Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association

Diabetes Care Online Edition


Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association

Diabetes Care 2018;41:2026–2044 | https://doi.org/10.2337/dci18-0023 link »»

Since the American Diabetes Association (ADA) published the Position Statement “Care of Children and Adolescents With Type 1 Diabetes” (1) in 2005, innovations have transformed the landscape and management of type 1 diabetes: novel autoantibodies, sophisticated devices for delivering insulin and measuring glucose, and diabetes registries. However, strategies to prevent or delay type 1 diabetes in youth remain elusive, and meanwhile the number of affected children continues to grow.
The SEARCH for Diabetes in Youth (SEARCH) study found a 21.1% rise in the prevalence of type 1 diabetes from 2001 to 2009 in youth aged 0 through 19 years, with increases observed in all sex, age, and race/ethnic subgroups except those with the lowest prevalence (0–4 years old and American Indians) (2). Incidence has also increased; the adjusted risk for developing type 1 diabetes increased 1.4% annually between 2002 and 2012, with significant increases in all age-groups except those 0–4 years
old (3). One theme of this Position Statement is that “children are not little adults”dpediatric-onset diabetes is different from adult diabetes because of its distinct epidemiology, pathophysiology, developmental considerations, and response to therapy (4,5). Diabetes management for children must not be extrapolated from adult diabetes care. In caring for children and adolescents, clinicians need to be mindful of the child’s evolving developmental stages and must adapt care to the child’s needs and circumstances. Timely anticipatory guidance and care coordination will enable a seamless child/adolescent/young adult transition for both the developing patient and his or her family.
Although the ADA stopped developing new position statements in 2018 (6), this Position Statement was developed under the 2017 criteria (7) and provides recommendations for current standards of care for youth (children and adolescents) with type 1 diabetes. It is not intended to be an exhaustive compendium on all aspects of disease management, nor does it discuss type 2 diabetes in youth, which is the subject of anADAPosition Statement currently under review. While adult clinical trials produce robust evidence that has advanced care and improved outcomes (8), pediatric clinical trials remain scarce. Therefore, the majority of pediatric recommendations are not based on large, randomized clinical trials (evidence level A) but rely on supportive evidence from cohort/registry studies (B or C) or expert consensus/clinical
experience (E) (Table 1). Please refer to the ADA’s “Standards of Medical Care in Diabetes” for updates to these recommendations (professional.diabetes.org/SOC).

CV Status First: 2018 – Η Νέα Έκδοση της Θεραπευτικής Προσέγγισης του ΣΔ τ2 από τις ADA / EASD

Η αναθεωρημένη έκδοση των θεραπευτικών συστάσεων για το διαβήτη τύπου 2 από τις δύο κορυφαίες επιστημονικές εταιρείες ADA και EASD αναμένεται τον Οκτώβρη του 2018 και θα εστιάζει όπως αναμενόταν από καιρό στο καρδιαγγειακό προφίλ του ασθενή.

New ADA/EASD Guidance 2018 on Diabetes: Assess CV Status First (!)

The treatment approach to type 2 diabetes should begin with an assessment of cardiovascular disease (CVD) status, other comorbidities, and patient preferences, according to a draft of the upcoming 2018 joint consensus statement from the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD).

The final version of the 2018 update to the current 2015 ADA/EASD Management of Hyperglycemia in Type 2 Diabetes statement (Diabetes Care. 2015;38:140-149) will be presented on October 5, 2018 at the EASD annual meeting in Berlin and will be published in Diabetes Care and Diabetologia.

A preview of the draft document was presented in a 2-hour symposium on June 26 here at the American Diabetes Association (ADA) 2018 Scientific Sessions. A live webcast of the session is now available and comments can be submitted to adacomments@diabetes.org until midnight on July 2.

