Care of Children and Adolescents With Type 1 Diabetes

A statement of the American Diabetes Association

  1. Janet Silverstein, MD1,
  2. Georgeanna Klingensmith, MD2,
  3. Kenneth Copeland, MD3,
  4. Leslie Plotnick, MD4,
  5. Francine Kaufman, MD5,
  6. Lori Laffel, MD, MPH6,
  7. Larry Deeb, MD7,
  8. Margaret Grey, DRPH, CPNP8,
  9. Barbara Anderson, PHD9,
  10. Lea Ann Holzmeister, RD, CDE10 and
  11. Nathaniel Clark, MD, MS, RD11
  1. 1Department of Pediatrics, Division of Endocrinology, University of Florida, Gainesville, Florida
  2. 2Department of Pediatrics, Barbara Davis Center, Denver, Colorado
  3. 3Department of Pediatrics, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma
  4. 4Department of Pediatrics, Division of Endocrinology, John Hopkins Medical Institutions, Baltimore, Maryland
  5. 5Department of Pediatrics, Keck School of Medicine, University of Southern California Children’s Hospital, Los Angeles, California
  6. 6Pediatric and Adolescent Unit, Joslin Diabetes Center, Boston, Massachusetts
  7. 7Children’s Clinic, Tallahassee, Florida
  8. 8Yale School of Nursing, New Haven, Connecticut
  9. 9Pediatric Metabolism and Endocrinology, Baylor College of Medicine, Houston, Texas
  10. 10Holzmeister Nutrition Communications, Tempe, Arizona
  11. 11American Diabetes Association, Alexandria, Virginia
  1. 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{at}

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 (, in Lifshitz’s Pediatric Endocrinology (9–11), and by Plotnick and colleagues (12,13).

Children have characteristics and needs that dictate different standards of care. The management of diabetes in children must take the major differences between children of various ages and …

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