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T2DM > T2DM PEDIA > Flashcards

T2DM PEDIA Flashcards

1
Q

What is the alert value for hypoglycemia in patients with diabetes?

A

The alert value for hypoglycemia in patients with diabetes is ≤ 70 mg/dL (3.9 mmol/L).

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2
Q

What is the recommended duration to check blood glucose after treatment for hypoglycemia in patients with diabetes?

A

The recommended duration to check blood glucose after treatment for hypoglycemia in patients with diabetes is 15 minutes.

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3
Q

What should be monitored during illness to prevent ketosis?

A

Glucose and ketone levels should be monitored every 1-2 hours.

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4
Q

What is the target range for blood glucose during illness?

A

The target range for blood glucose during illness is between 3.9-10 mmol/L (70-180 mg/dL).

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5
Q

When should insulin dosing be adjusted during illness?

A

Insulin dose should be adjusted in response to blood or interstitial glucose and blood ketone levels.

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6
Q

How should hydration be maintained during illness?

A

Hydration should be maintained with oral fluids, including carbohydrate if blood glucose is < 250 mg/dL (14 mmol/L), and without carbohydrate if blood glucose is > 250 mg/dL (14 mmol/L).

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7
Q

What is the only FDA approved nonprescription weight loss aid?

A

Alli

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8
Q

Is Alli approved for patients under 18 years old?

A

No

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9
Q

What is the FDA-approved indication for liraglutide in patients ≥ 12 years old?
Obesity

A

Liraglutide is FDA approved as an adjunct to diet and exercise for chronic weight management in patients ≥ 12 years old with body weight > 60 kg and initial BMI corresponding to 30 kg/m2 in adults.

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10
Q

What type of medication is liraglutide?

A

Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist.

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11
Q

For whom is orlistat FDA approved for long-term weight loss?

A

Orlistat is FDA approved for long-term weight loss in adolescents ≥ 12 years old with initial body mass index (BMI) ≥ 30 kg/m2 or ≥ 27 kg/m2 with obesity-related comorbidities.

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12
Q

What are the criteria for adolescents to be eligible for orlistat for long-term weight loss?

A

Adolescents must have an initial body mass index (BMI) ≥ 30 kg/m2 or ≥ 27 kg/m2 with obesity-related comorbidities (such as diabetes, hypertension, and dyslipidemia) to be eligible for orlistat for long-term weight loss.

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13
Q

What is metformin FDA approved for in children?

A

Metformin is FDA approved for type 2 diabetes, but not for obesity in children.

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14
Q

When should a patient with diabetes mellitus type 2 in children and adolescents be referred to gastroenterology?

A

A patient with diabetes mellitus type 2 in children and adolescents should be referred to gastroenterology for worsening or persistently elevated transaminases.

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15
Q

What are the criteria for monitoring finger-stick blood glucose concentrations in patients?

A

The criteria for monitoring finger-stick blood glucose concentrations in patients include taking insulin or other medications with a risk of hypoglycemia, initiating or changing their diabetes treatment regimen, not meeting treatment goals, or having intercurrent illnesses.

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16
Q

Are there evidence-based recommendations for complementary and alternative medicine in children and adolescents with type 2 diabetes mellitus?

A

No, there are no evidence-based recommendations for complementary and alternative medicine in children and adolescents with type 2 diabetes mellitus.

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17
Q

What is the recommended action for individuals at risk for level 2 hypoglycemia?

A

Follow-up to prescribe glucagon and instruct caregivers or family members on its use.

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18
Q

How is level 2 hypoglycemia defined?

A

Level 2 hypoglycemia is defined as blood glucose < 54 mg/dL [3 mmol/L].

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19
Q

What should patients carry at all times to treat hypoglycemia?

A

Patients should carry carbohydrates at all times to treat hypoglycemia.

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20
Q

What is the dosage and administration of intranasal glucagon for the treatment of severe hypoglycemia in patients with diabetes?

A

Each single-dose container delivers glucagon 3 mg intranasally in one actuation into one nostril. Inhalation of dose is not necessary, as the dose is passively absorbed through nasal mucos.

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21
Q

What is the age requirement for the use of intranasal glucagon for the treatment of severe hypoglycemia in patients with diabetes?

A

Intranasal glucagon is FDA approved and authorized by the European Commission for treatment of severe hypoglycemia in patients with diabetes ≥ 4 years old.

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22
Q

What is the purpose of using intranasal glucagon for the treatment of severe hypoglycemia in patients with diabetes?

A

The purpose of using intranasal glucagon is to treat severe hypoglycemia in patients with diabetes.

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23
Q

What is the dosage for patients aged 12 years or older and pediatric patients who weigh 45 kg or more?

A

The dosage for these patients is 1 mg injected subcutaneously.

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24
Q

What is the dosage for children aged 2-11 years who weigh less than 45 kg?

A

The dosage for these children is 0.5 mg injected subcutaneously.

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25
Q

What is the FDA-approved use for injectable liquid-stable glucagon?

A

The FDA approved use for injectable liquid-stable glucagon is the treatment of severe hypoglycemia in patients with diabetes ≥ 2 years old.

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26
Q

What is the recommended treatment for hypoglycemia in patients with diabetes based on the ADA guidelines?

A

The recommended treatment for hypoglycemia in patients with diabetes is to give 15-20 g of glucose (preferably pure glucose) if the patient is conscious and oral intake is feasible. Any glucose-containing carbohydrate is acceptable for treatment. Carbohydrate sources high in protein should be

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27
Q

What is the boxed warning for this medication in relation to thyroid C-cell tumors?

A

The boxed warning states that there is a risk of thyroid C-cell tumors with this medication.

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28
Q

Who are the contraindicated patients for this medication?

A

The medication is contraindicated in patients with personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia syndrome type 2.

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29
Q

What is the recommended dose of Exenatide Extended Release (Bydureon BCise) for patients ≥ 10 years old with type 2 diabetes?

