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must include management of comorbid-\nities such as obesity, dyslipidemia, hyper-tension, and microvascular complications.\nCurrent pharmacologic treatment op-\ntions for youth-onset type 2 diabetes are\nlimited to four approved drug classes: in-sulin, metformin, glucagon-like peptide 1(GLP-1) receptor agonists, and so... | [
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glucose cotransporter 2 inhibitors (speci fi-\ncally empagli flozin). Presentation with ke- | [
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toacidosis or marked ketosis requires aperiod of insulin therapy until fasting andpostprandial glycemia have been restoredto normal or near-normal levels. Insulinpump therapy may be considered as anoption for those on long-term multiple dailyinjections who are able to safely managethe device. Initial treatment should a... | [
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device. Initial treatment should also bewith insulin when the distinction between | [
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type 1 diabetes and type 2 diabetes is un-clear and in individuals who have randomblood glucose concentrations $250 mg/dL\n($13.9 mmol/L) and/or A1C $8.5%\n($69 mmol/mol) (232). Metformin therapy\nshould be added after resolution of keto-sis/ketoacidosis.\nWhen initial insulin treatment is not | [
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When initial insulin treatment is not\nrequired, initiation of metformin is rec-ommended. The TODAY study found thatmetformin alone provided durable glyce-mic control (A1C #8% [#64 mmol/mol]\nfor 6 months) in approximately half of | [
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for 6 months) in approximately half of\nthe subjects (233). The Restoring InsulinSecretion (RISE) Consortium study did notdemonstrate differences in measures ofglucose or b-cell function preservation\nbetween metformin and insulin, but there\nwas more weight gain with insulin (234).\nTo date, the TODAY study is the onl... | [
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To date, the TODAY study is the only\ntrial combining lifestyle and metformin\ntherapy in youth with type 2 diabetes; theNew-Onset Diabetes in Youth With Overweight or Obesity With Clinical Suspicion of Type 2 Diabetes\nInitiate lifestyle management and diabetes education\nA1C <8.5%\nNo acidosis or ketosisA1C ≥8.5% | [
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A1C <8.5%\nNo acidosis or ketosisA1C ≥8.5%\nNo acidosis with or without ketosisAcidosis and/or DKA and/or HHNK\n/g131/g3Metformin\n • Titrate up to 2,000 mg per day\n as tolerated/g131/g3Metformin\n • Titrate up to 2,000 mg per day as tolerated\n/g131/g3Long-acting insulin: start at 0.5 units/kg/day\n and titrate... | [
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and titrate every 2–3 days based on\n BGM/g131/g3Manage DKA or HHNK\n/g131/g3i.v. insulin until acidosis resolves, then\n subcutaneous, as for type 1 diabetes\n until antibodies are known\n/g131/g3Continue or start metformin\n/g131/g3If on insulin, titrate guided by glucose values/g131/g3Continue or initiate MDI insuli... | [
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as for type 1 diabetes\n/g131/g3Discontinue metformin\n/g131/g3Continue metformin\n/g131/g3Consider adding GLP-1 receptor agonist or SGLT2\n inhibitor approved for youth with type 2 diabetes\n/g131/g3Titrate/initiate insulin therapy; if using long-acting insulin\n only and glycemic goal not met with escalating | [
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only and glycemic goal not met with escalating\n doses, then add prandial insulin; total daily insulin dose may exceed 1 unit/kg/day Pancreatic autoantibodies\nNEGATIVE POSITIVE\nA1C goals not met\nFigure 14.1— Management of new-onset diabetes in youth with overweight or obesity with clinical suspicion of type 2 diabet... | [
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Adapted from the ADA position statement “Evaluation and Management of Youth-Onset Type 2 Diabetes ”(3). BGM, blood glucose monitoring; CGM, contin-\nuous glucose monitoring; DKA, diabetic ketoacidosis; GLP-1, glucagon-like peptide 1; HHNK, hyperosmolar hyperglycemic nonketotic syndrome; i.v ., intrave- | [
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nous; MDI, multiple daily injections; SGLT2, sodium –glucose cotransporter 2.S270 Children and Adolescents Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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combination did not perform better than\nmetformin alone in achieving durable gly-cemic levels (233).\nRandomized controlled trials in youth\nhave shown that GLP-1 receptor agonistsare safe and effective for decreasing A1C\n(235–239). Use of GLP-1 receptor ago-\nnists can increase the frequency of gas-trointestinal sid... | [
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be used in individuals with a family his-\ntory of medullary thyroid cancer.\nIn a recent multicenter double-blind, pla-\ncebo-controlled trial, 158 children with type 2diabetes aged between 10 and 17 years\nwere randomized to 10 mg empagli flozin,\n5 mg linagliptin, or placebo. There was a sig-\nnificant reduction in th... | [