Διαβάστε περισσότερα στο Medscape »»

2018 – Οι Νέες Συστάσεις για το Διαβήτη της Ε.Δ.Ε. – 2018

Οι Nέες Kατευθυντήριες Oδηγίες για τον Σακχαρώδη Διαβήτη 2018 της Ε.Δ.Ε. »»

Οι νέες κατευθυντήριες οδηγίες για τη διαχείριση του διαβητικού ασθενούς 2018

Κατεβάστε το αρχείο (Download) »»

Ο νέος αλγόριθμος διαχείρισης του διαβητικού ασθενή από την AACE – 2018

2018 – Ο νέος διαγνωστικός και θεραπευτικός αλγόριθμος διαχείρισης του / της ασθενή με Σακχαρώδη Διαβήτη τύπου 2 από την The American Association of Clinical Endocrinologists (AACE) and The American College of Endocrinology (ACE)

This algorithm for the comprehensive management of persons with type 2 diabetes (T2D) was developed to provide clinicians with a practical guide that considers the whole patient, his or her spectrum of risks and complications, and evidence-based approaches to treatment. It is now clear that the progressive pancreatic beta-cell defect that drives the deterioration of metabolic control over time begins early and may be present before the diagnosis of diabetes (1). In addition to advocating glycemic control to reduce microvascular complications, this document high lights obesity and prediabetes as underlying risk factors for the development of T2D and associated macrovascular complications. In addition, the algorithm provides recommendations for blood pressure (BP) and lipid control, the two most important risk factors for cardiovascular disease (CVD).

Σπύρος Καραμαγκιώλης
Επιμελητής Α’ ΕΣΥ
Παθολόγος με εξειδίκευση στο Διαβήτη και στο Διαβητικό Πόδι
Ιατρεία: Αγρίνιο και Λάρισα

Υπολογισμός Κινδύνου για Διαβήτη – QDiabetes 2018

Αναρτήθηκε online η νέα έκδοση της εφαρμογής υπολογισμού του κινδύνου για σακχαρώδη διαβήτη QDiabetes-2018.

Στην νέα έκδοση του web-calculator έχουν ενσωματωθεί “νεότεροι” παράγοντες κινδύνου (πχ χρήση στατινών ή άτυπων αντιψυχωσικών, σύνδρομο πολυκυστικών ωοθηκών, κλπ).

Προσοχή! Δεν έχουν γίνει μελέτες χρήσης αξιοπιστίας της εφαρμογής για άτομα εκτός της Μ. Βρετανίας.

Είσοδος στο site QDiabetes-2018 »»

Δείτε επίσης: Εφαρμογές για τον Σακχαρώδη Διαβήτη

Οι Νέες Οδηγίες για το Διαβήτη 2018 από την American Diabetes Association

Δημοσιεύτηκαν οι νέες συστάσεις για τον Σακχαρώδη Διαβήτη  – 2018 από την Αμερικανική Διαβητολογική Εταιρεία (ADA) »»

* Download – Κατεβάστε το πλήρες αρχείο »»

The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge. With annual updates since 1989, the American Diabetes Association’s (ADA’s) “Standards of Medical Care in Diabetes” (Standards of Care) has long been a leader in producing guidelines that capture the most current state of the field. Starting in 2018, the ADA will update the Standards of Care even more frequently online should the Professional Practice Committee determine that new evidence or regulatory changes merit immediate incorporation into the Standards of Care. In addition, the Standards of Care will now become the ADA’s sole source of clinical practice recommendations, superseding all prior position and scientific statements. The change is intended to clarify the Association’s current positions by consolidating all clinical practice recommendations into the Standards of Care.


Section 8. Pharmacologic Approaches to Glycemic Treatment

New recommendations for antihyperglycemic therapy for adults with type 2 diabetes have been added to reflect recent cardiovascular outcomes trial (CVOT) data, indicating that people with atherosclerotic cardiovascular disease (ASCVD) should begin with lifestyle management and metformin and subsequently incorporate an agent proven to reduce major adverse cardiovascular events and/or cardiovascular mortality after considering drug-specific and patient factors.

The algorithm for antihyperglycemic treatment (Fig. 8.1) was updated to incorporate the new ASCVD recommendation.