A

The recommended dose is 2 mg subcutaneously to abdomen, thigh, or upper arm region once weekly (using a different injection site each week).

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30
Q

When should Exenatide Extended Release (Bydureon BCise) be administered if insulin is required?

A

Exenatide should be administered separately from insulin.

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31
Q

What is the expanded FDA approval for Exenatide Extended Release (Bydureon BCise)?

A

The expanded FDA approval is as an adjunct to diet and exercise to improve glycemic control in patients ≥ 10 years old with type 2 diabetes.

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32
Q

What is the approved initial dose of the subcutaneous medication?

A

The approved initial dose is 0.6 mg once daily.

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33
Q

How much can the daily dose be increased to in patients requiring additional glycemic control?

A

The daily dose can be increased to 1.2 mg after 1 week, and then further to 1.8 mg.

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34
Q

What is the maximum daily dose of subcutaneous injection for pediatric patients with type 2 diabetes mellitus?

A

The maximum daily dose is 1.8 mg.

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35
Q

What is the potential risk associated with antihyperglycemic therapies in pediatric patients with type 2 diabetes mellitus?

A

The risk of hypoglycemia may be higher in pediatric patients regardless of concomitant antihyperglycemic therapies used.

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36
Q

What is the recommended dosage of liraglutide for weight control management of obesity?

A

Liraglutide up to 3 mg daily is considered for weight control management of obesity.

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37
Q

What is the recommended dosage of liraglutide for management of type 2 diabetes?

A

Liraglutide up to 1.8 mg daily is considered for management of type 2 diabetes.

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38
Q

What therapy should be considered if glycemic targets are no longer met with metformin + OR - BASAL INSULIN?

A

Glucagon-like peptide 1 (GLP-1) receptor agonist therapy, such as liraglutide, should be considered.

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39
Q

What is the age group of children that can be considered for GLP-1 receptor agonist therapy?

A

Children aged ≥ 10 years can be considered for GLP-1 receptor agonist therapy.

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40
Q

What are the contraindications for GLP-1 receptor agonist therapy in children?

A

The contraindications for GLP-1 receptor agonist therapy in children are past medical history or family history of medullary thyroid carcinoma or multiple endocrine neoplasia.

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41
Q

When should you refer a patient to a nephrologist for diabetes mellitus type 2 in children and adolescents?

A

You should refer to a nephrologist if there is uncertain etiology of kidney disease, worsening urinary albumin-to-creatinine ratio, or reduction in estimated glomerular filtration rate.

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42
Q

What is the significance of the ADA Grade E recommendation for referring to a nephrologist in diabetes mellitus type 2 in children and adolescents?

A

The ADA Grade E recommendation indicates that there is uncertain evidence to support the referral to a nephrologist in these cases.

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43
Q

When should a comprehensive eye exam be done in children and adolescents with type 2 diabetes?

A

A comprehensive eye exam should be done at the time of diagnosis.

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44
Q

What level of diabetic retinopathy necessitates a referral to an ophthalmologist?

A

Any level of macular edema, severe nonproliferative, or any proliferative diabetic retinopathy requires a referral to an ophthalmologist.

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45
Q

What type of ophthalmologist should be consulted for the management of diabetic retinopathy?

A

An ophthalmologist experienced in the management of diabetic retinopathy should be consulted.

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46
Q

What is the significance of routine follow-up in patients with body mass index > 95th percentile?

A

Routine follow-up with dietation is important for patients with a body mass index > 95th percentile.

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47
Q

According to the American Diabetes Association (ADA), what term do they use instead of bariatric surgery for treatment of type 2 diabetes in adolescents?

A

The ADA uses the term metabolic surgery.

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48
Q

When should metabolic surgery be considered as a treatment for type 2 diabetes in adolescents?

A

Metabolic surgery should be considered for adolescents with a body mass index (BMI) > 35 kg/m2 who have uncontrolled glycemia and/or serious comorbidities despite lifestyle and pharmacological intervention.

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49
Q

What is the grading given to the recommendation of considering metabolic surgery for treatment of type 2 diabetes in adolescents by the American Diabetes Association (ADA)?

A

The American Diabetes Association (ADA) gives a Grade A to the recommendation of considering metabolic surgery for treatment of type 2 diabetes in adolescents.

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50
Q

For children and adolescents aged 6-18 years with no history of PPSV23, when should the dose of PPSV23 be given?

A

The dose of PPSV23 should be given at least 8 weeks after all recommended PCV doses.

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51
Q

What is the recommended dose of PPSV23 for children and adolescents aged 6-18 years with no history of PPSV23?

A

The recommended dose of PPSV23 is 1 dose.

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52
Q

What is the dosing recommendation for pneumococcal vaccines in children aged 2-5 years with an incomplete PCV schedule?

A

If a child aged 2-5 years has an incomplete PCV schedule, consisting of 3 PCV doses, they should be given 1 dose of PCV ≥ 8 weeks.

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53
Q

Why is SGLT2I not recommended for patients with type 1 diabetes and a GFR < 30 mL/minute/1.73 m2?

A

SGLT2I is not recommended due to the increased risk of diabetic ketoacidosis in these patients.

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54
Q

When is SGLT2I unlikely to be effective for glucose control?

A

SGLT2I is unlikely to be effective for glucose control during the second and third trimesters of pregnancy or during breastfeeding.

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55
Q

What is the initial dose of empagliozin for glycemic control?

A

The initial dose of empagliozin for glycemic control is 10 mg orally once daily in the morning.

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56
Q

When can the dose of empagliozin be increased for additional glycemic control?

A

The dose of empagliozin can be increased to 25 mg orally once daily for additional glycemic control.

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57
Q

What is the boxed warning for this medication?

A

The boxed warning is for the risk of C-cell tumors and it is contraindicated in patients with personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia syndrome type 2.

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58
Q

What are some adverse effects of this medication (occurring in at least 5% of patients)?

