1.0.0.0 Type 1 Di­a­betes

1.1.0.0 In­tro­duc­tion

The Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) “Stan­dards of Med­i­cal Care in Di­a­betes” in­cludes ADA’s cur­rent clin­i­cal prac­tice rec­om­men­da­tions and is in­tend­ed to pro­vide the com­po­nents of di­a­betes care, gen­er­al treat­ment goals and guide­lines, and tools to eval­u­ate qual­i­ty of care. Mem­bers of the ADA Pro­fes­sion­al Prac­tice Com­mit­tee, a mul­ti­dis­ci­plinary ex­pert com­mit­tee, are re­spon­si­ble for up­dat­ing the Stan­dards of Care an­nu­al­ly, or more fre­quent­ly as war­rant­ed. For a de­tailed de­scrip­tion of ADA stan­dards, state­ments, and re­ports, as well as the ev­i­dence-‍grad­ing sys­tem for ADA’s clin­i­cal prac­tice rec­om­men­da­tions, please refer to the Stan­dards of Care In­tro­duc­tion. Read­ers who wish to com­ment on the Stan­dards of Care are in­vit­ed to do so at pro­fes­sion­al.di­a­betes.org/‍SOC.

The man­age­ment of di­a­betes in chil­dren and ado­les­cents can­not sim­ply be de­rived from care rou­tine­ly pro­vided to adults with di­a­betes. The epi­demi­ol­o­gy, patho­phys­i­ol­o­gy, de­vel­op­men­tal con­sid­er­a­tions, an­dre­sponse tother­a­py inpe­di­atric-‍onset di­a­betes are dif­fer­ent from adult di­a­betes. There are also dif­fer­ences in rec­om­mend­ed care for chil­dren and ado­les­cents with type 1 as op­posed to type 2 di­a­betes. This sec­tion first ad­dress­es care for chil­dren and ado­les­cents with type 1 di­a­betes and next ad­dress­es care for chil­dren and ado­les­cents with type 2 di­a­betes. Fig­ure 13.1 pro­vides guid­ance on man­ag­ing new-‍onset di­a­betes in over­weight youth be­fore type 1 or type 2 di­a­betes is di­ag­nosed and so ap­plies to all over­weight youth. Last­ly, guid­ance is pro­vided in this sec­tion on tran­si­tion of care from pe­di­atric to adult pro­viders to en­sure that the con­tin­u­um of care is ap­pro­pri­ate as the child with di­a­betes de­vel­ops into adult­hood. Due to the na­ture of clin­i­cal re­search in chil­dren, the rec­om­men­da­tions for chil­dren and ado­les­cents with di­a­betes are less like­ly to be based on clin­i­cal trial ev­i­dence. How­ev­er, ex­pert opin­ion and a re­view of avail­able and rel­e­vant ex­per­i­men­tal data are sum­ma­rized in the Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) po­si­tion state­ments “Type 1 Di­a­betes in Chil­dren and Ado­les­cents” (1) and “Eval­u­a­tion and Man­age­ment of Youth-‍Onset Type 2 Di­a­betes” (2). The ADA con­sen­sus re­port “Youth-‍Onset Type 2 Di­a­betes Con­sen­sus Re­port: Cur­rent Sta­tus, Chal­lenges, and Pri­or­i­ties” (3) char­ac­ter­izes type 2 di­a­betes in chil­dren and eval­u­ates treat­ment op­tions as well, but also dis­cuss­es knowl­edge gaps and re­cruit­ment chal­lenges in clin­i­cal and trans­la­tion­al re­search in youth-‍onset type 2 di­a­betes.

TYPE 1 DI­A­BETES

Type 1 di­a­betes is the most­com­mon form of di­a­betes in youth (4), al­though re­cent data sug­gest­that itmay ac­count­for a large pro­por­tionof­cas­es di­ag­nosed in adultlife (5). The pro­vider must con­sid­er the unique as­pects of care and man­age­ment of chil­dren and ado­les­cents with type 1 di­a­betes, such as changes in in­sulin sen­si­tiv­i­ty re­lat­ed to phys­i­cal growth and sex­u­al mat­u­ra­tion, abil­i­ty to pro­vide self-‍care, su­per­vi­sion in the child care and school en­vi­ron­ment, neu­ro­log­i­cal vulnerabil­i­ty to hy­po­glycemia and hy­per­glycemia in young chil­dren, as well as pos­si­ble ad­verse neu­rocog­ni­tive ef­fects of di­a­bet­ic ke­toaci­do­sis (DKA) (6,7). At­ten­tion to fam­i­ly dy­nam­ics, de­vel­op­men­tal stages, and phys­i­o­log­ic dif­fer­ences re­lat­ed to sex­u­al ma­tu­ri­ty is es­sen­tial in de­vel­op­ing and im­ple­ment­ing an op­ti­mal di­a­betes treat­ment plan (8).

A mul­ti­dis­ci­plinary team of spe­cial­ists trained in pe­di­atric di­a­betes man­age­ment and sen­si­tive to the chal­lenges of chil­dren and ado­les­cents with type 1 di­a­betes and their fam­i­lies should pro­vide care for this pop­u­la­tion. It is es­sen­tial that di­a­betes self-‍man­age­ment ed­u­ca­tion and sup­port, med­i­cal nu­tri­tion ther­a­py, and psy­choso­cial sup­port be pro­vided at di­ag­no­sis and reg­u­lar­ly there­after in a de­vel­op­men­tally ap­pro­pri­ate for­mat that builds on prior knowl­edge by in­di­vid­u­als ex­pe­ri­enced with the ed­u­ca­tional, nu­tri­tional, be­hav­ioral, and emo­tion­al needs of the grow­ing child and fam­i­ly. The ap­pro­pri­ate bal­ance be­tween adult su­per­vi­sion and in­de­pen­dent self­care should be defined at the first in­ter­ac­tion and reeval­u­ated at sub­se­quent vis­its, with the ex­pec­ta­tion that it will evolve as the ado­les­cent grad­u­al­ly be­comes an emerg­ing young adult.