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nificant reduction in the primary outcome\n(A1C):/C00.84% from baseline in the empagli-\nflozin group compared with the placebo\ngroup ( P=0 . 0 1 2 ) .T h e r ew e r en oe p i s o d e so f\nsevere hypoglycemia during the study (240).\nBlood glucose monitoring plans should | [
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Blood glucose monitoring plans should\nbe individualized, taking into considerationthe pharmacologic treatment of the per-\nson. Although data on CGM in youth withtype 2 diabetes are sparse (241), CGM\ncould be considered in individuals requir-\ning frequent blood glucose monitoring for\ndiabetes management.\nMetabolic... | [
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diabetes management.\nMetabolic Surgery\nRecommendations\n14.72 Metabolic surgery may be con-\nsidered for the treatment of adoles-\ncents with type 2 diabetes who haveclass 2 obesity or higher (BMI >35\nkg/m\n2or 120% of 95th percentile for\nage and sex, whichever is lower) and\nwho have elevated A1C and/or seri- | [
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who have elevated A1C and/or seri-\nous comorbidities despite lifestyleand pharmacologic intervention. A\n14.73 Metabolic surgery should be per- | [
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14.73 Metabolic surgery should be per-\nformed only by an experienced surgeonworking as part of a well-organized andengaged interprofessional team, includ-ing a surgeon, endocrinologist, regis-tered dietitian nutritionist, behavioralhealth specialist, and nurse. A\nThe results of weight loss and lifestyle in- | [
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The results of weight loss and lifestyle in-\nterventions for obesity in children and ado-\nlescents have been disappointing, and\ntreatment options as adjuncts to lifestyle\ntherapy are limited. Recent U.S. Food and\nDrug Administration– approved medica- | [
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Drug Administration– approved medica-\ntions for youth ages 12 and older includephentermine and topiramate extended-release capsules and GLP-1 receptor ago-\nnists (242– 245). Over the last decade,weight loss surgery has been increasingly | [
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performed in adolescents with obesity.Small retrospective analyses and a prospec-tive multicenter, nonrandomized study sug-gest that bariatric or metabolic surgeryhave bene fits in adolescents with obesity | [
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and type 2 diabetes similar to thoseobserved in adults. Teenagers experiencesimilar degrees of weight loss, diabetes re-mission, and improvement of cardiometa-bolic risk factors for at least 3 years aftersurgery (246). A secondary data analysisfrom the Teen-Longitudinal Assessment of\nBariatric Surgery (Teen-LABS) and ... | [
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studies suggests surgical treatment of ado-lescents with severe obesity and type 2 dia-betes is associated with improved glycemia(247); however, no randomized trials haveyet compared the effectiveness and safetyof surgery to those of conventional treat-ment options in adolescents (248). Theguidelines used as an indicat... | [
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(248). Theguidelines used as an indication for met-abolic surgery in adolescents generallyinclude class 2 obesity or higher (BMI>35 kg/m | [
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2or 120% of 95th percentile\nfor age and sex, whichever is lower, with co-morbidities) or BMI >40 kg/m\n2with or\nwithout comorbidities (249 –261). A num-\nber of groups, including the Pediatric Bariat-ric Study Group and Teen-LABS study, havedemonstrated the effectiveness of meta-bolic surgery in adolescents (253 –259... | [
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Prevention and Management of\nDiabetes Complications\nHypertension\nRecommendations\n14.74 Blood pressure should be mea-\nsured at every clinic visit. In youth\nwith high blood pressure (blood pres-sure$90th percentile for age, sex,\nand height or, in adolescents aged\n$13 years, $120/80 mmHg) on three\nseparate measur... | [
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$13 years, $120/80 mmHg) on three\nseparate measurements, ambulatory\nblood pressure monitoring should be\nstrongly considered. B\n14.75 Treatment of elevated blood\npressure (de fin e da s9 0 t ht o <95th\npercentile for age, sex, and height or, in\nadolescents aged $13 years, 120 –129/\n<80 mmHg) is lifestyle modifi ca... | [
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<80 mmHg) is lifestyle modifi cation fo-\ncused on healthy nutrition, physical ac-tivity, sleep, and, if appropriate, weightmanagement. C\n14.76 In addition to lifestyle modi fica-\ntion, ACE inhibitors or angiotensin re-\nceptor blockers should be started fortreatment of con firmed hypertension | [