A

Some adverse effects (occurring in at least 5% of patients) include nausea, diarrhea, vomiting, abdominal pain, and decreased appetite.

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59
Q

Is this medication safe to use in patients with a history of pancreatitis?

A

No, this medication is not recommended in patients with a history of pancreatitis. Other antidiabetic therapies should be considered.

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60
Q

What is the maximum recommended dose of dulaglutide (Trulicity) in children ≥ 10 years old with type 2 diabetes?

A

The maximum recommended dose of dulaglutide (Trulicity) in children ≥ 10 years old with type 2 diabetes is 1.5 mg subcutaneously once weekly.

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61
Q

What trial was the efficacy of dulaglutide (Trulicity) in children ≥ 10 years old with type 2 diabetes based on?

A

The efficacy of dulaglutide (Trulicity) in children ≥ 10 years old with type 2 diabetes was based on the AWARD-PEDS trial.

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62
Q

What is the initial dosing and administration recommendation for dulaglutide (Trulicity) in children ≥ 10 years old with type 2 diabetes?

A

The initial dosing and administration recommendation for dulaglutide (Trulicity) in children ≥ 10 years old with type 2 diabetes is 0.75 mg subcutaneously once weekly.

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63
Q

What are some common adverse effects of the medication?

A

The common adverse effects of the medication include nausea, diarrhea, headache, vomiting, constipation, injection-site pruritus, injection-site nodule, and dyspepsia.

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64
Q

What percentage of people experience the adverse effects?

A

The adverse effects occur in at least 5% of people taking the medication, and they are more frequent compared to the comparator.

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65
Q

What is the boxed warning for risk of thyroid C-cell tumors?

A

The boxed warning is for the risk of thyroid C-cell tumors and it is contraindicated in patients with personal or family history of medullary thyroid carcinoma or in patients.

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66
Q

How often should children and adolescents with type 2 diabetes be screened for psychosocial problems?

A

Children and adolescents with type 2 diabetes should be screened for psychosocial problems.

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67
Q

How often is strength training suggested for children and adolescents with type 2 diabetes?

A

Strength training is suggested at least 3 days per week.

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68
Q

According to ADA and AAP, how much daily physical activity is recommended for children and adolescents with type 2 diabetes?

A

At least 60 minutes daily.

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69
Q

What type of exercise is recommended for children and adolescents with type 2 diabetes?

A

Moderate-to-vigorous aerobic exercise.

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70
Q

How is moderate-to-vigorous aerobic exercise defined?

A

Exercise that makes an individual breathe hard, perspire, and elevate heart rate.

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71
Q

What dietary recommendations are given for patients with triglycerides > 600 mg/dL?

A

Decrease dietary intake of simple carbohydrates and fat.

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72
Q

What is the recommended dietary fat intake for patients with LDL cholesterol level ≥ 130 mg/dL?

A

Dietary fat should be less than 30% of total calories.

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73
Q

What is the recommended saturated fat intake for patients with LDL cholesterol level ≥ 130 mg/dL?

A

Saturated fat should be less than 7% of total calories.

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74
Q

What is the recommended protein intake for patients with nondialysis dependent diabetic kidney disease?

A

The recommended protein intake for patients with nondialysis dependent diabetic kidney disease is 0.8 g/kg/day.

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75
Q

When should statin therapy be initiated for patients with LDL cholesterol > 130 mg/dL?

A

Statin therapy should be initiated after 6 months of dietary intervention for patients with LDL cholesterol > 130 mg/dL.

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76
Q

What is the goal LDL cholesterol level for patients on statin therapy?

A

The goal LDL cholesterol level for patients on statin therapy is < 100 mg/dL.

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77
Q

What should be provided to children and adolescents who are overweight or obese with type 2 diabetes and their families?

A

Children and adolescents who are overweight or obese with type 2 diabetes and their families should be provided with culturally and developmentally appropriate lifestyle programs that are integrated with diabetes management.

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78
Q

What is the recommended weight reduction for children and adolescents who are overweight or obese with type 2 diabetes?

A

A 7%-10% reduction in excess weight is recommended for children and adolescents who are overweight or obese with type 2 diabetes.

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79
Q

How should macronutrient intake be individualized for children and adolescents with type 2 diabetes?

A

Macronutrient intake (carbohydrate, protein, fat) should be individualized while considering total calorie and metabolic goals.

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80
Q

How often should blood pressure be measured for children and adolescents with type 2 diabetes?

A

Blood pressure should be measured at each visit.

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81
Q

How often should the lipid profile be assessed for children and adolescents with type 2 diabetes?

A

The lipid profile should be assessed annually.

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82
Q

What is the limitation of using accurate diagnosis methods for children and adolescents with obesity?

A

The limitation is that accurate diagnosis methods may have limited accuracy for children and adolescents with obesity.

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83
Q

What does HbA1c measure?

A

HbA1c measures the glycemic effect on hemoglobin over the preceding 4-8 weeks.

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84
Q

When may HbA1c be inaccurate for diagnosis in children and adolescents with obesity?

A

HbA1c may be inaccurate for diagnosis in children and adolescents with obesity if there is the presence of abnormal red cell turnover, hemoglobinopathy, or other disorders affecting erythrocytes.

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85
Q

What is the recommended assessment for hyperglycemic hyperosmolar nonketotic syndrome in children and adolescents with severe hyperglycemia at diagnosis?

A

The recommended assessment is referral to a pediatric sleep specialist for assessment and polysomnogram.

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86
Q

What evaluations should be done for female adolescents with type 2 diabetes?

A

Evaluation for polycystic ovary syndrome, including laboratory testing as indicated.

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87
Q

What annual assessments are recommended for children and adolescents with diabetic nephropathy?

A

Annual assessments of estimated glomerular filtration rate, serum potassium, and urinary albumin-to-creatinine ratio.

88
Q

What is the recommended frequency for obtaining an estimated glomerular filtration rate for diabetic children and adolescents?

A

Annually, after diagnosis and thereafter.

