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Glycemic Targets
Consider risk-benefit assessment, including hypoglycemia risk, when individualizing targets*
A1C: 0-6 yrs 6-12 yrs 13-19 yrs
A1C <8.5%† <8%† <7.5%†
PG: prior to meals 100-180 mg/dL 90-180 mg/dL 90-130 mg/dL
PG: bedtime & overnight 110-200 mg/dL 100-180 mg/dL 90-150 mg/dL
*If on basal-bolus: measure postprandial PG to monitor glycemic values and if discrepancy between
preprandial PG and A1C; modification of targets may be needed in children aged <7 yrs due to
hypoglycemic unawareness; †Reasonable to consider lower target if achieved in absence of
excessive hypoglycemia
Nephropathy
Treatment: ACEI titrated to normalization of albumin excretion
Retinopathy
ACEIs are not approved by the U.S. Food and Drug Administration (FDA) for treatment of
Treatment: SBP or DBP >90th percentile*
SBP or DBP >95th percentile* or >130/80 mm Hg ????
*For age, sex, height; †Provide counseling re: potential teratogenic effects.
Dyslipidemia in Children & Adolescents With Type 1 Diabetes
Treatment
Initial
• Control glucose
Target: LDL-C <100 mg/dL (<2.6 mmol/L)
Microvascular Complications in Children & Adolescents With Type 1 Diabetes
Nephropathy
Screening : Aged ≥10 yrs or puberty onset (whichever occurs first) with 5-yr diabetes duration
• Albumin levels: yearly
• ACR: random urine sample
Treatment: ACEI titrated to normalization of albumin excretion
• If elevated ACR confirmed over 6 mos, after efforts to control glucose, normalize BP
Retinopathy
Screening: Initial dilated and comprehensive eye exam
• Aged ≥10 yrs or puberty onset (whichever occurs first) with 3-5–yr diabetes duration
Follow-up
• Yearly
• Yearly
• Less frequently: per recommendation of eye care professional
ACEIs are not approved by the U.S. Food and Drug Administration (FDA) for treatment of
nephropathy. Not all ACEIs are indicated for use in children/adolescents by the FDA. Refer to full
prescribing information for indications and uses in pediatric populations.
High Blood Pressure in Children & Adolescents With Type 1 Diabetes
Screening
• Measure BP at every visit
Screening
• Measure BP at every visit
• Confirm elevated BP at separate visit
Treatment: SBP or DBP >90th percentile*
• Lifestyle changes (diet & exercise)
• If target BP not met in 3-6 mos ????
Pharmacologic therapy: ACEI: initial treatment†
SBP or DBP >95th percentile* or >130/80 mm Hg ????
Target: <130/80 mm Hg or <90th percentile*
*For age, sex, height; †Provide counseling re: potential teratogenic effects.
Not all ACEIs are indicated for use in children/adolescents by the U.S. Food and Drug
Administration (FDA). Refer to full prescribing information for indications and uses in pediatric
Dyslipidemia in Children & Adolescents With Type 1 Diabetes
Screening
Obtain fasting lipids
Obtain fasting lipids
Family history
CV event aged <55 yrs or hypercholesterolemia ???? Aged >2 yrs
CV event aged <55 yrs or hypercholesterolemia ???? Aged >2 yrs
post-diagnosis*
Unknown ????
Unremarkable ???? Aged ≥10 yrs
Diabetes diagnosed prior to/post-puberty Post-diagnosis*
Lipid monitoring: all patients
• If lipids abnormal: yearly
• LDL-C <100 mg/dL (<2.6 mmol/L): every 5 yrs
Treatment
Initial
• Control glucose
• MNT: decrease saturated fat intake†
Aged ≥10 yrs
• Lifestyle changes and MNT
• Lifestyle changes and MNT
• After lifestyle changes, add statin‡ if LDL-C >160 mg/dL (>4.1 mmol/L) or >130 mg/dL (>3.4 mmol/L) + ≥1 CVD risk factor
Target: LDL-C <100 mg/dL (<2.6 mmol/L)
*When glucose levels well controlled
†Use American Heart Association Step 2 diet: saturated fat 7% of total calories; dietary cholesterol
200 mg/d
‡Statins are approved by the U.S. Food and Drug Administration for treatment of heterozygous
familial hypercholesterolemia in children and adolescents. Not all statins are FDA approved for use
under the age of 10 yrs; statins should generally not be used in children with type 1 diabetes before
age 10. Refer to full prescribing information for indications and uses in pediatric populations. For
postpubertal girls, pregnancy prevention is important as statins are contraindicated in pregnancy.
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