View source for Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes

__NOTOC__
{{ADA guidelines}}
{{CMG}} {{AE}} {{SCh}}; {{TarekNafee}}
==2016 ADA Standards of Medical Care in Diabetes Guidelines<ref name="urlcare.diabetesjournals.org">{{cite web |url=http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf |title=care.diabetesjournals.org |format= |work= |accessdate=}}</ref>==
==='''TYPE 1 DIABETES'''===
====HYPERTENSION====
=====Screening=====
{|class="wikitable"
| bgcolor="Seashell"|<nowiki>"</nowiki>'''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.''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>

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=====Treatment=====
{|class="wikitable"
| bgcolor="Seashell"|<nowiki>"</nowiki>'''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 ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''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 ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''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. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' The goal of treatment is blood pressure consistently < 90th percentile for age, sex, and height. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>

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====DYSLIPIDEMIA====
=====Testing=====
{|class="wikitable"
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Obtain a fasting lipid profile in children ≥10 years of age soon after the diagnosis (after glucose control has been established)''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''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 ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>

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=====Treatment=====
{|class="wikitable"
| bgcolor="Seashell"|<nowiki>"</nowiki>'''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 ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''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 ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' The goal of therapy is an LDL cholesterol value <100 mg/dL (2.6 mmol/L). ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>

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====SMOKING====
{|class="wikitable"
| bgcolor="Seashell"|<nowiki>"</nowiki>'''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 ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>

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==References==
{{Reflist|2}}
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