89
Q

According to ADA, is routine screening for heart disease recommended for asymptomatic youth with type 2 diabetes?

A

No, routine screening for heart disease using echocardiogram, electrocardiogram, or stress testing is not recommended.

90
Q

What is the recommended screening approach for heart disease in asymptomatic youth with type 2 diabetes?

A

Routine screening for heart disease using echocardiogram, electrocardiogram, or stress testing is not recommended.

91
Q

According to ADA guidelines, when should genetic testing for neonatal diabetes be performed?

A

Genetic testing for neonatal diabetes should be performed in all children diagnosed with diabetes in the first 6 months of life (ADA Grade A).

92
Q

What is the recommended time frame for performing genetic testing for neonatal diabetes?

A

Genetic testing for neonatal diabetes should be performed in the first 6 months of life (ADA Grade A).

93
Q

What test should be done for a child or adolescent with overweight or obesity who is being considered for a diagnosis of type 2 diabetes?

A

Pancreatic autoantibodies should be tested to exclude the possibility of autoimmune type 1 diabetes.

94
Q

What is the significance of testing for pancreatic autoantibodies in children or adolescents?

A

Testing for pancreatic autoantibodies helps exclude the possibility of autoimmune type 1 diabetes.

95
Q

How often should the lipid profile be assessed in children and adolescents with type 2 diabetes?

A

The lipid profile should be assessed annually.

96
Q

What is the recommended frequency for measuring HbA1c in children and adolescents with type 2 diabetes according to the American Diabetes Association (ADA)?

A

Measure HbA1c every 3 months.

97
Q

What is the recommended approach for monitoring glycemic control in children and adolescents with type 2 diabetes according to the American Diabetes Association (ADA)?

A

Monitor glycemic control by measuring HbA1c every 3 months.

98
Q

What is the recommended practice for female adolescents with diabetes beginning at puberty?

A

Incorporate preconception counseling discussing adverse pregnancy outcomes into routine diabetes visits.

99
Q

When should metabolic surgery be considered as a treatment option for type 2 diabetes in adolescents according to the ADA recommendation?

A

Metabolic surgery should be considered for adolescents with body mass index > 35 kg/m2 who have uncontrolled glycemia and/or serious comorbidities despite lifestyle and pharmacological intervention.

100
Q

What is the ADA Grade of metabolic surgery as a treatment for type 2 diabetes in adolescents with a body mass index > 35 kg/m2 and uncontrolled glycemia and/or serious comorbidities despite lifestyle and pharmacological intervention?

A

Metabolic surgery is recommended with an ADA Grade A.

101
Q

What is the recommendation for antihypertensive treatment in children and adolescents with confirmed hypertension?

A

Initiate either angiotensin converting enzyme inhibitor or angiotensin receptor blocker after appropriate reproductive counseling due to potential teratogenic effects (ADA Grade B).

102
Q

When is hypertension defined in adolescents aged 13 years and older?

A

Hypertension is defined as blood pressure consistently ≥ 130/80 mm Hg in adolescents aged ≥ 13 years.

103
Q

What is the criteria for initiating antihypertensive treatment in children and adolescents with confirmed hypertension?

A

Initiate antihypertensive treatment if blood pressure is consistently ≥ 95th percentile for age, sex, and height, or ≥ 130/80 mm Hg in adolescents aged ≥ 13 years, in addition to lifestyle modification.

104
Q

When should statin therapy be initiated in children and adolescents with type 2 diabetes according to ADA guidelines?

A

Statin therapy should be initiated if low-density lipoprotein cholesterol remains > 130 mg/dL despite 6 months of dietary intervention, with a goal of low-density lipoprotein < 100 mg/dL (2.6 mmol/L) (ADA Grade B).

105
Q

What is the recommended goal for low-density lipoprotein (LDL) cholesterol in children and adolescents with type 2 diabetes on statin therapy?

A

The recommended goal for LDL cholesterol in children and adolescents with type 2 diabetes on statin therapy is < 100 mg/dL (2.6 mmol/L) (ADA Grade B).

106
Q

What is the recommended fasting glucose range for children and adolescents with type 2 diabetes according to the American Academy of Pediatrics (AAP)?

A

The recommended fasting glucose range for children and adolescents with type 2 diabetes is 70-130 mg/dL (3.9-7.2 mmol/L).

107
Q

What should be considered if a patient is unable to achieve an HbA1c goal of < 7% safely?

A

If a patient is unable to achieve an HbA1c goal of < 7% safely, a higher goal should be set.

108
Q

According to the ISPAD 2022 recommendations, what is the initial target HbA1c for children and adolescents with type 2 diabetes?

A

The initial target HbA1c for children and adolescents with type 2 diabetes is < 7% (53 mmol/mol), with < 6.5% (48 mmol/mol) considered in some situations if it can be attained without hypoglycemia.

109
Q

What is the grading level assigned by ISPAD to the recommendation of attaining HbA1c < 7% (53 mmol/mol) for initial treatment in children and adolescents with type 2 diabetes?

A

ISPAD assigns a Grade C to the recommendation of attaining HbA1c < 7% (53 mmol/mol) for initial treatment in children and adolescents with type 2 diabetes.

110
Q

What is the recommended HbA1c target for most children and adolescents with type 2 diabetes treated with oral medications alone?

A

The recommended HbA1c target for most children and adolescents with type 2 diabetes treated with oral medications alone is < 7% (53 mmol/mol).

111
Q

For children and adolescents with increased risk of hypoglycemia, what HbA1c goal may be appropriate?

A

For children and adolescents with increased risk of hypoglycemia, an HbA1c goal of 7.5% (58 mmol/mol) may be appropriate.

112
Q

What factors might suggest a more stringent HbA1c target for selected children and adolescents with type 2 diabetes?

A

Lesser degrees of beta-cell dysfunction, shorter duration of diabetes, and significant weight loss while treated with lifestyle or metformin only might suggest a more stringent HbA1c target for selected children and adolescents with type 2 diabetes.

