Microvascular Complications in Children and Adolescents with Diabetes

2016 ADA Guideline Recommendations
Types of Diabetes Mellitus
Main Diabetes Page
Diabetes type I
Diabetes type II
Gestational Diabetes Mellitus
2016 ADA Standard of Medical Care Guideline Recommendations
Strategies for Improving Care
Classification and Diagnosis of Diabetes
Foundations of Care and Comprehensive Medical Evaluation Diabetes Self-Management, Education, and Support Nutritional Therapy
Prevention or Delay of Type II Diabetes
Glycemic Targets
Obesity Management for Treatment of Type II Diabetes
Approaches to Glycemic Treatment
Cardiovascular Disease and Risk Management Hypertension and Blood Pressure Control Lipid Management Antiplatelet Agents Coronary Heart Disease
Microvascular Complications and Foot Care Diabetic Kidney Disease Diabetic Retinopathy Diabetic Neuropathy Diabetic Footcare
Older Adults with Diabetes
Children and Adolescents with Diabetes Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes Microvascular Complications in Children and Adolescents with Diabetes
Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]

2016 ADA Standards of Medical Care in Diabetes Guidelines

TYPE 1 DIABETES

NEPHROPATHY

Screening

"1. Annual screening for albuminuria with a random spot urine sample for albumin–to–creatinine ratio should be considered once the child has had diabetes for 5 years .(Level of Evidence: B)"

"2. Estimate glomerular filtration rate at initial evaluation and then based on age, diabetes duration, and treatment (Level of Evidence: E)"

Treatment

"1. Treatment with an ACE inhibitor, titrated to normalization of albumin excretion, should be considered when elevated urinary albumin– to–creatinine ratio (>30 mg/g) is documented with at least two of three urine samples. These should be obtained over a 6-month interval following efforts to improve glycemic control and normalize blood pressure (Level of Evidence: B)"

RETINOPATHY

"1. An initial dilated and comprehensive eye examination is recommended at age ≥10 years or after puberty has started, which- ever is earlier, once the youth has had diabetes for 3–5 years (Level of Evidence: B)"

"2. After the initial examination, annual routine follow-up is generally recommended. Less frequent examinations, every 2 years, may be acceptable on the advice of an eye care professional (Level of Evidence: E)"

NEUROPATHY

"1. Consider an annual comprehensive foot exam for the child at the start of puberty or at age ≥10 years, whichever is earlier, once the youth has had type 1 diabetes for 5 years (Level of Evidence: E)"

= TRANSITION FROM PEDIATRIC TO ADULT CARE

"1. Health care providers and families should begin to prepare youth in early to mid-adolescence and, at the latest, at least 1 year before the transition to adult health care (Level of Evidence: E)"

"2. Both pediatricians and adult health care providers should assist in providing support and links to resources for the teen and emerging adult (Level of Evidence: B)"