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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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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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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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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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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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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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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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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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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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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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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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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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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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0.... |
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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0.... |
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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0.04104114696383476,
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0... |
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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0.01648685336112976,
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-0.01868065632879734,
0.040991... |
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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0.024443110451102257,
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0.019145619124174118,
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0.07634435594081879,
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-0.03138047084212303,
-0.1514434516429901,
0.032... |
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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0.011019069701433182,
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0... |
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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0.04208... |
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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-0... |
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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0.032... |
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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0.0038753908593207598,
0.02077760174870491,
0.0392720066010952,
-0.10533832013607025,
0.003082... |
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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0.00... |
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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-0.06344439834356308,
0.04... |
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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0.04468115046620369,
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-0.03... |
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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0.02336... |
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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0.04503680765628815,
0.035390932112932205,
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0.018... |
$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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0.015615621581673622,
0.0861361026763916,
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0.03835824504494667,
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-0.07959485054016113,
-0.03193... |
<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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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... | [
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0.0014801961369812489,
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0.051273517310619354,
0.1491856873035431,
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... |
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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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 | [
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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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... |
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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... |
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 | [
-0.04881279543042183,
-0.04192020371556282,
0.04241077974438667,
0.0313052162528038,
-0.08688878268003464,
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0.04934516176581383,
0.06207340583205223,
-0.09254061430692673,
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... | [
-0.03711850941181183,
-0.010692363604903221,
0.02783229388296604,
0.03306715190410614,
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0.05977055802941322,
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,
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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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0.045233774930238724,
-0.09807123988866806,
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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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0.00340843154117465,
-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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0.06812962889671326,
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0.020947549492120743,
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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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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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-0.05792803689837456,
... |
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.... |
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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0.018666965886950493,
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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,
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0.03924145922064781,
0.1514347344636917,
-0.006993851624429226,
-0.009535416960716248,
0.10609328001737595,
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-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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0.06965558975934982,
-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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0.03781808540225029,
0.01568598672747612,
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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,
0.1247185692191124,
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-0.00462701078504324,
0.06785596907138824,
-0.0707201361656189,
-0.07044245302677155,
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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0.03193172812461853,
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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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0.10973821580410004,
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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,
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0.09630592167377472,
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-0.036685485392808914,
0.014021228067576885,
0.041183263063430786,
-0.04074743762612343,
... |
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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0.07270447164773941,
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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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-0.004882902838289738,
0.05491572618484497,
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0.... |
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,
-0.08632893860340118,
0.031203364953398705,
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0.06704883277416229,
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,
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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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0.09762132912874222,
0.041305508464574814,
-0.08310578018426895,
0.019686629995703697,
0.0768963173031807,
-0.04925112798810005,
-0.10142845660448074,
-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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0.010868705809116364,
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0.08586075901985168,
0.050102438777685165,
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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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-0.017... |
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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0.04812176153063774,
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-0.054231248795986176,
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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0.041566990315914154,
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0.04853340983390808,
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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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0.040659718215465546,
-0.12946397066116333,
0.04... |
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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0.08861134201288223,
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-0.0626... |
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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0.11802129447460175,
-0.10616067051887512,
0.042760998010635376,
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0.08441402018070221,
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0.01797407865524292,
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0.07112486660480499,
-0.08320435136556625,
0.05658279... |
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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0.09689521789550781,
0.005948469042778015,
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0.05237184092402458,
-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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0.11030704528093338,
-0.06179526075720787,
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0.05877165496349335,
-0.01607619598507881,
0.0028359... |
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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0.09498605132102966,
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0.03231552988290787,
0.04023657366633415,
-0.01414169929921627,
0.0028857... |
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... | [
0.0008626973140053451,
0.09138510376214981,
0.02017311565577984,
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0.003516968572512269,
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0.123350590467453,
0.046721961349248886,
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0.03453715890645981,
0.08599041402339935,
0.014794415794312954,
-0.0596526637673378,
0.046924192... |
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