113
Q

What type of continuous glucose monitoring (CGM) should be offered for diabetes management in children capable of using devices safely?

A

Real-time CGM or intermittently scanned CGM should be offered for diabetes management in children capable of using devices safely.

114
Q

What are some benefits of using oral medication for diabetes mellitus type 2 in children and adolescents?

A

Benefits include lower risk of hypoglycemia compared to insulin or sulfonylurea, less frequent finger-stick glucose monitoring, improved insulin sensitivity, potential improvement in hyperandrogenism and menstrual cyclicity in children and adolescents with polycystic ovary syndrome, and potential improvement in fertility.

115
Q

What precaution should be taken for sexually active children and adolescents with diabetes mellitus type 2 who are receiving oral medication?

A

Sexually active children and adolescents with diabetes mellitus type 2 who are receiving oral medication should use contraception to prevent unintended pregnancy.

116
Q

What is the initial dosing recommendation for metformin in children and adolescents with type 2 diabetes?

A

The initial dose of metformin is 500-1,000 mg daily with food for 7 days.

117
Q

What is the maximum dose of metformin for children and adolescents with type 2 diabetes?

A

The maximum dose of metformin is 1 g twice daily of the standard preparation, or 2 g once daily of extended-release metformin (maximum dose 2 g/day).

118
Q

What are the contraindications for using iodinated contrast dyes?

A

The contraindications for using iodinated contrast dyes include impaired renal function, liver cirrhosis, hepatitis, alcoholism, and cardiopulmonary insufficiency.

119
Q

When should families and pediatric diabetes providers begin to prepare youth for transition to adult health care?

A

During early adolescence or ≥ 1 year before the transition to adult health care.

120
Q

What is the recommended approach for the management of diabetes care in children and adolescents with type 2 diabetes?

A

The management of diabetes care and close supervision are gradually shifted from parents and other adults to youth with type 2 diabetes throughout childhood and adolescence.

121
Q

What does the ADA recommend regarding routine screening for psychosocial problems in children and adolescents with type 2 diabetes?

A

The ADA recommends performing routine screening for psychosocial problems such as depression and diabetes-related distress, anxiety, disordered eating, and cognitive impairment at initial visit, periodic intervals, and if there is a change in disease, treatment, or life circumstances. They also suggest using patient-appropriate standardized and validated tools and including caregivers and family members in the screening process. (ADA Grade B)

122
Q

What is the limited usefulness of HbA1c for diabetes screening in obese children and adolescents?

A

HbA1c may have limited usefulness for diabetes screening in obese children and adolescents.

123
Q

What are the risk factors recommended for screening of type 2 diabetes in children and adolescents?

A

The recommended risk factors for screening of type 2 diabetes in children and adolescents are BMI 85th-95th percentile and ≥ 1 of immediate family history of type 2 diabetes, early cardiovascular disease, signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, or polycystic ovarian syndrome).

124
Q

According to the United States Preventive Services Task Force (USPSTF), what is their conclusion about screening for prediabetes and type 2 diabetes in children and adolescents?

A

The USPSTF concludes that there is insufficient evidence available to assess the balance of benefit and harm.

125
Q

What is the focus of screening for prediabetes and type 2 diabetes in children and adolescents according to the United States Preventive Services Task Force (USPSTF)?

A

The USPSTF focuses on assessing the balance of benefit and harm.

126
Q

What are the criteria for screening children for type 2 diabetes?

A

Children should be screened if they are ≥ 10 years old (or at puberty onset if puberty occurs at age < 10 years), overweight or obese, have a family history of type 2 diabetes, signs of insulin resistance, or belong to an ethnic group at increased risk.

127
Q

According to the American Diabetes Association (ADA) recommendations, how can screening for type 2 diabetes be conducted in asymptomatic patients?

A

Screening for type 2 diabetes can be conducted using informal assessment of risk factors or validated tools such as the ADA risk test to determine the need for diagnostic testing.

128
Q

What is the grade assigned by the American Diabetes Association (ADA) to using informal assessment of risk factors or validated tools for screening type 2 diabetes in asymptomatic patients?

A

The grade assigned by ADA is Grade B.

129
Q

Did the study find that insulin glargine followed by metformin or metformin alone slowed deterioration of beta-cell function in children and adolescents with impaired glucose tolerance or newly diagnosed type 2 diabetes?

A

No, the study found that insulin glargine followed by metformin or metformin alone may not slow deterioration of beta-cell function.

130
Q

What is the effect of metformin in obese children and adolescents with hyperinsulinemia and/or prediabetes?

A

Metformin is associated with a small reduction in body mass index in obese children and adolescents with hyperinsulinemia and/or prediabetes.

131
Q

Has the diagnostic value of HbA1c test and appropriate cutoffs been established in children?

A

No, the diagnostic value of HbA1c test and appropriate cutoffs have not been established in children in epidemiological studies, as they have been for adults.

132
Q

What condition is the HbA1c test used for diagnosing?

A

The HbA1c test is used for diagnosing diabetes mellitus type 2.

133
Q

What is considered hypertension in adolescents with type 2 diabetes mellitus?

A

Hypertension is diagnosed if the systolic or diastolic pressure is greater than or equal to the 95th percentile for age, sex, and height or, if they are 13 years old or older, if the blood pressure is greater than or equal to 130/80 mm Hg.

134
Q

What was the reported prevalence of hypertension in adolescents with type 2 diabetes mellitus in the SEARCH for diabetes in youth study?

A

The reported prevalence of hypertension in adolescents with type 2 diabetes mellitus in the study was 23.7%.

135
Q

How is high blood pressure defined in children and adolescents?

A

High blood pressure is defined as ≥ 90th percentile for age, sex, and height, or if ≥ 13 years old, blood pressure ≥ 120/80 mm Hg when confirmed on 3 separate measurements.