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(defined as blood pressure consistently$95th percentile for age, sex, and\nheight or, in adolescents aged$13 years, $130/80 mmHg). Due to\nthe potential teratogenic effects, indi-viduals of childbearing age should re-ceive reproductive counseling, and\nACE inhibitors and angiotensin recep- | [
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ACE inhibitors and angiotensin recep-\ntor blockers should be avoided in indi-viduals of childbearing age who are\nnot using reliable contraception. B\n14.77 The goal of treatment is blood\npressure <90th percentile for age, sex,\nand height or, in adolescents aged$13 years, <130/80 mmHg. C\nNephropathy\nRecommendation... | [
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0.06340295821428299,
0.004759501665830612,
0.1307993084192276,
-0.0032056106720119715,
-0.01813330501317978,
0.041990216821432114,
0.014378565363585949,
-0.07887884229421616,
-0.02... |
Nephropathy\nRecommendations\n14.78 Protein intake should be at\nthe recommended daily allowance of\n0.85–1 . 2g / k g / d a y( a c c o r d i n gt oa g e ) . E\n14.79 Urine albumin-to-creatinine ra-\ntio should be obtained at the time of\ndiagnosis and annually thereafter. An\nelevated urine albumin-to-creatinine\nrati... | [
-0.0008458282682113349,
-0.004986173007637262,
0.058348286896944046,
0.0014801961369812489,
-0.07122614979743958,
-0.05183907970786095,
0.051273517310619354,
0.1491856873035431,
-0.06980974227190018,
-0.04781056568026543,
-0.010363559238612652,
-0.04649753496050835,
-0.024393346160650253,
... |
ratio (>30 mg/g creatinine) should be\nconfirmed on two of three samples. B\n14.80 Estimated glomerular filtration\nrate (GFR) should be determined atthe time of diagnosis and annually\nthereafter. E\n14.81 I ny o u t hw i t hd i a b e t e sa n dh y -\npertension, either an ACE inhibitor oran angiotensin receptor blocker... | [
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-0.009621493518352509,
-0.01825874112546444,
0.005640279036015272,
-0.044072166085243225,
-0.01902872882783413,
0.09724245220422745,
-0.010441942140460014,
-0.038889069110155106,
0.02331284061074257,
-0.05435158684849739,
-0.02402600087225437,
0.... |
ommended for those with modestly el-\nevated urinary albumin-to-creatinineratio (30 –2 9 9m g / gc r e a t i n i n e )a n d\nis strongly recommended for thosewith urinary albumin-to-creatinine ra-\ntio>3 0 0m g / gc r e a t i n i n ea n d / o re s t i -\nmated GFR <60 mL/min/1.73 m\n2.E | [
0.02160024084150791,
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-0.0011353595182299614,
-0.0036092703230679035,
-0.0716492235660553,
-0.034223876893520355,
0.05185951665043831,
0.11411669850349426,
-0.048850707709789276,
-0.03964601084589958,
-0.008072263561189175,
-0.04341377690434456,
-0.06336173415184021,
0... |
mated GFR <60 mL/min/1.73 m\n2.E\nDue to the potential teratogenic ef-fects, individuals of childbearing age\nshould receive reproductive counsel-\ning, and ACE inhibitors and angiotensin\nreceptor blockers should be avoided in\nindividuals of childbearing age who are\nnot using reliable contraception. B\n14.82 For you... | [
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-0.00011511219054227695,
-0.00810012686997652,
0.0003408336779102683,
-0.04486270621418953,
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0.037667274475097656,
0.14753329753875732,
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0.01979394070804119,
0.07792097330093384,
-0.018730878829956055,
-0.08042538911104202,
... |
not using reliable contraception. B\n14.82 For youth with nephropathy,\ncontinue monitoring (yearly and/or\nas indicated by urinary albumin-to-\ncreatinine ratio and estimated GFR)\nto detect disease progression. E\n14.83 Referral to nephrology is rec-\nommended in case of uncertainty of\netiology, worsening urinary al... | [
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0.031563907861709595,
0.024157198145985603,
-0.01026498805731535,
-0.04160701110959053,
-0.00009751600737217814,
0.053148820996284485,
0.10886041820049286,
0.02079310454428196,
-0.027084898203611374,
0.028579777106642723,
0.007850272580981255,
-0.020904388278722763,
... |
etiology, worsening urinary albumin-\nto-creatinine ratio, or decrease in esti-\nmated GFR. Ediabetesjournals.org/care Children and Adolescents S271\n©AmericanDiabetesAssociation | [
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0.018716679885983467,
0.01894819550216198,
-0.05102917551994324,
0.... |
Neuropathy\nRecommendations\n14.84 Youth with type 2 diabetes\nshould be screened for the presence of\nneuropathy by foot examination at di-agnosis and annually. The examination\nshould include inspection, assessment\nof foot pulses, pinprick and 10-g mono-filament sensation tests, testing of | [
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0.04241077974438667,
0.0313052162528038,
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0.001939415349625051,
0.05285579338669777,
-0.005535389296710491,
-0.056356512010097504,
0.0717370... |
