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ISPAD Clinical Practice Consensus Guidelines 2018: Limited Care Guidance Appendix
Author(s) -
Codner Ethel,
Acerini Carlo L.,
Craig Maria E.,
Hofer Sabine E.,
Maahs David M.
Publication year - 2018
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12767
Subject(s) - library science , medicine , information retrieval , operations research , computer science , engineering
• Diagnostic criteria for all types of diabetes in children and adolescents are based on laboratory measurement of plasma glucose levels (BGL) and the presence or absence of symptoms. If blood glucose testing is unavailable, diabetes can be provisionally diagnosed, in the presence of symptoms, by the finding of high levels of glucose and ketones in the urine. • In geographical areas where the known incidence of type 1 diabetes is low, health care professionals should be aware that there is a higher rate of diabetic ketoacidosis at presentation due to lack of consideration of the diagnosis. • The possibility of other types of diabetes should be considered in the child who has: ○ an autosomal dominant family history of diabetes. ○ age less than 12 months and especially in the first 6 months of life. ○ associated conditions such as deafness, optic atrophy, or syndromic features. ○ mild fasting hyperglycemia (5.5-8.5 mmol [100-150 mg/dL]), especially if young, non-obese, and asymptomatic. ○ marked insulin resistance and acanthosis nigricans. ○ a history of exposure to drugs known to be toxic to beta cells or cause insulin resistance. ○ long interruption of insulin therapy without the occurrence of ketoacidosis. • The differentiation between type 1, type 2, monogenic, and other forms of diabetes has important implications for both treatment and education. Diagnostic tools, which may assist in confirming the diabetes type if the diagnosis is unclear, include: • Diabetes-associated autoantibodies: glutamic acid decarboxylase 65 autoantibodies (GAD); Tyrosine phosphatase-like insulinoma antigen 2 (IA2); insulin autoantibodies (IAA), and β-cell-specific zinc transporter 8 autoantibodies (ZnT8). The presence of one of more of these antibodies confirms the diagnosis of type 1 diabetes. • Molecular genetic testing can help define the diagnosis and treatment of children with suspected monogenic diabetes and should be limited to those who on clinical grounds are likely to be positive.