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of diabetes in youth (4), although data sug-gest that it accounts for a large proportionof cases diagnosed in adult life (5). Thehealth care professional must consider theunique aspects of care and managementof children and adolescents with type 1diabetes, such as changes in insulin sensi-tivity related to physical gro... | [
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insulin sensi-tivity related to physical growth and sexualmaturation, ability to provide self-care,supervision in the childcare and school en-vironment, neurological vulnerability to hy- | [
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poglycemia and hyperglycemia in young\nchildren, and possible adverse neurocog-nitive effects of diabetic ketoacidosis(DKA) (6,7). Attention to family dynamics,developmental stages, and physiologicdifferences related to sexual maturity isessential in developing and implementingan optimal diabetes treatment plan (8). | [
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An interprofessional team trained in\npediatric diabetes management and sensi-tive to the challenges of children and ado-lescents with type 1 diabetes and theirfamilies should provide diabetes-specifi c | [
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care for this population. It is essential thatdiabetes self-management education andsupport, medical nutrition therapy, andpsychosocial/behavioral support be pro-vided at diagnosis and regularly thereafterin a developmentally appropriate formatthat builds on prior knowledge by a teamof health care professionals experie... | [
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by a teamof health care professionals experiencedwith the biological, educational, nutritional,behavioral, and emotional needs of thegrowing child and family. The diabetesteam, taking into consideration the youth ’s | [
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developmental and psychosocial needs,should ask about and discuss diabetes man-agement responsibilities with youth and pa-rents/caregivers on an ongoing basis.\nDiabetes Self-Management Education\nand Support\nRecommendation\n14.1 Youth with type 1 diabetes and\ntheir parents/caregivers (for individu-\nals aged <18 yea... | [
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als aged <18 years) should receive\nculturally sensitive and developmen-tally appropriate individualized diabe-\ntes self-management education and\nsupport according to national stand-ards at diagnosis and routinely there-after. B\nSelf-management in pediatric diabetes in-\nvolves both the youth and their parents/adult... | [
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the medical plan is, it can only be effec-tive if the family and/or affected individu-\nals are able to implement it. Family\ninvolvement is a vital component of opti-\nmal diabetes management throughout\nchildhood and adolescence. As parents/\ncaregivers are critical to diabetes self- | [
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caregivers are critical to diabetes self-\nmanagement in youth, diabetes care re-quires an approach that places the youth\nand their parents/caregivers at the center\nof the care model. The pediatric diabetes\ncare team must be capable of evaluating\nthe educational, behavioral, emotional,\nand psychosocial factors tha... | [
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and psychosocial factors that impact the\nimplementation of a treatment plan andmust work with the youth and family to\novercome barriers or redefi ne goals as\nappropriate. Diabetes self-managementeducation and support requires periodic\nreassessment, especially as the youth\ngrows, develops, and acquires the need | [
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grows, develops, and acquires the need\nand desire for greater independent self-\ncare skills. The pediatric diabetes team\nshould work with the youth and their pa-rents/caregivers to ensure there is not a\npremature transfer of self-management\ntasks to the youth during this time. In addi-\ntion, it is necessary to as... | [
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tion, it is necessary to assess the educa-\ntional needs and skills of, and provide\ntraining to, daycare workers, school nurses,\nand school personnel who are responsiblefor the care and supervision of the child\nwith diabetes (2,9,10).\nNutrition Therapy\nRecommendations\n14.2 Individualized medical nutrition\ntherap... | [
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therapy is recommended for youth\nwith type 1 diabetes as an essential\ncomponent of the overall treatmentplan. A\n14.3 Monitoring carbohydrate intake,\nwhether by carbohydrate counting or\nexperience-based estimation, is a\nkey component to optimizing glyce-mic management. B\n14.4 Meal composition impacts\npostprandia... | [
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14.4 Meal composition impacts\npostprandial glucose excursions. Ed-\nucation on the impact of high-fat\nand high-protein meals and the ad-justment of insulin dosing is neces-sary. A\n14.5 Comprehensive nutrition edu-\ncation at diagnosis, with at leastannual updates and as needed, byan experienced registered dietitiann... | [
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sess caloric and nutrition intake inrelation to weight status and car-\ndiovascular disease risk factors andto inform macronutrient choices. E\nNutrition management should be individ-ualized: family habits, food preferences,religious or cultural needs, finances, sched-\nules, physical activity, and the youth ’sa n d | [
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ules, physical activity, and the youth ’sa n d\nfamily ’s abilities in numeracy, literacy, and | [
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self-management should be considered.Visits with a registered dietitian nutritionistshould include assessment for changes infood preferences over time, access tofood, growth, and development, weightstatus, cardiovascular risk, and potentialfor disordered eating. Following recom-mended nutrition plans is associated with... | [
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nutrition plans is associated withbetter glycemic outcomes in youth withtype 1 diabetes (11). | [
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Although carbohydrate content is the | [
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primary variable for calculation of mealinsulin dose, it is well known that mealswith higher content of fat and proteincan cause early hypoglycemia and de-layed postprandial excursion. Some ad-justments in insulin dosing, including anincrease in the calculated dose as wellas a split dose, will improve postpran-dial glu... | [
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Physical Activity and Exercise\nRecommendations\n14.6 Physical activity is recommended\nfor all youth with type 1 diabetes with\nthe goal of 60 min of moderate- tovigorous-intensity aerobic activity daily,\nwith vigorous muscle-strengthening and\nbone-strengthening activities at least3 days per week. C\n14.7 Frequent g... | [
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14.7 Frequent glucose monitoring\nbefore, during, and after exercise,via blood glucose meter or continu-ous glucose monitoring (CGM), is\nimportant to prevent, detect, and\ntreat hypoglycemia and hyperglyce-mia associated with exercise. C\n14.8 Youth and their parents/care- | [
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14.8 Youth and their parents/care-\ngivers should receive education ongoals and management of glycemiabefore, during, and after physical ac-\ntivity, individualized according to the\ntype and intensity of the plannedphysical activity. E\n14.9 Youth and their parents/care- | [
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14.9 Youth and their parents/care-\ngivers should be educated on strate-gies to prevent hypoglycemia during,after, and overnight following physical\nactivity and exercise, which maydiabetesjournals.org/care Children and Adolescents S261\n©AmericanDiabetesAssociation | [
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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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0.018613846972584724,
0.04269321262836456,
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0.... |
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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-0.0668351799249649,
0.05310... |
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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-0.07438263297080994,
-0.02441... |
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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0.01535... |
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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0.07... |
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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0.0299... |
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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0.0635... |
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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0.068... |
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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0.043329704552... |
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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0.0262... |
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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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,
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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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-0.0164... |
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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circumstances, desires, and needs. A\n14.20 Insulin pump therapy alone | [
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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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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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-... |
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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0.0... |
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.... |
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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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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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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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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0.03766978159546852,
-0.08660509437322617,
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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(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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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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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.... |
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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0.0105... |
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,
-0.07928550988435745,
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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0.009395353496074677,
0.08190160989761353,
-0.1039280891418457,
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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0.051285598427057266,
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0.05097782239317894,
-0.006120751146227121,
-0.0... |
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