vibration sensation using a 128-Hz tun-ing fork, and ankle re flex tests. C\n14.85 Prevention of neuropathy should\nfocus on achieving glycemic goals. C\nRetinopathy\nRecommendations\n14.86 Screening for retinopathy should\nbe performed by dilated fundoscopy at\nor soon after diagnosis and annually\nthereafter. C\n14.87... | [
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0.02783229388296604,
0.03306715190410614,
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0.14828819036483765,
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0.011835310608148575,
0.05961637571454048,
-0.035773713141679764,
-0.07005024701356888,
0.0065... |
thereafter. C\n14.87 Optimizing glycemia is recom-\nmended to decrease the risk or slow\nthe progression of retinopathy. B\n14.88 Less frequent examination (every\n2 years) may be considered if achiev-ing glycemic goals and a normal eye\nexam. C\n14.89 Programs that use retinal pho-\ntography (with remote reading or us... | [
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0.03898552432656288,
0.008944244123995304,
-0.03774969279766083,
0.01028296... |
tography (with remote reading or use\nof a validated assessment tool) to im-\nprove access to diabetic retinopathy\nscreening can be appropriate screening\nstrategies for diabetic retinopathy. Suchprograms need to provide pathways for\ntimely referral for a comprehensive eye\nexamination when indicated. E\nNonalcoholic... | [
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-0.056932233273983,
-0.02153107151389122,
0.096518844... |
Nonalcoholic Fatty Liver Disease\nRecommendations\n14.90 Evaluation of youth with type 2\ndiabetes for nonalcoholic fatty liver\ndisease (by measuring AST and ALT)\nshould be done at diagnosis and annu-\nally thereafter. B\n14.91 Referral to gastroenterology\nshould be considered for persis-\ntently elevated or worseni... | [
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0.0032669880893081427,
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-0.009212675504386425,
0.11337413638830185,
-0.09641639143228531,
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0.045233774930238724,
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0.... |
tently elevated or worsening transa-\nminases. B\nObstructive Sleep Apnea\nRecommendation\n14.92 Screening for symptoms of sleep\napnea should be done at each visit,\nand referral to a pediatric sleepspecialist for evaluation and a polysom-nogram, if indicated, is recommended.Obstructive sleep apnea should betreated wh... | [
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0.049219727516174316,
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-0.009502791799604893,
0.04199909418821335,
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0.02372805029153824,
0.00340843154117465,
-0.018292024731636047,
-0.013985008001327515,
0.10... |
Polycystic Ovary Syndrome\nRecommendations\n14.93 Evaluate for polycystic ovary\nsyndrome in female adolescents with\ntype 2 diabetes, including laboratory\nstudies, when indicated. B\n14.94 Metformin, in addition to life-\nstyle modi fication, is likely to improve\nthe menstrual cyclicity and hyperan-drogenism in femal... | [
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0.02628818154335022,
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0.03904753178358078,
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0.07024455070495605,
0.06812962889671326,
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-0.0633389800786972,
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0.020947549492120743,
-0.057283882051706314,
0.0... |
type 2 diabetes. E\nCardiovascular Disease\nRecommendation\n14.95 Intensive lifestyle interventions\nfocusing on weight loss, dyslipidemia,\nhypertension, and dysglycemia areimportant to prevent overt macrovas-cular disease in early adulthood. E\nDyslipidemia\nRecommendations\n14.96 Lipid screening should be per-\nform... | [
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0.003098009154200554,
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-0.009766612201929092,
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-0.0... |
formed initially after optimizing gly-\ncemia and annually thereafter. B\n14.97 Optimal goals are LDL cholesterol\n<100 mg/dL ( <2.6 mmol/L), HDL cho-\nlesterol >35 mg/dL ( >0.91 mmol/L),\nand triglycerides <150 mg/dL\n(<1.7 mmol/L). E\n14.98 If lipids are abnormal, initial ther-\napy should consist of optimizing glyce... | [
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0.11138288676738739,
-0.06319337338209152,
-0.04031258448958397,
0.05770349130034447,
-0.012458370998501778,
-0.05792803689837456,
... |
apy should consist of optimizing glyce-\nmia and medical nutritional 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 fats, and aim for /C2410% calories\nfrom monounsaturated fats for ele-vated LDL. For elevated triglycerides,medical ... | [
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0.09016472846269608,
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-0.... |
focus on decreasing simple sugar intake\nand increasing dietary n-3 fatty acids in\naddition to the above changes. A\n14.99 If LDL cholesterol remains\n>130 mg/dL ( >3.4 mmol/L) after\n6 months of dietary intervention, initi-ate therapy with statin, with a goal of\nLDL<100 mg/dL ( <2.6 mmol/L). Due | [
