2014糖尿病指南: Type 1 Diabetes in Children & Adolescents

Glycemic Targets
 

Consider risk-benefit assessment, including hypoglycemia risk, when individualizing targets*

A1C:                                      0-6 yrs                  6-12 yrs                   13-19 yrs

A1C                                       <8.5%†                   <8%†                        <7.5%†

PG: prior to meals           100-180 mg/dL       90-180 mg/dL           90-130 mg/dL

PG: bedtime & overnight 110-200 mg/dL       100-180 mg/dL          90-150 mg/dL

*If on basal-bolus: measure postprandial PG to monitor glycemic values and if discrepancy between

preprandial PG and A1C; modification of targets may be needed in children aged <7 yrs due to

hypoglycemic unawareness; †Reasonable to consider lower target if achieved in absence of

excessive hypoglycemia

Microvascular Complications in Children & Adolescents With Type 1 Diabetes

Nephropathy

Screening : Aged ≥10 yrs or puberty onset (whichever occurs first) with 5-yr diabetes duration

      • Albumin levels: yearly

      • ACR: random urine sample

Treatment: ACEI titrated to normalization of albumin excretion

      • If elevated ACR confirmed over 6 mos, after efforts to control glucose, normalize BP

Retinopathy

Screening: Initial dilated and comprehensive eye exam

     • Aged ≥10 yrs or puberty onset (whichever occurs first) with 3-5–yr diabetes duration

Follow-up
   • Yearly

    • Less frequently: per recommendation of eye care professional

ACEIs are not approved by the U.S. Food and Drug Administration (FDA) for treatment of

nephropathy. Not all ACEIs are indicated for use in children/adolescents by the FDA. Refer to full

prescribing information for indications and uses in pediatric populations.
 

High Blood Pressure in Children & Adolescents With Type 1 Diabetes
Screening
   • Measure BP at every visit

   • Confirm elevated BP at separate visit

Treatment: SBP or DBP >90th percentile*

    • Lifestyle changes (diet & exercise)

    • If target BP not met in 3-6 mos ????

   Pharmacologic therapy: ACEI: initial treatment†

   SBP or DBP >95th percentile* or >130/80 mm Hg ????

   Target: <130/80 mm Hg or <90th percentile*

*For age, sex, height; †Provide counseling re: potential teratogenic effects.

Not all ACEIs are indicated for use in children/adolescents by the U.S. Food and Drug

Administration (FDA). Refer to full prescribing information for indications and uses in pediatric

 
Dyslipidemia in Children & Adolescents With Type 1 Diabetes

Screening
                                                                                                                      Obtain fasting lipids

Family history
      CV event aged <55 yrs or hypercholesterolemia ????                                    Aged >2 yrs

                                                                                                                       post-diagnosis*

      Unknown ????

      Unremarkable ????                                                                                         Aged ≥10 yrs

Diabetes diagnosed prior to/post-puberty                                                       Post-diagnosis*

Lipid monitoring: all patients

   • If lipids abnormal: yearly

   • LDL-C <100 mg/dL (<2.6 mmol/L): every 5 yrs

Treatment

Initial
   • Control glucose

   • MNT: decrease saturated fat intake†

Aged ≥10 yrs
   • Lifestyle changes and MNT

   • After lifestyle changes, add statin‡ if LDL-C >160 mg/dL (>4.1 mmol/L) or >130 mg/dL (>3.4 mmol/L) + ≥1 CVD risk factor

Target: LDL-C <100 mg/dL (<2.6 mmol/L)
 

*When glucose levels well controlled

†Use American Heart Association Step 2 diet: saturated fat 7% of total calories; dietary cholesterol

200 mg/d

‡Statins are approved by the U.S. Food and Drug Administration for treatment of heterozygous

familial hypercholesterolemia in children and adolescents. Not all statins are FDA approved for use

under the age of 10 yrs; statins should generally not be used in children with type 1 diabetes before

age 10. Refer to full prescribing information for indications and uses in pediatric populations. For

postpubertal girls, pregnancy prevention is important as statins are contraindicated in pregnancy.