A new table was added (Table 8.1) to summarize drug-specific and patient factors of antihyperglycemic agents. Figure 8.1 and Table 8.1 are meant to be used together to guide the choice of antihyperglycemic agents as part of patient–provider shared decision-making.

Table 8.2 was modified to focus on the pharmacology and mechanisms of available glucose-lowering medicines in the U.S.

To provide a second set of cost information for antihyperglycemic agents, NADAC data was added to the average wholesale prices information in Table 8.3 and Table 8.4.

Section 9. Cardiovascular Disease and Risk Management

A new recommendation was added that all hypertensive patients with diabetes should monitor their blood pressure at home to help identify masked or white coat hypertension, as well as to improve medication-taking behavior.

A new figure (Fig. 9.1) was added to illustrate the recommended antihypertensive treatment approach for adults with diabetes and hypertension.

A new table (Table 9.1) was added summarizing studies of intensive versus standard hypertension treatment strategies.

A recommendation was added to consider mineralocorticoid receptor antagonist therapy in patients with resistant hypertension.

The lipid management recommendations were modified to stratify risk based on two broad categories: those with documented ASCVD and those without.

Owing to studies suggesting similar benefits in older versus middle-aged adults, recommendations were consolidated for patients with diabetes 40–75 years and >75 years of age without ASCVD to use moderate-intensity statin.

Table 9.2 (“Recommendations for statin and combination treatment in adults with diabetes”) was updated based on the new risk stratification approach and consolidated age-groups.

To accommodate recent data on new classes of lipid-lowering medications, a recommendation was modified to provide additional guidance on adding nonstatin LDL-lowering therapies for patients with diabetes and ASCVD who have LDL cholesterol ≥70 mg/dL despite maximally tolerated statin dose.

The same recommendations were added here as in Section 8 that people with type 2 diabetes and ASCVD should begin with lifestyle management and metformin and subsequently incorporate an agent proven to reduce major adverse cardiovascular events and/or cardiovascular mortality after considering drug-specific and patient factors.

The text was substantially modified to describe CVOT data on new diabetes agents and outcomes in people with type 2 diabetes, providing support for the new ASCVD recommendations.

A new Table 9.4 was added to summarize the CVOT studies.

Section 10. Microvascular Complications and Foot Care

A new table was added (Table 10.1), replacing previous tables 10.1 and 10.2, that combines information on staging chronic kidney disease and the appropriate kidney-related care for each stage.

A new Table 10.2 was included describing the complications of chronic kidney disease and related medical and laboratory evaluations.

A new section on acute kidney injury was included.

The effect of specific glucose-lowering medications on the delay and progression of kidney disease was discussed, with reference to recent CVOT trials that examined kidney effects as secondary outcomes.

A new recommendation was added on the noninferiority of the anti–vascular endothelial growth factor treatment ranibizumab in reducing the risk of vision loss in patients with proliferative diabetic retinopathy when compared with the traditional standard treatment, panretinal laser photocoagulation therapy.

A new section was added describing the mixed evidence on the use of hyperbaric oxygen therapy in people with diabetic foot ulcers.

Σπύρος Καραμαγκιώλης – Διαβητολόγος
Αγρίνιο Λάρισα Διαβητικό Πόδι

Οι Νέες Οδηγίες για την Υπέρταση – Νοέμβρης 2017 από τις AHA και ACC

Οι νέες κατευθυντήριες οδηγίες για την Αρτηριακή Υπέρταση 2017 από τις The American Heart Association (AHA) και The American College of Cardiology (ACC): Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults


Whelton PK, et al.
2017 High Blood Pressure Clinical Practice Guideline: Executive Summary
Page 5
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated
scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve
cardiovascular health. In 2013, the National Heart, Lung, and Blood Institute (NHLBI) Advisory Council
recommended that the NHLBI focus specifically on reviewing the highest-quality evidence and partner with
other organizations to develop recommendations (1, 2). Accordingly, the ACC and AHA collaborated with the
NHLBI and stakeholder and professional organizations to complete and publish 4 guidelines (on assessment
of cardiovascular risk, lifestyle modifications to reduce cardiovascular risk, management of blood cholesterol
in adults, and management of overweight and obesity in adults) to make them available to the widest possible
constituency. In 2014, the ACC and AHA, in partnership with several other professional societies, initiated a
guideline on the prevention, detection, evaluation, and management of high blood pressure (BP) in adults.
Under the management of the ACC/AHA Task Force, a Prevention Subcommittee was appointed to help guide
development of the suite of guidelines on prevention of cardiovascular disease (CVD). These guidelines, which
are based on systematic methods to evaluate and classify evidence, provide a cornerstone for quality
cardiovascular care. The ACC and AHA sponsor the development and publication of guidelines without
commercial support, and members of each organization volunteer their time to the writing and review efforts.
Guidelines are official policy of the ACC and AHA.

2018 – Ελληνικά και Διεθνή Συνέδρια για το Διαβήτη

Επιλεγμένα διεθνή και ελληνικά συνέδρια για τον Σακχ. Διαβήτη – περίοδος 2018:

  • 1 – 4 / 02 / 2018: ΕΜΕΔΙΠ – 6ο Πανελλήνιο Συνέδριο για το Διαβητικό Πόδι, Αθήνα »»
  • 9 – 11 / 02 / 2018: ADA – 65th Adnanced Postgraduate Course, San Francisco CA, USA »»
  • 14 – 17/ 03 /2018: ΕΔΕ – 16ο Πανελλήνιο Διαβητολογικό Συνέδριο, Αθήνα »»
  • 22 – 24/ 03 /2018: Greek Institute of Internal Medicine & Hepatology: 10th International Congress of Internal Medicine, Athens »»
  • 22 – 26 / 06 / 2018: ADA – 78th Scientific Sessions, Orlando FL, USA »»


14 Νοέμβρη 2017: Παγκόσμια Ημέρα για το Διαβήτη

 14 Νοεμβρίου 2017 – Παγκόσμια Ημέρα Διαβήτη

Φέτος η παγκόσμια ημέρα για τον σακχ. διαβήτη είναι αφιερωμένη στην γυναίκα με διαβήτη.

1 to 10 women are living with diabetes.
Many do not have access to education, treatment and care.
Act today to change tomorrow.

⇒ Δείτε περισσότερα στον ιστότοπο της International Diabetes Federation »» και στο site της Ε.Δ.Ε. »»

ADA Position Statement 2017 – Διαβήτης και Υπέρταση

Το νέο Position Statement για τον Σακχ. Διαβήτη και την Αρτ. Υπέρταση της Αμερικανικής Διαβητολογικής Εταιρείας (ADA) »»


Hypertension is common among patients with diabetes, with the prevalence depending on type and duration of diabetes, age, sex, race/ethnicity, BMI, history of glycemic control, and the presence of kidney disease, among other factors. Furthermore, hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications. ASCVD—defined as acute coronary syndrome, myocardial infarction (MI), angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin—is the leading cause of morbidity and mortality for individuals with diabetes and is the largest contributor to the direct and indirect costs of diabetes. Numerous studies have shown that antihypertensive therapy reduces ASCVD events, heart failure, and microvascular complications in people with diabetes. Large benefits are seen when multiple risk factors are addressed simultaneously. There is evidence that ASCVD morbidity and mortality have decreased for people with diabetes since 1990 likely due in large part to improvements in blood pressure control. This Position Statement is intended to update the assessment and treatment of hypertension among people with diabetes, including advances in care since the American Diabetes Association (ADA) last published a Position Statement on this topic in 2003.

Διαβάστε και κατεβάστε το άρθρο – σύνδεσμος »»

Σπύρος Καραμαγκιώλης
Ειδικός Παθολόγος – Διαβητολόγος
Αγρίνιο, Λάρισα