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-0.0... |
LDL<100 mg/dL ( <2.6 mmol/L). Due\nto the potential teratogenic effects,individuals of childbearing age should\nreceive reproductive counseling, and\nstatins should be avoided in individu-\nals of childbearing age who are not us-ing reliable contraception. B\n14.100 If triglycerides are >400 mg/dL\n(>4.7 mmol/L) fastin... | [
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0.003518394660204649,
-0.02660510502755642,
-0.021381748840212822,
-0.01632307656109333,
0.058163486421108246,
0.03924145922064781,
0.1514347344636917,
-0.006993851624429226,
-0.009535416960716248,
0.10609328001737595,
-0.02124752290546894,
-0.12564262747764587,
-0.0... |
(>4.7 mmol/L) fasting or >1,000 mg/dL\n(>11.6 mmol/L) nonfasting, optimize\nglycemia and begin fibrate, with a goal\nof<400 mg/dL ( <4.7 mmol/L) fasting\nto reduce risk for pancreatitis. C\nCardiac Function Testing\nRecommendation\n14.101 Routine screening for heart\ndisease with electrocardiogram, echo- | [
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0.008119244128465652,
0.01630789041519165,
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0.06965558975934982,
-0.03134198859333992,
-0.10107927769422531,
0.02486282028257847,
-0.024151194840669632,
-0.04796566069126129,
0.0... |
disease with electrocardiogram, echo-\ncardiogram, or stress testing is not rec-ommended in asymptomatic youthwith type 2 diabetes. B\nComorbidities may already be present\nat the time of diagnosis of type 2 diabe-\ntes in youth (208,262). Therefore, blood | [
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0.08038785308599472,
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-0.020566483959555626,
0.03781808540225029,
0.01568598672747612,
-0.03755569085478783,
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0.017816049978137016,
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0.0... |
tes in youth (208,262). Therefore, blood\npressure measurement, a fasting lipidpanel, assessment of random urine al-bumin-to-creatinine ratio, and a dilatedeye examination should be performed\nat diagnosis. Additional medical conditions | [
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0.05724595859646797,
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0.1055358... |
at diagnosis. Additional medical conditions\nthat may need to be addressed includepolycystic ovary disease and other comor-bidities associated with pediatric obesity,\nsuch as sleep apnea, hepatic steatosis, or-\nthopedic complications, and psychosocialconcerns. The ADA position statement“Evaluation and Management of Y... | [
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-0.028538454324007034,
0.0494171641767025,
-0.00034482195042073727,
-0.060690827667713165,
0.059... |
Onset Type 2 Diabetes ”(3) provides guid-\nance on the prevention, screening, andtreatment of type 2 diabetes and its co-morbidities in children and adolescents.\nYouth-onset type 2 diabetes is associ-\nated with signi ficant microvascular and | [
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... |
ated with signi ficant microvascular and\nmacrovascular risk burden and a substan-tial increase in the risk of cardiovascularmorbidity and mortality at an earlier agethan in those diagnosed later in life(209,263). The higher complication risk in\nearlier-onset type 2 diabetes is likely re- | [
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0.06604079902172089,
0.0033827887382358313,
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0.09630592167377472,
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-0.036685485392808914,
0.014021228067576885,
0.041183263063430786,
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... |
earlier-onset type 2 diabetes is likely re-\nlated to prolonged lifetime exposure tohyperglycemia and other atherogenic riskfactors, including insulin resistance, dys-\nlipidemia, hypertension, and chronic in-\nflammation. There is a low risk of | [
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0.11415793746709824,
0.03845236450433731,
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0.031299177557229996,
0.09555965662002563,
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0.07270447164773941,
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-0.0... |
flammation. There is a low risk of\nhypoglycemia in youth with type 2 dia-betes, even if they are being treatedwith insulin (264), and there are high\nrates of complications (224 –227). These\ndiabetes comorbidities also appear toS272 Children and Adolescents Diabetes Care Volume 47, Supplement 1, January 2024\n©America... | [
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0.002011800417676568,
0.036871690303087234,
-0.06199562922120094,
0.019... |
be higher than in youth with type 1 dia-\nbetes despite shorter diabetes duration\nand lower A1C (262). In addition, the pro-\ngression of vascular abnormalities ap-\npears to be more pronounced in youth-\nonset type 2 diabetes than with type 1\ndiabetes of similar duration, including is-\nchemic heart disease and stro... | [
