to have age-\nappropriate protein intake (228). Physical\nactivity should include aerobic, muscle-strengthening, and bone-strengtheningactivities (33). A family-centered approachto nutrition and lifestyle modi fication is es-\nsential in children and ... | [
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sential in children and adolescents with\ntype 2 diabetes, and nutrition recommen-dations should be culturally appropriateand sensitive to family resources (seeSection 5, “Facilitating Positive Health\nBehaviors and Well-being to Improve\nHealth Outcomes ”). Given the complex | [
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Health Outcomes ”). Given the complex\nsocial and environmental context sur-rounding youth with type 2 diabetes,individual-level lifestyle interventions maynot be suf ficient to address the complex\ninterplay of family dynamics, behavioral\nhealth, community readiness, and thebroader environmental system (3).\nAn interp... | [
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An interprofessional diabetes team, in-\ncluding a physician, diabetes care andeducation specialist, registered dietitiannutritionist, and psychologist or social\nworker, is essential. In addition to achiev-\ning glycemic goals and self-managementeducation (229 –231), initial treatment\nmust include management of comor... | [
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