Rhode Island Medical Home Portal

Type 1 Diabetes

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Key Points
Practice Guidelines
Diagnosis
Treatment & Management
Services & Referrals
Resources

Guidance for primary care clinicians diagnosing and managing children with Type 1 diabetes

Type 1 diabetes is a chronic condition in which the pancreas produces little to no insulin, leading to hyperglycemia. It is due to autoimmune destruction of the pancreatic islet cells, specifically beta cells, leading to insulin deficiency. Children can present at any age, including infancy.

Common symptoms when children present with type 1 diabetes outside of diabetic ketoacidosis (DKA) include:

Polyuria
Polydipsia
Weight loss or inadequate weight gain
Headache
Abdominal pain
New onset of enuresis
Recurrent candidal diaper rash
Vital signs may be normal or altered

About 25% of children present in DKA; DKA is a more common presentation in younger children. Symptoms of DKA: [Klingensmith: 2013]

Significant dehydration that may induce tachycardia, cool skin, poor peripheral perfusion, and decreased skin turgor
Abdominal pain, nausea, and vomiting
Lethargy, confusion, and possibly obtundation
Fruity breath and rapid, deep (Kussmaul) respirations
Vital sign abnormalities, including fever, which may be present if DKA is triggered by an infection

Other Names

Childhood-onset diabetes
Insulin-dependent diabetes
Juvenile diabetes
T1D
Type 1 diabetes mellitus

Key Points

Roles of primary care:

Refer a child with type 1 diabetes to a pediatric endocrinologist for management of type 1 diabetes.
Ensure that children with type 1 diabetes have access to a certified diabetes educator, a dietician, and a licensed care social worker (assists with psychological support as well as resources).
In locations remote from an endocrinologist, the medical home may assist with monitoring hemoglobin A1c, adjusting insulin doses, and lab monitoring for co-morbidities associated with type 1 diabetes. Telehealth and/or E-consults can provide opportunities for the primary care clinician and family to stay in close contact with the specialist team.

Roles of the Diabetes/Endocrinology Team

A pediatric endocrinologist provides optimal type 1 diabetes management through frequent insulin adjustments with special attention to activity level, growth, and puberty, as this changes insulin sensitivity. The endocrinologist also can offer specialized training for patients to use diabetes technology, such as pumps, and monitor them over time.
The diabetes program may include a certified diabetes educator, a dietician, and a licensed care social worker; these may be available through a coordinated diabetes program.

Care during illness:

Illness and infections (both viral and bacterial) can lead to hyperglycemia and ketogenesis. Many children with type 1 diabetes have increased insulin requirements during illness despite poor oral intake. Increased blood glucose (BG) monitoring is required as well as monitoring for ketone production (either with urine or blood test). If ketones develop, children will often need to follow a sick day protocol which involves taking extra insulin.
While most children have hyperglycemia during illness, some will develop hypoglycemia. If the child has a BG <120-150mg/dl, it is recommended that the child take fluids containing sugar or carbohydrates (without associated carbohydrate insulin dose) until glucose has risen above this level. If the child is vomiting, it is recommended to offer sips of clear fluids containing sugar (popsicles, clear soda, sports drinks). If vomiting is persistent, it is recommended to reach out to the diabetes team to discuss further steps.
The use of systemic steroids (e.g., for croup or asthma exacerbations) in patients with type 1 diabetes will likely lead to hyperglycemia. Steroids lead to insulin resistance, often necessitating increased insulin doses while being treated with steroids.

Practice Guidelines

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. The Professional Practice Committee: Standards of Medical Care in Diabetes—2020 is responsible for updating the Standards of Care annually or more frequently as warranted.

Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, Green J, Huang E, Isaacs D, Kahan S, Leon J, Lyons SK, Peters AL, Prahalad P, Reusch JEB, Young-Hyman D.
14. Children and Adolescents: Standards of Medical Care in Diabetes-2022.
Diabetes Care. 2022;45(Suppl 1):S208-S231. PubMed abstract / Full Text

Diagnosis

The following provides guidance about the diagnostic process and in-depth detail about presenting signs and symptoms in infants, children, and adolescents, including those in and not in diabetic ketoacidosis (DKA).

Presentations

Classically, children with T1D present with polyuria and polydipsia. Some children also have weight loss. A prospective study of patients aged 0-15 years evaluating the initial symptoms at initial presentation found that symptoms of polyuria and polydipsia were present in 97% of patients and weight loss in 46%. They are less common in younger children, only about 8% and 36% in children 0-2 years old and 2-5 respectively. [Roche: 2005] Weight loss is a common finding at presentation and becomes more common with age. For instance, 48% of 10-15 have weight loss at diagnosis compared to only 5% for children 0-2 years old. Some younger children may experience inadequate weight gain as opposed to frank weight loss. [Roche: 2005] Many children have nonspecific symptoms, including headache and abdominal pain. Previously toilet-trained children may have enuresis, especially nocturnal. Younger children may have a recurrent candidal diaper rash. [Quinn: 2006] Duration of symptoms can vary from a few days to a few months. [Roche: 2005]