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0.05589697137475014,
-0.0076292045414447784,
0.025634190067648888,
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0.061451900750398636,
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chemic heart disease and stroke (263).\nIn youth with type 2 diabetes and\npolycystic ovary syndrome, oral contra-ceptives are appropriate agents.\nPsychosocial Factors\nRecommendations\n14.102 Health care professionals\nshould screen for food insecurity, hous-\ning instability/homelessness, health lit-eracy, financial ... | [
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0.062056221067905426,
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0.023776032030582428,
0.05675259605050087,
-0.05779053270816803,
-0.04031066969037056,
0.052518103271722794,
0.01735507883131504,
-0.09067690372467041,
0.01042... |
community support and apply that in-\nformation to treatment decisions. E\n14.103 Use age-appropriate standard-\nized and validated tools to screen for\ndiabetes distress, depressive symp-\ntoms, and behavioral health in youthwith type 2 diabetes, with attentionto symptoms of depression and disor-\ndered eating, and re... | [
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0.07658405601978302,
-0.07591467350721359,
0.031650181859731674,
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0.04953183978796005,
0.04524633288383484,
0.1213827133178711,
-0.08687885850667953,
-0.0014333324506878853,
0.013444356620311737,
-0.009930077940225601,
-0.08785956352949142,
0.02... |
dered eating, and refer to a quali fied\nbehavioral health professional when\nindicated. B\n14.104 Starting at puberty, precon-\nception counseling should be incor-\nporated into routine diabetes clinicvisits for all individuals of childbear-\ning potential because of the ad-\nverse pregnancy outcomes in thispopulation.... | [
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0.08370112627744675,
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0.0768963173031807,
-0.04925112798810005,
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-0.0021725... |
verse pregnancy outcomes in thispopulation. A\n14.105 Adolescents and young adults\nshould be screened for tobacco/nico-\ntine, electronic cigarettes, substance\nuse, and alcohol use at diagnosis andregularly thereafter. C\nMost youth with type 2 diabetes come\nfrom racial/ethnic minority groups, have\nlow socioeconomi... | [
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0.08586075901985168,
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0.05656474456191063,
0.10798552632331848,
0.0023143463768064976,
-0.1262659877538681,
-0.0129... |
low socioeconomic status, and often ex-\nperience multiple psychosocial stressors\n(41,56,212,213). Consideration of the\nsociocultural context and efforts to per-\nsonalize diabetes management are of\ncritical importance to minimize barriers\nto care, enhance participation, and max-\nimize response to treatment.\nEvid... | [
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imize response to treatment.\nEvidence about psychiatric disorders\nand symptoms in youth with type 2 dia-\nb e t e si sl i m i t e d( 2 6 5 –269), but given the\nsociocultural context for many youth andthe medical burden and obesity associ-\nated with type 2 diabetes, ongoing sur- | [
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0.039... |
ated with type 2 diabetes, ongoing sur-\nveillance of behavioral health is indicated.Symptoms of depression and disordered\neating are common and associated with\nhigher A1C (53,266,270,271). Early detec-tion of psychological and behavioral con-\ncerns can facilitate effective treatment\noptions to improve psychosocial... | [
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options to improve psychosocial well-\nbeing and support diabetes (56). When\npsychological symptoms are identi fied,\nreferral to a behavioral health profes-\nsional, ideally with experience in pediatric\ndiabetes, may be warranted. Although farless research has been done on psycho-\nlogical and behavioral intervention... | [
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logical and behavioral interventions for\nyouth with type 2 diabetes than for youthwith type 1 diabetes, behavioral profes-\nsionals can provide behavioral health care\nservices to support youth with type 2 dia-betes (61 –63). Many of the medications | [
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0.07... |
prescribed for diabetes and psychiatricdisorders are associated with weight gainand can increase concerns about eating,\nbody shape, and weight (272,273).\nThe TODAY study documented high\nrates of maternal complications during\npregnancy and low rates of preconcep-\ntion counseling and contraception use | [
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tion counseling and contraception use\n(274). Preconception counseling tailoredfor adolescents with diabetes (including\ntype 2 diabetes) has sustained behav-\nioral bene fits (71).\nSUBSTANCE USE IN PEDIATRIC\nDIABETES\nTobacco and Electronic Cigarettes\nRecommendations\n14.106 Elicit a smoking history at ini-\ntial an... | [
