Routine monitoring of children and adolescents with type 2 diabetes for chronic complications

Evaluation	Screening approach	Abnormal result	Usual treatment
Hypertension	Measure BP at each routine visit, with additional visits as needed if BP is elevated.	Adolescents ≥13 years:*^[1,2] Elevated BP – SBP 120 to 129 with DBP <80 (Measured on 3 occasions)	Nonpharmacologic intervention (diet and exercise, with weight reduction if appropriate) Initiate pharmacologic intervention (ACE inhibitor or ARB)^¶ if BP remains in this range despite nonpharmacologic intervention for 3 to 6 months
Hypertension		Hypertension^[1] – SBP ≥130 or DBP ≥80 (Measured on 3 occasions)	Continue and intensify nonpharmacologic intervention, and Initiate pharmacologic intervention (ACE inhibitor or ARB)^¶^[3]
Dyslipidemia	Lipid panel at diagnosis of diabetes, once glycemic control is achieved. If sample was nonfasting (random) and results are indeterminate, confirm with a fasting lipid panel. Repeat annually.	LDL ≥100 to 130 mg/dL (2.59 to 3.36 mmol/L)	Nonpharmacologic intervention – Optimize glycemic control; exercise and diet to limit dietary cholesterol (≤200 mg/day) and saturated fat (≤7% of total calories) and aim to attain and maintain healthy body weight Aim for LDL ≤100 mg/dL
		LDL ≥130 mg/dL (≥3.36 mmol/L)	Pharmacologic intervention (statin) for children ≥10 years if nonpharmacologic intervention is not successful after 6 months, and after reproductive counseling Aim for LDL ≤100 mg/dL
		TG ≥150	Optimize glycemic control and weight reduction In the rare patient with fasting TG ≥400 mg/dL (4.5 mmol/L), treat with fibric acid
Nephropathy	UACR (spot specimen). If abnormal, repeat on at least 2 occasions during the next 3 to 6 months. Repeat screening annually.	UACR ≥30 mg albumin/g creatinine^Δ	Treat (ACE inhibitor or ARB)^¶ if BP is elevated, targeting normal BP Treat (ACE inhibitor or ARB)^¶ if UACR is ≥300 mg albumin/g creatinine, regardless of BP Treatment may be appropriate for patients with normal BP and moderately elevated UACR (30 to 300 mg albumin/g creatinine) that is persistent and increasing
Retinopathy	Dilated eye examination or retinal imaging. Repeat annually or as advised by eye care professional.	Nonproliferative, preproliferative, or proliferative retinopathy	Optimizing glycemic control may reverse nonproliferative retinopathy Laser therapy or intravitreous injections for more advanced disease
Neuropathy	Foot examination (pulses and ankle reflex); sensory testing for vibration (tuning fork) and sensation (10 g monofilament). Repeat annually.	Any abnormalities	Refer to neurologist for further evaluation Optimize glycemic control
Psychosocial assessment	Screen for depression, eating disorders, family conflict, risk-taking behaviors, or other psychosocial dysfunction. Repeat at each routine visit or as needed.	Clinical symptoms of depression, eating disorder, or psychosocial dysfunction	Refer to mental health professional Preconception counseling for girls of childbearing potential
Smoking	Ask about use or experimentation with tobacco products including vaping (e-cigarettes). Provide anticipatory guidance to avoid smoking and vaping. Repeat at each routine visit.	History of smoking or vaping	Advise that smoking increases the vascular and kidney complications of diabetes in addition to other health effects, and discourage all smoking and vaping For youth who smoke or vape, provide counseling and/or referral for cessation assistance Refer to UpToDate content on smoking and vaping cessation in adolescents

This table reflects recommendations for routine monitoring of children and adolescents with type 2 diabetes, as outlined by the American Diabetes Association^[1].

BP: blood pressure; SBP: systolic blood pressure; DBP: diastolic blood pressure; ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; LDL: low-density lipoprotein; TG: triglycerides; UACR: urine albumin-to-creatinine ratio.

* For children <13 years, elevated BP (prehypertension) is defined as BP 90^th to 95^th percentile and hypertension BP ≥95^th percentile. Refer to UpToDate topic and table for American Academy of Pediatrics definitions for pediatric BP categories.

¶ ACE inhibitors (eg, lisinopril or enalapril) and ARBs have teratogenic potential, so appropriate reproductive counseling should be given to young females. Aim for BP consistently <120/80 mmHg (or <90^th percentile for children <13 years).

Δ Transient albuminuria is common in children. Abnormal results should be confirmed on at least 2 occasions, ruling out orthostatic albuminuria with a first morning sample, or with a 24-hour urine collection.

References:

American Diabetes Association Professional Practice Committee, Draznin B, Aroda VR, et al. 14. Children and Adolescents: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45:S208.
Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140:e20171904.
Donaghue KC, Marcovecchio ML, Wadwa RP, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2018; 19:262.

Graphic 129761 Version 3.0

خرید پکیج

Routine monitoring of children and adolescents with type 2 diabetes for chronic complications