136
Q

When should blood pressure be measured in children and adolescents with diabetes mellitus type 2?

A

Blood pressure should be measured at each visit to assess for high or elevated blood pressure or hypertension.

137
Q

What are some examples of eating disorders discussed in the content?

A

Bulimia nervosa, anorexia nervosa, binge eating disorder

138
Q

What are the characteristics of bulimia nervosa?

A

Recurrent episodes of excessive eating followed by compensatory behaviors to prevent weight gain

139
Q

What is the definition of anorexia nervosa?

A

Intense fear of weight gain and distorted body image

140
Q

What are some symptoms of depression in patients with poor glycemic control or frequent emergency department visits?

A

Some symptoms of depression in patients with poor glycemic control or frequent emergency department visits include significant change in weight or appetite, insomnia or hypersomnia, fatigue or loss of energy, and feelings of worthlessness or excessive or inappropriate guilt.

141
Q

What is the recommended grade from the American Diabetes Association (ADA) for assessing symptoms of depression in patients with diabetes mellitus type 2 in children and adolescents?

A

The American Diabetes Association (ADA) recommends using appropriate standardized tools to assess for symptoms of depression, with a grade of B.

142
Q

What is the primary cause of type 2 diabetes in children?

A

Type 2 diabetes in children is primarily caused by insulin resistance and progressive insulin secretory defects, likely in combination with other contributing factors such as genetic predisposition.

143
Q

What is the family history associated with type 2 diabetes in children?

A

Family history is present in almost 90% of cases of type 2 diabetes in children.

144
Q

What are some risk factors for type 2 diabetes mellitus in children and adolescents?

A

Some risk factors for type 2 diabetes mellitus in children and adolescents include prediabetes, obesity, metabolic syndrome, family history of type 2 diabetes, acanthosis nigricans, polycystic ovary syndrome, puberty, and intrauterine exposure to hyperglycemia.

145
Q

What percentage of obese children and adolescents have insulin resistance?

A

Up to 50% of obese children and adolescents have insulin resistance.

146
Q

Who is most affected by type 2 diabetes in children and adolescents?

A

Children and adolescents who are ≥ 10 years old, female, and have obesity and sedentary behavior are most affected.

147
Q

How is childhood diabetes mellitus type 2 defined?

A

Childhood diabetes mellitus type 2 is defined as disease in a child who is usually overweight or obese, has a strong family history of type 2 diabetes, demonstrates insulin resistance, and lacks evidence for diabetic autoimmunity.

148
Q

What are the clinical features associated with insulin resistance in childhood diabetes mellitus type 2?

A

The clinical features associated with insulin resistance in childhood diabetes mellitus type 2 include polycystic ovary syndrome, acanthosis nigricans, dyslipidemia, and nonalcoholic fatty liver disease.

149
Q

When should statin therapy be initiated for youth with type 2 diabetes?

A

Statin therapy should be initiated for youth with type 2 diabetes when low-density lipoprotein cholesterol remains above goal (> 130 mg/dL) despite 6 months of dietary intervention.

150
Q

What is the goal level of low-density lipoprotein (LDL) cholesterol for youth with type 2 diabetes on statin therapy?

A

The goal level of LDL cholesterol for youth with type 2 diabetes on statin therapy is < 100 mg/dL (2.6 mmol/L).

151
Q

What are the recommended glucose targets for a child or adolescent with type 2 diabetes treated with insulin and metformin?

A

The glucose targets should be determined based on home blood glucose monitoring.

152
Q

How can basal insulin be adjusted for a child or adolescent with type 2 diabetes treated with insulin and metformin?

A

Basal insulin can be decreased by 10%-30% every few days over 2-6 weeks.

153
Q

What does the American Academy of Pediatrics (AAP) recommend for children and adolescents with type 2 diabetes?

A

The AAP recommends insulin therapy for children and adolescents with random venous or plasma glucose concentrations ≥ 250 mg/dL, HbA1c > 9%, ketosis, or diabetic ketoacidosis, without clear distinction between type 1 diabetes and type 2 diabetes.

154
Q

What are the factors that the American Academy of Pediatrics (AAP) considers in recommending insulin therapy for children and adolescents with type 2 diabetes?

A

The AAP recommends insulin therapy for children and adolescents with random venous or plasma glucose concentrations ≥ 250 mg/dL, HbA1c > 9%, ketosis, or diabetic ketoacidosis, without clear distinction between type 1 diabetes and type 2 diabetes.

155
Q

What are the initial insulin recommendations for children or adolescents with blood glucose ≥ 250 mg/dL or HbA1c ≥ 8.5% without ketoacidosis at diagnosis and experiencing symptoms?

A

Initial treatment should include basal insulin while metformin is started and titrated.

156
Q

What is the typical starting dose for long-acting insulin in children and adolescents with type 2 diabetes?

A

The typical starting dose for long-acting insulin in children and adolescents with type 2 diabetes is 0.1-0.2 units/kg/day.

157
Q

What is the recommended treatment for children or adolescents presenting with ketoacidosis or ketosis?

A

Treatment should be initiated with IV or subcutaneous insulin to rapidly correct metabolic derangements and hyperglycemia.

158
Q

What should be monitored frequently in children and adolescents using insulin for type 2 diabetes?

A

Self-monitoring blood glucose should be done frequently to monitor for asymptomatic hypoglycemia, particularly at night.

159
Q

How often should the random spot urine sample for albumin to creatinine ratio be assessed in patients being treated with an angiotensin-converting enzyme inhibitor for persistent albuminuria?

A

The random spot urine sample for albumin to creatinine ratio should be assessed every 3-6 months.

160
Q

What should be the goal of medication titration in patients being treated with an angiotensin-converting enzyme inhibitor for persistent albuminuria?

A

The goal of medication titration should be to achieve optimal albumin-to-creatinine ratio.

161
Q

According to ADA guidelines, what should be monitored annually for patients with nephropathy?