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tial and follow-up diabetes visits; dis-\ncourage smoking in youth who donot smoke and encourage smokingcessation in those who do smoke. A\n14.107 Electronic cigarette use should\nbe discouraged. A\nThe adverse health effects of smoking and\nuse of tobacco products are well recog- | [
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-0.04247969016432762,
0.028380224... |
use of tobacco products are well recog-\nnized with respect to future cancer andCVD risk. Despite this, smoking rates are\nsignifi cantly higher among youth with dia-\nbetes than among youth without diabetes\n(275,276). In youth with diabetes, it is im-\nportant to avoid additional CVD risk fac-\ntors. Smoking increases... | [
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tors. Smoking increases the risk of the\nonset of albuminuria; therefore, smoking\navoidance is important to prevent bothmicrovascular and macrovascular compli-\ncations (184,277). Discouraging use of\ntobacco products, including electronic cig-arettes (278,279), is an important part ofroutine diabetes care. Individual... | [
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betes should be advised to avoid vapingand using electronic cigarettes, either as a\nway to stop smoking tobacco or as a recre-\national drug. In younger children, it is im-\nportant to assess exposure to cigarette\nsmoke in the home because of the ad-\nverse effects of secondhand smoke and\nto discourage youth from ev... | [
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to discourage youth from ever smoking.\nSee Section 5, “Facilitating Positive Health\nBehaviors and Well-being to Improve\nHealth Outcomes, ”for more information\nabout smoking, tobacco, and electronic\ncigarettes in people with diabetes.\nAs alcohol use has implications for\nglycemic management and safety in\nyouth an... | [
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0.01429... |
youth and young adults with diabetes,\nefforts are warranted to reduce alcohol\nuse and increase education about the\nrisks of alcohol use and strategies to\nminimize risks. A psychoeducational in-tervention for adolescents with chronic\nmedical conditions, including type 1 dia-\nbetes, has demonstrated bene fits for | [
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betes, has demonstrated bene fits for\nknowledge, perceived bene fits, and re-\nduced use (280).\nTRANSITION FROM PEDIATRIC TO\nADULT CARE\nRecommendations\n14.108 Pediatric diabetes care teams\nshould implement transition prepara-\ntion programs for youth beginning in\nearly adolescence and, at the latest, | [
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early adolescence and, at the latest,\nat least 1 year before the anticipatedtransfer from pediatric to adult healthcare. E\n14.109 Interprofessional adult and pe-\ndiatric health care teams should providesupport and resources for adolescents,\nyoung adults, and their families prior to | [
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0.05... |
young adults, and their families prior to\nand during the transition process frompediatric to adult health care. E\n14.110 Pediatric diabetes specialists\nshould partner with youth with diabe-tes and their caregivers to decide onthe timing of transfer to an adult dia-\nbetes specialist. E\nCare and close supervision of... | [
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0.... |
betes specialist. E\nCare and close supervision of diabetes\nmanagement are increasingly shifted from\nparents and other adults to the youth with\ntype 1 or type 2 diabetes throughout child-\nhood and adolescence. The shift from pe-\ndiatric to adult health care professionals,\nhowever, often occurs abruptly as theolde... | [
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stage, referred to as emerging adulthooddiabetesjournals.org/care Children and Adolescents S273\n©AmericanDiabetesAssociation | [
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... |
(281), which is a critical period for young\npeople who have diabetes. During this pe-riod of major life transitions, youth maybegin to move out of their parents ’or\ncaregivers ’homes and become increas-\ningly responsible for their diabetes care. | [
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ingly responsible for their diabetes care.\nTheir new responsibilities include self-management of their diabetes, makingmedical appointments, and financing\nhealth care once they are no longer cov-\nered by their parents ’health insurance\nplans (ongoing coverage until age 26 years | [
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plans (ongoing coverage until age 26 years\nis currently available under provisions ofthe U.S. Affordable Care Act). In additionto lapses in health care, this is also a period\nassociated with deterioration in glycemic | [
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associated with deterioration in glycemic\nstability; increased occurrence of acutecomplications; psychosocial, emotional,and behavioral challenges; and the emer-gence of chronic complications (282 –287). | [
