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ADA Stresses Differences In Care For Pediatric And Adult Type 1 Diabetes Patients

The American Diabetes Association issued a new position statement addressing the specific needs of pediatric patients affected by type 1 diabetes today.

A team of leading pediatric diabetes authorities from diabetes care centers across the U.S. created the position statement, which is comprised of recommendations and guidelines based on the body of evidence from over 190 pieces of literature, including research studies and consensus reports, according to a press release from the ADA

This is the first updated ADA pediatric type 1 diabetes position statement since 2005.

The majority of recommendations for youth with Type 1 diabetes rely on supportive evidence from cohort/registry studies or expert consensus and clinical experience.

“It is critical for us to remember that children are not little adults, thus, pediatric-onset diabetes is different from adult-onset diabetes due to its distinct epidemiology, pathophysiology, developmental considerations and response to therapy,” said senior author, Dr. Desmond Schatz in the ADA release. 

“Clinicians must be mindful of a child’s current and evolving developmental stages and must adapt care plans, particularly during the adolescent years, in order to maximize glycemic control and appropriately support the needs of both the patient and their family,” he added.

The statement contains guidelines on T1D staging, screenings and T1D diagnosis, including the importance of distinguishing between type 1 diabetes, type 2 diabetes, monogenic diabetes and other forms of diabetes.

Specific information is provided on blood glucose management, lower blood glucose and HbA1c targets with details outlining self-blood glucose monitoring, the increasing use of continuous glucose monitoring and novel automated insulin delivery systems.

Proper lifestyle management including nutrition and exercise for youth with T1D is also emphasized, as well as complications of T1D and the behavioral aspects of self-management that clinicians should be familiar with, including potential depression, anxiety and eating disorders.

The statement also addresses the specific needs of adolescent patients and the challenges that arise within this age group, including making the transition to self-care and the dangers of high-risk behavior among adolescent patients.

The authors also address the fact that providers should encourage developmentally appropriate family involvement in diabetes management tasks for children and adolescents and cite that premature transfer of diabetes care from the pediatric to the adult care setting may result in poor self-management behaviors and deterioration in glycemic control.

“While we are still uncovering the complex markers and potential triggers for type 1 diabetes in youth, these guidelines represent our commitment to personalized care to meet the unique needs of each individual living with diabetes,” said Dr. William T. Cefalu, ADA’s chief scientific, medical and mission officer, in the release.

“We also encourage rapid diagnosis and treatment, and whole-family care, given the 24/7 burdens of diabetes management in children, in the hopes of yielding improved short- and long-term health outcomes and quality of life,” he states.

The new guidelines will be available online and published in next month’s Diabetes Care journal.

Any future updates to pediatric care will be published in the ADA’s annual Standards 

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