A

Estimated glomerular filtration rate, albumin-to-creatinine ratio, and serum potassium should be monitored annually.

162
Q

What is the purpose of monitoring estimated glomerular filtration rate, albumin-to-creatinine ratio, and serum potassium in patients with nephropathy and Type 2 diabetes mellitus?

A

The monitoring helps evaluate adherence and detect disease progression.

163
Q

How often should the estimated glomerular filtration rate be measured in children and adolescents with type 2 diabetes?

A

The estimated glomerular filtration rate should be measured annually.

164
Q

What is the recommended method to assess albuminuria in children and adolescents with type 2 diabetes?

A

The recommended method is to measure urine albumin-to-creatinine ratio.

165
Q

What are the optimal lipid goals for individuals with type 2 diabetes?

A

The optimal lipid goals are low-density lipoprotein cholesterol < 100 mg/dL (2.6 mmol/L), high-density lipoprotein cholesterol > 35 mg/dL (0.91 mmol/L), and triglycerides < 150 mg/dL (1.7 mmol/L).

166
Q

How is elevated blood pressure defined in children and adolescents?

A

Elevated blood pressure is defined as the 90th to < 95th percentile for age, sex, and height, or a blood pressure of 120-129/< 80 mm Hg in adolescents aged ≥ 13 years.

167
Q

What is the first-line drug of choice for children and adolescents with type 2 diabetes?

A

Metformin.

168
Q

What is the recommended HbA1c range for prescribing Metformin in children and adolescents with type 2 diabetes?

A

HbA1c < 8.5% (69 mmol/mol) to ≤ 9% (75 mmol/mol).

169
Q

What is the recommended target for low-density lipoprotein cholesterol in children with type 2 diabetes?

A

The recommended target for low-density lipoprotein cholesterol in children with type 2 diabetes is < 100 mg/dL (2.6 mmol/L).

170
Q

What is the recommended target for high-density lipoprotein cholesterol in children with type 2 diabetes?

A

The recommended target for high-density lipoprotein cholesterol in children with type 2 diabetes is > 35 mg/dL (0.905 mmol/L).

171
Q

What is the recommended target for triglycerides in children with type 2 diabetes?

A

The recommended target for triglycerides in children with type 2 diabetes is < 150 mg/dL (1.7 mmol/L).

172
Q

What is the recommended HbA1c goal for children and adolescents at an increased risk of hypoglycemia?

A

The recommended HbA1c goal for children and adolescents at an increased risk of hypoglycemia is 7.5% (58 mmol/mol).

173
Q

What is the significance of using less stringent HbA1c goals for children and adolescents at an increased risk of hypoglycemia?

A

Using less stringent HbA1c goals for children and adolescents at an increased risk of hypoglycemia is appropriate to reduce the likelihood of hypoglycemic episodes.

174
Q

What is the recommended HbA1c target for most children and adolescents with type 2 diabetes?

A

For most children and adolescents with type 2 diabetes, the recommended HbA1c target is < 7% (53 mmol/mol).

175
Q

What is the FDA-approved medication to improve glycemic control in patients aged 10 years and older with type 2 diabetes mellitus?

A

Empagliflozin

176
Q

What treatment option should be considered if glycemic targets are not met with metformin in children aged 10 years and older with type 2 diabetes mellitus?

A

Consider glucagon-like peptide-1 receptor agonist

177
Q

What are the criteria for considering a glucagon-like peptide-1 receptor agonist as a treatment option for children aged 10 years and older with type 2 diabetes mellitus?

A

Consider glucagon-like peptide-1 receptor agonist in children aged ≥ 10 years who have no past medical history or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2.

178
Q

What is the first-line therapy recommended for children and adolescents with type 2 diabetes?

A

Metformin

179
Q

What are the criteria for using metformin as a first-line therapy in children and adolescents with type 2 diabetes?

A

Metformin is recommended for children and adolescents with type 2 diabetes who have normal renal function ≥ 30 mL/minute/1.73 m², are metabolically stable, or incidentally diagnosed with HbA1c ≤ 9% or random fasting glucose < 250 mg/dL at the time of diagnosis, and do not have diabetic ketoacidosis or ketosis.

180
Q

When should pharmacologic therapy be initiated for children and adolescents with type 2 diabetes according to ADA guidelines?

A

Pharmacologic therapy should be initiated along with lifestyle therapy at the time of type 2 diabetes diagnosis.

181
Q

What level of evidence does the ADA assign to initiating pharmacologic therapy along with lifestyle therapy at the time of type 2 diabetes diagnosis in children and adolescents?

A

The ADA assigns a Grade A level of evidence.

182
Q

What does ADA recommend at the initial visit for patients with established diabetes?

A

At the initial visit, ADA recommends reviewing previous treatment and risk factor control and beginning patient engagement in formulation of care management plan.

183
Q

What is the ADA Grade for developing a plan for continuing care for patients with established diabetes?

A

The ADA Grade for developing a plan for continuing care is Grade A.

184
Q

What should be screened for symptoms at each visit in patients with established diabetes?

A

Sleep apnea

185
Q

What is the routine PCV schedule for children aged 2-5 years?

A

The routine PCV schedule for children aged 2-5 years is a 4-dose PCV series completed by age 15 months.

186
Q

When should a dose of PCV be given for a child aged 2-5 years with 3 PCV doses on the schedule?

A

For a child aged 2-5 years with 3 PCV doses on the schedule, a dose of PCV should be given ≥ 8 weeks after any prior PCV dose.

187
Q

What vaccines does the American Diabetes Association recommend for children with diabetes?

A

The American Diabetes Association recommends routine vaccinations for children with diabetes as recommended for the general population.

188
Q

What changes are made to the routine vaccination schedule for children with diabetes according to the CDC Advisory Committee on Immunization Practices (ACIP)?

A

The changes made to the routine vaccination schedule for children with diabetes include the addition of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) after the age of 2 years and after giving all doses of the 13-valent or 15-valent pneumococcal conjugate vaccine (PCV), if possible. There is also an altered catch-up schedule for PCV and PPSV23.

