Diabetes Guidelines for Pediatric Patients Updated by ADA

The American Diabetes Association (ADA) has updated its “Children and adolescents: standards of care in diabetes” for 2023, discussing how to manage diabetes in pediatric patients.¹

Diabetes often has different pathophysiology, developmental considerations, and response to therapy in patients aged under 18 years old compared to adults. Family dynamics, stages of development, and sexual maturity should all be considered when deciding treatment.

Type 1 diabetes is the most common diabetes type in children, requiring consideration of aspects specific to children by health care providers. This includes insulin sensitivity, supervision in school environments, neurological vulnerability to hypoglycemia and hyperglycemia, and potential adverse effects of diabetic ketoacidosis.

Diabetes-specific care should be provided by a multidisciplinary team with training in pediatric diabetes treatment. Patients must receive self-managed education and support, nutritional therapy, and psychosocial support. Pediatric patients and their parents will both be involved in self-management, making family involvement in these processes vital.

Children are recommended to engage in 60 minutes of moderate- to vigorous-intensity aerobic activity per day. Those with diabetes should be evaluated for complications which may restrict activity, such as hyperglycemia risk. Methods to decrease hyperglycemia associated with physical activity include decreasing the prandial insulin for a meal before exercise and eating more.

School and day care personnel must also receive training to manage diabetes in children, as most youths spend the majority of their day in these settings. Schools and day care facilities are also required toprovide necessary diabetes care by federal and state laws.

The impact of diabetes on quality of life should also be considered. This can be assessed by screening for anxiety, depression, disordered eating behaviors, and eating disorders. Screening for diabetes distress should begin as early as 7 or 8 years of age.

Type 1 diabetes increases the risks of other autoimmune diseases, making screening for thyroid dysfunction and celiac disease valuable. Diseases such as Addison disease, autoimmune gastritis, autoimmune hepatitis, dermatomyositis, and myasthenia gravis should also be considered.

Cardiovascular risk factors are also increased in children with type 1 diabetes, with 15% to 45% estimated as having 2 or more atherosclerotic cardiovascular disease risk factors. These risk factors increase with age and ethnic minority status, and the atherosclerotic process begins in childhood. To evaluate risk, an initial lipid evaluation should be performed shortly after diagnosis.

Children are also at risk of type 2 diabetes, with the prevalence increasing over the past 20 years. According to the CDC, if the rate of type 2 diabetes in individuals aged under 20 years increases 2.3% per year, the prevalence will increase 4-fold in the next 40 years.

Data has indicated type 2 diabetes differs in children than in adults and differs from type 1 diabetes in children. Racial and ethnic minorities are disproportionately affected, and healthy lifestyle behaviors may be difficult to maintain in complex psychosocial and cultural environments.

Management of type 2 diabetes can be accomplished through similar methods as type 1 diabetes, such as cooperation with families and school personnel. However, the current obesity epidemic often makes it difficult to differentiate between type 1 diabetes and type 2 diabetes. Clinicians should make sure a diagnosis is accurate to provide proper treatment.

As comorbidities may be present at the time of type 2 diabetes diagnosis, blood pressure measurements, a fasting lipid panel, assessment of random urine albumin-to-creatinine ratio, and a dilated eye examination should all be performed. These comorbidities are more common in youth with type 2 diabetes than type 1 diabetes, making detection vital.

As children age, clinicians will also need to be prepared to help them transition from pediatric to adult health care professionals. The Endocrine Society and the ADA have provided transition tools to help children, families, and clinicians complete the transition process.

This article originally appeared on Contemporary Pediatrics.

Reference

1. ElSayed NA, Aleppo G, Aroda VR, et al., Children and adolescents: standards of care in diabetes—2023. Diabetes Care. 2023;46(Suppl. 1): S230–S253. doi:10.2337/dc23-S014