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The transfer period from pediatric to adultcare is prone to fragmentation in healthcare delivery, which may adversely impacthealth care quality, cost, and outcomes(288). Worsening diabetes health out-\ncomes during the transition to adult care\nand early adulthood have been docu-mented (289,290).\nIt is clear that comp... | [
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It is clear that comprehensive and co-\nordinated planning that begins in earlyadolescence is necessary to facilitate a\nseamless transition from pediatric to\nadult health care (282,283,291,292). Re-search on effective interventions to pro-mote successful transition to adult careis limited, although there are promisin... | [
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developments that may improve atten-\ndance at follow-up appointments andlower hospitalizations (293). Use of transi-tion coordinators, technology to supportcommunication with young adults, and\nother interventions may be useful in ad-\ndressing the identi fied needs and preferen-\nces of young adults for transition (29... | [
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ces of young adults for transition (294) and\nin supporting successful establishment inadult care settings (295 –300). Given the be-\nhavioral, psychosocial, and developmentalfactors that relate to this transition, diabe-tes care teams addressing transition shouldinclude physicians, certi fied diabetes care\nand educati... | [
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and education specialists, nurses, behav-\nioral health professionals, nutritionists, and\nsocial workers (61,301). Resources to en-hance social/peer support during the transi-tion process may also be valuable (302).A comprehensive discussion regarding the\nchallenges faced during this period, includ-\ning speci fic rec... | [
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0.03... |
ing speci fic recommendations, is found in\nthe ADA position statement “Diabetes Carefor Emerging Adults: Recommendations for\nTransition From Pediatric to Adult DiabetesCare Systems ”(283).\nThe Endocrine Society, in collabora-\ntion with the ADA and other organiza-tions, has developed transition tools forclinicians an... | [
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0.048... |
References\n1. Centers for Disease Control and Prevention.\nVaccines Site: Healthcare Providers/Professionals,2021. Accessed 21 August 2023. Available from\nhttps://www.cdc.gov/vaccines/hcp/index.html.\n2. Chiang JL, Maahs DM, Garvey KC, et al. Type 1 | [
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0.04662376642227173,
-0.037273261696100235,
0.009595204144716263,
0.01296021... |
2. Chiang JL, Maahs DM, Garvey KC, et al. Type 1\ndiabetes in children and adolescents: a positionstatement by the American Diabetes Association.Diabetes Care 2018;41:2026– 2044\n3. Arslanian S, Bacha F, Grey M, Marcus MD,White NH, Zeitler P . Evaluation and management ofyouth-onset type 2 diabetes: a position statemen... | [
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0.066769078373909,
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0.07589438557624817,
0.0641217902302742,
-0.023904982954263687,
-0.04476390406489372,
-0.02755940891802311,
0.08620192110538483,
-0.09518995881080627,
0.01031... |
by the American Diabetes Association. Diabetes\nCare 2018;41:2648 –2668\n4. Lawrence JM, Divers J, Isom S, et al.; SEARCHfor Diabetes in Youth Study Group. Trends inprevalence of type 1 and type 2 diabetes inchildren and adolescents in the US, 2001-2017.JAMA 2021;326:717 –727\n5. Thomas NJ, Jones SE, Weedon MN, Shields | [
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-0.04005272313952446,
-0.0003879536525346339,
0.08311150223016739,
-0.09050638973712921,
0.0... |
5. Thomas NJ, Jones SE, Weedon MN, Shields\nBM, Oram RA, Hattersley AT. Frequency and\nphenotype of type 1 diabetes in the first six\ndecades of life: a cross-sectional, geneticallystrati fied survival analysis from UK Biobank.\nLancet Diabetes Endocrinol 2018;6:122– 129 | [
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0.04850848391652107,
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0.05361379310488701,
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0.02645774930715561,
-0.12844696640968323,
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Lancet Diabetes Endocrinol 2018;6:122– 129\n6. Barnea-Goraly N, Raman M, Mazaika P, et al.;Diabetes Research in Children Network (DirecNet).\nAlterations in white matter structure in young\nchildren with type 1 diabetes. Diabetes Care 2014;37:332– 340 | [
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Examining parent perceptions. Pediatr Diabetes\n2015;16:613– 620\n10. Jackson CC, Albanese-O ’Neill A, Butler KL,\net al. Diabetes care in the school setting: aposition statement of the American DiabetesAssociation. Diabetes Care 2015;38:1958– 1963\n11. Mehta SN, Volkening LK, Anderson BJ, et al.;\nFamily Management of... | [
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