189
Q

When should the 23-valent pneumococcal polysaccharide vaccine (PPSV23) be given to children with diabetes?

A

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) should be given to children with diabetes after the age of 2 years and after giving all doses of the 13-valent or 15-valent pneumococcal conjugate vaccine (PCV), if possible.

190
Q

Is rosiglitazone approved by the FDA for use in children and adolescents?

A

No, rosiglitazone is not approved by the FDA for use in children and adolescents.

191
Q

What is the expanded FDA approval for empagli ozin/metformin (Synjardy)?

A

empagli ozin/metformin (Synjardy) receives expanded FDA approval as an adjunct to diet and exercise to improve glycemic control in patients ≥ 10 years old with type 2 diabetes mellitus.

192
Q

What are the common adverse effects of type 2 diabetes medication in children and adolescents?

A

Common adverse effects of type 2 diabetes medication in children and adolescents include urinary tract infections and female genital mycotic infections.

193
Q

What is the recommended assessment for sleep apnea in children and adolescents with type 2 diabetes?

A

The recommended assessment for sleep apnea in children and adolescents with type 2 diabetes is to screen for symptoms suggestive of sleep apnea at each visit.

194
Q

What should be done if obstructive sleep apnea is suspected in children and adolescents with type 2 diabetes?

A

If obstructive sleep apnea is suspected, it is recommended to refer to a pediatric sleep specialist for evaluation and polysomnogram as indicated.

195
Q

What additional tests should be performed if a child or adolescent with type 2 diabetes is positive for obstructive sleep apnea?

A

If a child or adolescent with type 2 diabetes is positive for obstructive sleep apnea, it is recommended to perform an electrocardiogram and echocardiogram to detect right ventricular hypertrophy.

196
Q

Should routine screening for heart disease be performed in asymptomatic youth with type 2 diabetes?

A

No, routine screening for heart disease is not recommended for asymptomatic youth with type 2 diabetes.

197
Q

What are the recommended tests for evaluating heart disease in asymptomatic youth with type 2 diabetes?

A

Routine screening for heart disease with echocardiogram, electrocardiogram, or stress testing is not recommended for asymptomatic youth with type 2 diabetes.

198
Q

What should be done if albuminuria of 30-299 mg/24 hours is detected?

A

Repeat the test on a first morning void specimen to rule out orthostatic proteinuria.

199
Q

How often should annual assessment of urinary albumin-to-creatinine ratio be done for children and adolescents with nephropathy?

A

Annually.

200
Q

What is the definition of albuminuria?

A

Albuminuria is defined as albumin > 30 mg/g creatinine.

201
Q

How often should dilated fundoscopy or retinal photography be performed in patients with adequately controlled glycemia and a normal eye exam?

A

Annually

202
Q

At what stage should dilated fundoscopy or retinal photography be performed for patients with type 2 diabetes mellitus in children and adolescents?

A

At diagnosis

203
Q

When should a lipid profile be obtained for diabetic children and adolescents?

A

A lipid profile should be obtained after initial glycemic control has been established and annually thereafter.

204
Q

How often should an estimated glomerular filtration rate be obtained for diabetic children and adolescents?

A

An estimated glomerular filtration rate should be obtained at diagnosis and annually thereafter.

205
Q

Which tests should be done annually to test for diabetic complications in children and adolescents?

A

Annually, alanine aminotransferase, aspartate aminotransferase, and urine albumin-to-creatinine ratio should be tested to assess for diabetic complications.

206
Q

For which children should genetic testing for neonatal diabetes be performed?

A

Genetic testing for neonatal diabetes should be performed in all children who are diagnosed with diabetes in the first 6 months of life.

207
Q

What should be evaluated in female adolescents with type 2 diabetes?

A

Female adolescents with type 2 diabetes should be evaluated for polycystic ovary syndrome and perform laboratory tests when indicated.

208
Q

What should be assessed if a patient presents with blood glucose ≥ 600 mg/dL (33.3 mmol/L)?

A

Hyperglycemic hyperosmolar nonketotic syndrome

209
Q

For children and adolescents with nephropathy, what annual assessments might assist with evaluating adherence and detecting disease progression?

A

Annual assessments of estimated glomerular filtration rate (calculated from serum creatinine) and serum potassium.

210
Q

What should be assessed for female adolescents with type 2 diabetes?

A

Female adolescents with type 2 diabetes should be assessed for polycystic ovary syndrome.

211
Q

What laboratory tests should be performed for female adolescents with type 2 diabetes?

A

Laboratory tests should be performed as indicated for female adolescents with type 2 diabetes.

212
Q

What are the optimal lipid goals for children recently diagnosed with diabetes?

A

The optimal lipid goals for children recently diagnosed with diabetes are: low-density lipoprotein cholesterol < 100 mg/dL (2.6 mmol/L), high-density lipoprotein cholesterol > 35 mg/dL (0.91 mmol/L), and triglycerides < 150 mg/dL (1.7 mmol/L).

213
Q

When should lipid profile measurements be obtained in children with recently diagnosed diabetes?

A

Lipid profile measurements should be obtained in children with recently diagnosed diabetes after the establishment of glucose control and annually thereafter.

214
Q

What is the recommended low-density lipoprotein cholesterol level for children with diabetes?

A

The recommended low-density lipoprotein cholesterol level for children with diabetes is less than 100 mg/dL (2.6 mmol/L).

215
Q

When should C-peptide levels be assessed in children and adolescents diagnosed with type 2 diabetes?

A

C-peptide levels should be assessed especially if the initial diagnosis of type 2 diabetes is after age 13 years and there is worsening glycemic control on oral agents.

216
Q

What should be considered if C-peptide levels are low in children and adolescents with type 2 diabetes?

A

If C-peptide levels are low, insulin therapy may be needed and the diabetes classification should be reconsidered.

T2DM (6 decks)

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