Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes

	2016 ADA Guideline Recommendations
Types of Diabetes Mellitus
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2016 ADA Standard of Medical Care Guideline Recommendations
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Classification and Diagnosis of Diabetes
Foundations of Care and Comprehensive Medical Evaluation Diabetes Self-Management, Education, and Support Nutritional Therapy
Prevention or Delay of Type II Diabetes
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Cardiovascular Disease and Risk Management Hypertension and Blood Pressure Control Lipid Management Antiplatelet Agents Coronary Heart Disease
Microvascular Complications and Foot Care Diabetic Kidney Disease Diabetic Retinopathy Diabetic Neuropathy Diabetic Footcare
Older Adults with Diabetes
Children and Adolescents with Diabetes Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes Microvascular Complications in Children and Adolescents with Diabetes
Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Tarek Nafee, M.D. [3]

2016 ADA Standards of Medical Care in Diabetes Guidelines^[1]

"1. Blood pressure should be measured at each routine visit. Children found to have high-normal blood pressure (systolic blood pressure or diastolic blood pressure ≥ 90th percentile for age, sex, and height) or hypertension (systolic blood pressure or diastolic blood pressure ≥95th percentile for age, sex, and height) should have blood pressure confirmed on 3 separate days.(Level of Evidence: B)"

"1. Initial treatment of high-normal blood pressure (systolic blood pressure or diastolic blood pressure consistently Initial treatment of high-normal blood pressure (systolic blood pressure or diastolic blood pressure consistently ≥90th percentile for age, sex, and height) includes dietary modification and increased exercise, if appropriate, aimed at weight control. If target blood pressure is not reached with 3–6 months of initiating lifestyle intervention, pharmacological treatment should be considered (Level of Evidence: E)"
"2. In addition to lifestyle modification, pharmacological treatment of hypertension (systolic blood pressure or diastolic blood pressure consistently ≥ 95th percentile for age, sex, and height) should be considered as soon as hypertension is confirmed (Level of Evidence: E)"
"3. ACE inhibitors or angiotensin receptor blockers should be considered for the initial pharmacological treatment of hypertension, following reproductive counseling due to the potential teratogenic effects of both drug classes. (Level of Evidence: E)"
"4. The goal of treatment is blood pressure consistently < 90th percentile for age, sex, and height. (Level of Evidence: E)"

"1. Obtain a fasting lipid profile in children ≥10 years of age soon after the diagnosis (after glucose control has been established)(Level of Evidence: E)"
"2. If lipids are abnormal, annual monitoring is reasonable. If LDL cholesterol values are within the accepted risk level (<100 mg/dL [2.6 mmol/L]), a lipid profile repeated every 3–5 years is reasonable (Level of Evidence: E)"

"1. Initial therapy should consist of optimizing glucose control and medical nutrition therapy using a Step 2 American Heart Association diet to decrease the amount of saturated fat in the diet (Level of Evidence: B)"
"2.After the age of 10 years, addition of a statin is suggested in patients who, despite medical nutrition therapy and lifestyle changes, continue to have LDL cholesterol >160 mg/dL (4.1 mmol/L) or LDL cholesterol >130 mg/dL (3.4 mmol/L) and one or more cardiovascular disease risk factor (Level of Evidence: E)"
"3. The goal of therapy is an LDL cholesterol value <100 mg/dL (2.6 mmol/L). (Level of Evidence: E)"

"1. Elicit a smoking history at initial and follow-up diabetes visits and discourage smoking in youth who do not smoke and encourage smoking cessation in those who do smoke (Level of Evidence: B)"