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Diabetes Care 28:186-212, 2005
© 2005 by the American Diabetes Association, Inc.

Reviews/Commentaries/ADA Statements
ADA Statement

Care of Children and Adolescents With Type 1 Diabetes

A statement of the American Diabetes Association

Janet Silverstein, MD1, Georgeanna Klingensmith, MD2, Kenneth Copeland, MD3, Leslie Plotnick, MD4, Francine Kaufman, MD5, Lori Laffel, MD, MPH6, Larry Deeb, MD7, Margaret Grey, DRPH, CPNP8, Barbara Anderson, PHD9, Lea Ann Holzmeister, RD, CDE10 and Nathaniel Clark, MD, MS, RD11

1 Department of Pediatrics, Division of Endocrinology, University of Florida, Gainesville, Florida
2 Department of Pediatrics, Barbara Davis Center, Denver, Colorado
3 Department of Pediatrics, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma
4 Department of Pediatrics, Division of Endocrinology, John Hopkins Medical Institutions, Baltimore, Maryland
5 Department of Pediatrics, Keck School of Medicine, University of Southern California Children’s Hospital, Los Angeles, California
6 Pediatric and Adolescent Unit, Joslin Diabetes Center, Boston, Massachusetts
7 Children’s Clinic, Tallahassee, Florida
8 Yale School of Nursing, New Haven, Connecticut
9 Pediatric Metabolism and Endocrinology, Baylor College of Medicine, Houston, Texas
10 Holzmeister Nutrition Communications, Tempe, Arizona
11 American Diabetes Association, Alexandria, Virginia

Address correspondence to Nathaniel G. Clark, MD, MS, RD, National Vice President, Clinical Affairs, American Diabetes Association, 1701 N. Beauregard St., Alexandria, VA 22311. E-mail: nclark@diabetes.org

Abbreviations: ADA, American Diabetes Association • AER, albumin excretion rate • CVD, cardiovascular disease • DCCT, Diabetes Control and Complications Trial • DKA, diabetic ketoacidosis • EDIC, Epidemiology of Diabetes Interventions and Complications • EMA, endomysial autoantibody • MDI, multiple daily insulin injection • NCEP, National Cholesterol Education Program • NCEP-Peds, National Cholesterol Education Program for Pediatrics • SMBG, self-monitoring of blood glucose • tTG, tissue transglutaminase

The first 300 words of the full text of this article appear below.

During recent years, the American Diabetes Association (ADA) has published detailed guidelines and recommendations for the management of diabetes in the form of technical reviews, position statements, and consensus statements. Recommendations regarding children and adolescents have generally been included as only a minor portion of these documents. For example, the most recent ADA position statement on "Standards of Medical Care for Patients With Diabetes Mellitus" (last revised October 2003) included "special considerations" for children and adolescents (1). Other position statements included age-specific recommendations for screening for nephropathy (2) and retinopathy (3) in children with diabetes. In addition, the ADA has published guidelines pertaining to certain aspects of diabetes that apply exclusively to children and adolescents, including care of children with diabetes at school (4) and camp (5) and a consensus statement on type 2 diabetes in children and adolescents (6).

The purpose of this document is to provide a single resource on current standards of care pertaining specifically to children and adolescents with type 1 diabetes. It is not meant to be an exhaustive compendium on all aspects of the management of pediatric diabetes. However, relevant references are provided and current works in progress are indicated as such. The information provided is based on evidence from published studies whenever possible and, when not, supported by expert opinion or consensus (7). Several excellent detailed guidelines and chapters on type 1 diabetes in pediatric endocrinology texts exist, including those by the International Society of Pediatric and Adolescent Diabetes (ISPAD) (8), by the Australian Pediatric Endocrine Group (www.chw.edu/au/prof/services/endocrinology/apeg), in Lifshitz’s Pediatric Endocrinology (9–11), and by Plotnick and colleagues (12,13).

Children have characteristics and needs that dictate different . . . [Full Text of this Article]

DIAGNOSIS

Recommendations
INITIAL CARE

Recommendation
DIABETES EDUCATION

Education components
Continuing education
Recommendations
IDENTIFICATION

Recommendation
APPROPRIATE SELF-MANAGEMENT BY AGE

Infants (<1 year)
Toddlers (1–3 years)
Preschoolers and early school-aged children (3–7 years)
School-aged children (8–11 years)
Adolescents
DIABETES CARE

GLYCEMIC CONTROL

Age-specific glycemic goals
Children <6 years old.
Children 6–12 years old.
Adolescents (13–19 years).
INSULIN MANAGEMENT OF DIABETES

Basal bolus insulin regimens
Pumps
Recommendations
BLOOD GLUCOSE MONITORING

Recommendations
NUTRITION FOR CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES

MEDICAL NUTRITION THERAPY

Recommendations
EXERCISE

Recommendations
ASSESSMENT OF CHILD AND FAMILY RISK FACTORS AT DIAGNOSIS

PSYCHOSOCIAL ISSUES AFFECTING THE DIABETES CARE PLAN

Recommendation
ACUTE COMPLICATIONS

Growth assessment
Recommendations
DKA
1. DKA at diagnosis.
2. DKA after diagnosis.
3. Recurrent DKA.
Recommendations
Hypoglycemia
Recommendations
IMMUNIZATION

CHRONIC COMPLICATIONS

Nephropathy
Recommendations
Screening
Treatment
Hypertension
Definition of hypertension.
Treatment.
Recommendations
Dyslipidemia
Recommendations
Screening
Treatment
Retinopathy
Recommendations
Screening
Foot care
Recommendation
ASSOCIATED AUTOIMMUNE CONDITIONS
Thyroid disease
Recommendations
Celiac disease
Recommendations
ADJUSTMENT AND PSYCHIATRIC DISORDERS

Recommendations
Eating disorders
Recommendations
SPECIAL SITUATIONS

Sick day management
Diabetes care at school and day care
ADOLESCENCE

Recommendations
ADHERENCE TO SELF-MANAGEMENT

Recommendation
RISK BEHAVIORS

Recommendations

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