The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents

During recent years, the American Diabetes Association (ADA) has published detailed guidelines and recommendations for the management of diabetes in the form of technical reviews, position statements, and consensus statements. Recommendations regarding children and adolescents have generally been included as only a minor portion of these documents. For example, the most recent ADA position statement on “Standards of Medical Care for Patients With Diabetes Mellitus” (last revised October 2003) included “special considerations” for children and adolescents (1). Other position statements included age-specific recommendations for screening for nephropathy (2) and retinopathy (3) in children with diabetes. In addition, the ADA has published guidelines pertaining to certain aspects of diabetes that apply exclusively to children and adolescents, including care of children with diabetes at school (4) and camp (5) and a consensus statement on type 2 diabetes in children and adolescents (6).

The purpose of this document is to provide a single resource on current standards of care pertaining specifically to children and adolescents with type 1 diabetes. It is not meant to be an exhaustive compendium on all aspects of the management of pediatric diabetes. However, relevant references are provided and current works in progress are indicated as such. The information provided is based on evidence from published studies whenever possible and, when not, supported by expert opinion or consensus (7). Several excellent detailed guidelines and chapters on type 1 diabetes in pediatric endocrinology texts exist, including those by the International Society of Pediatric and Adolescent Diabetes (ISPAD) (8), by the Australian Pediatric Endocrine Group (www.chw.edu/au/prof/services/endocrinology/apeg), in Lifshitz’s Pediatric Endocrinology (9–11), and by Plotnick and colleagues (12,13).

Children have characteristics and needs that dictate different standards of care. The management of diabetes in children must take the major differences between children of various ages and …

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Care of Children and Adolescents With Type 1 Diabetes A statement of the American Diabetes Association

K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients.

Diabetes mellitus is a disease of metabolic dysregulation, most notably abnormal glucose metabolism, accompanied by characteristic long-term complications. The complications that are specific to diabetes include retinopathy, nephropathy, and neuropathy. Patients with all forms of diabetes of sufficient duration, including insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM), are vulnerable to these complications, which cause serious morbidity (Table 1 and Table 2). Retinopathy is so characteristic of diabetes that its presence has been incorporated into the nosologic definition of NIDDM. Only hyperglycemia of sufficient magnitude to be associated with retinopathy is classified as NIDDM, while lower levels of hyperglycemia that are . . .

Long-term complications of diabetes mellitus

Current concepts: Fibromuscular dysplasia

Indomethacin and renal function in premature infants with persistent patent ductus arteriosus

PATIENTS AND TECHNIQUES The age range of the patients was 4.8 months to 18.6 years with a mean age of 7.3 years. Ten patients were less than 6 years of age and the mean age of this younger group was only 2.3 years. There were 11 boys and 10 girls. The underlying renal diseases were pyelonephritis in three, glomerulonephritis in four, and obstructive uropathy and/or reflux nephropathy in six. Two children had the hemolytic uremic syndrome and two had juvenile nephronophthisis. One patient each had congenital oxalosis, Wilms' tumor, Triad syndrome (prune belly syndrome) and congenital nephrotic syndrome (Finnish type). Our patient with Wilms' tumor had a nephrectomy and radiation of the other kidney. She is now tumor-free and has been on CAPD for more than two years. At present, the prognosis for a successful renal transplant in children with Wilms' tumor is poor; they frequently die of sepsis or tumor recurrence. The longer the interval between the cure of the malignancy and the transplantation, the better the post-transplant results ( 4); consequently we elected to leave her

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J. Williamson Balfe

Papers

Indomethacin and renal function in premature infants with persistent patent ductus arteriosus

The use of capd in the treatment of children with end-stage renal disease

Angiotensin converting enzyme inhibitor therapy to decrease microalbuminuria in normotensive children with insulin-dependent diabetes mellitus.

Acetoacetyl CoA thiolase deficiency: A cause of severe ketoacidosis in infancy simulating salicylism

Diagnosis and management of stenotic aorto-arteriopathy in childhood