Throughout the U.S., the overall rates of DKA at diagnosis are about 25%, and DKA as a presenting symptom is more common in younger children. [Klingensmith: 2013] [Wolfsdorf: 2006] If in DKA, patients may experience tachypnea and deep (Kussmaul) respirations as a result of hypercapnea. A fruity breath odor may be present due to exhaled acetone. Patients in DKA may present with drowsiness, lethargy, confusion, and may even be obtunded. The degree of mental alteration is proportionally related to degree of acidosis. [Edge: 2006] Additional signs and symptoms may include significant dehydration, abdominal pain, nausea and vomiting, lethargy, tachycardia, and rapid (Kussmaul) breathing. If a patient presents with dehydration, the skin may cool with compromised peripheral perfusion and decreased skin turgor. Vital signs can range from normal to significantly altered, particularly if a patient is progressing into DKA. Sepsis and other infections can trigger DKA and may cause changes in temperature.

Diagnostic Criteria & Classifications

A diagnosis of diabetes is based on 1 of the following:

In the setting of symptoms of hyperglycemia, 1 of the following:
- Fasting blood glucose >126mg/dL
- Random blood glucose >200mg/dL
In the absence of symptoms, abnormal glycemia must be present on 2 different occasions/days:
- Hemoglobin A1c 6.5% or greater
- Fasting blood glucose >126mg/dL
- Random blood glucose >200mg/dL
Abnormal result during oral glucose tolerance test (OGTT): 2-hour BG ≥200mg/dL

Stage 1: Asymptomatic beta cell autoimmunity
The appearance of beta cell autoantibodies represents the earliest established sign of autoimmunity towards the pancreatic islet beta cells. Duration of this stage may vary from a few months to a few decades and may progress to beta cell destruction.

Stage 2: Asymptomatic beta cell autoimmunity with dysglycemia
At this stage, enough beta cell mass has been lost that impaired glucose tolerance may be observed; however, no symptoms develop. These patients may show an altered pattern of insulin and c-peptide secretion along with reduced glucose tolerance as beta cell mass declines. Reduced insulin response may be observed during an oral glucose tolerance test. A gradually increasing HbA1c may be observed.

Stage 3: Symptomatic type 1 diabetes
The remaining beta cells produce insufficient insulin to prevent persistent hyperglycemia. Classic symptoms are observed. Following initiation of insulin treatment, 80% of children and adolescents experience partial remission. Despite partial remission following diagnosis, patients soon become dependent on exogenous insulin for survival. [Regnell: 2017]

Diagnostic Testing & Screening

Screening for pertinent history below will help rule out other forms of diabetes:

Obesity – increases risk that patient has type 2 diabetes, but most obese children with new-onset diabetes will still have type 1 diabetes
Exposure to exogenous steroids
History of pancreatitis – can lead to non-autoimmune beta cell destruction
Family history of:
- Diabetes
- Type 1, type 2, or maturity-onset diabetes of youth (MODY)
- History of gestational diabetes in mother
- Other autoimmune diseases

No routine screening for type 1 diabetes is recommended for asymptomatic children.

Lab Testing

Labs with abnormal fasting or random blood glucoses, hemoglobin A1c, oral glucose tolerance test (OGTT). See Diagnostic Criteria and Classifications (above) for cutoff values.

A urinary analysis should be done to ensure a patient is not on the verge of diabetic ketoacidosis. A comprehensive metabolic panel and blood gas are also advised if they can be obtained quickly in the primary care setting.

Although not routinely recommended for diagnosis, an insulin and/or c-peptide level would be expected to be low in the setting of hyperglycemia in a patient with T1D.

Upon diagnosis, additional labs should be coordinated with Pediatric Endocrinology and will likely include Type 1 diabetes antibodies (GAD AB, IA-2 AB, Insulin AB, ZnT8 AB).

After diagnosis, periodic screening for the following common co-morbidities is recommended:

Autoimmune thyroid disease: TSH and anti-thyroperoxidase (TPO) antibodies soon after diagnosis; repeat screening every 1-2 years if TSH is normal, more often in symptoms develop of presence of thyroid antibodies.
Celiac disease: celiac reflexive panel with IgA and tissue transglutaminase (TTG) soon after diagnosis of Type 1 diabetes; repeat screening within 2 years of diabetes diagnosis and then again after 5 years and consider more frequent screening in children who have symptoms or a first-degree relative with celiac disease. (TTG <4U/mL)
Dyslipidemia: fasting lipid panel after diagnosis once glycemia has improved and age ≥2 years; if initial LDL cholesterol is ≤100 mg/dL, subsequent testing should be performed at 9-11 years of age. Screen every 3 years if normal (goal LDL <100mg/dL)
Nephropathy: urine microalbumin/creatinine ratio checked annually, beginning at age 10 or puberty (whichever is earlier) AND once the child has had diabetes for 5 years

Imaging

No routine imaging is recommended.

Testing for Family Members

No routine screening of asymptomatic family members is recommended at this time. Type 1 Diabetes (TrialNet) is an international network of leading academic institutions, endocrinologists, physicians, scientists, and healthcare teams at the forefront of type 1 diabetes research. They offer risk screening for relatives (meeting certain criteria) of people with type 1 diabetes.

Genetics

Type 1 diabetes is a genetically complex disease without a clear pattern of inheritance. About 13% of patients have a first-degree relative with type 1 diabetes. The risk depends on which family member is affected: 3% if the mother, 5% if the father, and 8% if a sibling has type 1 diabetes. [Dahlquist: 1985]

ß-cell autoimmunity, the key trait resulting in susceptibility, is likely genetic in origin, arising mainly in those with HLA-DR3-DQ2 or HLA-DR4-DQ8 haplotypes; however, close to 60 genetic loci have been associated with susceptibility to type I diabetes. Variations in the HLA region on chromosome 6p21 account for about half of familial genetic risk. [Regnell: 2017]

The more ß-cell autoantibody types an individual has, the greater the risk of developing type 1 diabetes. [Regnell: 2017] Over 90% of people with new-onset type 1 diabetes have measurable ß-cell autoantibodies against 1 or more of the following: insulin, glutamate decarboxylase, islet antigen 2, zinc transporter 8. [Regnell: 2017] Autoantibodies against GAD-65 are found in 80% of patients with type 1 diabetes at clinical presentation. The presence of 2 or more autoantibodies carries an 84% risk of developing type 1 diabetes over 15 years. [Regnell: 2017]

Environmental triggers may also play a role in the pathogenesis of type 1 diabetes and research is ongoing. [Regnell: 2017] [Pociot: 2016] Viral infections are the most well-established environmental trigger; duration of breastfeeding, infant formula type, and introduction of solid foods has not yielded any consistent results.

Prevalence & Incidence

The prevalence of type 1 diabetes in children (ages 0-18) in the United States is approximately 2-3 per 1000. The incidence of type 1 diabetes is increasing and thought to be due to environmental factors, but the exact etiology is unknown. There is wide variation in incidence among different nationalities/ethnicities; Scandinavian countries have the highest incidence and China has the lowest. [Lifshitz: 2006] Males and females have an equal incidence of type 1 diabetes.

Differential Diagnosis

Type 2 diabetes - more common in obese, pubertal children and adolescents who often have acanthosis nigricans on the exam; islet cell autoimmunity testing is negative; typically, there is a strong family history of type 2 diabetes.
Maturity-onset diabetes of the young (MODY) - a type of diabetes inherited in an autosomal dominant manner, often able to trace inheritance through generations.
Steroid-induced diabetes - abnormal blood glucose increase associated with the use of glucocorticoids can be seen in patients without a history of diabetes or exacerbate known diabetes. Glucocorticoid duration, potency, and absolute dose are important predictors. [Hwang: 2014] This can be seen in association with many diseases that require high-dose steroids, including, but not limited to, leukemia, solid organ transplant, and certain autoimmune or rheumatologic diseases.
Stress-induced hyperglycemia - glucose metabolism is altered in acute illness due to increased cortisol, catecholamines, and other counter-regulatory hormones, which leads to increased gluconeogenesis and glycogenolysis, resulting in hyperglycemia. [Weiss: 2010] Blood glucose values above 300mg/dL are extremely rare; almost all hyperglycemia resolves with hydration and treatment of underlying disease process.

Comorbid Conditions

Autoimmune thyroid disease
Celiac disease
Dyslipidemia
Nephropathy
Hypertension
Retinopathy
Neuropathy

Prognosis

Tight blood glucose control is critical in reducing microvascular and macrovascular complications from diabetes. [Diabetes: 2016] Microvascular complications include nephropathy, retinopathy, and neuropathy. Reduced hyperglycemia and hemoglobin A1c are associated with a lower risk of microvascular complications. More recently, however, it has been shown that glycemic variability also plays a role in the incidence of complications. [Virk: 2016] Macrovascular complications, including atherosclerosis and thrombosis, are not only worsened with poor blood sugar control but also by obesity, hypertension, and dyslipidemia. [American: 2020] Cardiovascular disease is the major cause of morbidity and mortality in patients with type 1 diabetes, with almost a 12-year reduction in expected lifespan. [American: 2020]

Diabetic ketoacidosis (DKA), a severe complication of diabetes, carries an increased mortality risk. Although the overall mortality among children and adolescents with DKA is <1% [Umpierrez: 2016], it is the leading cause of mortality in this population, accounting for nearly 50% of all deaths. [Vellanki: 2018]

Treatment & Management

Overview

Diabetes is a chronic condition with a complex pathophysiology that affects many aspects of an individual's life and causes considerable changes, which, if not monitored closely, can lead to complications as a patient ages. The treatment of type 1 diabetes initially involves the endocrinology and primary care medical home team, medication administration and titration, nutrition, glucose monitoring, and frequent clinical visits. If complications or comorbid conditions develop, the care becomes increasingly multidisciplinary. Psychosocial problems must also be addressed to achieve optimal treatment. Communicating information in ways that are understandable to the patient and their family allows them to take greater ownership of their treatment and achieve better health outcomes. [Strawbridge: 2017]

In general, type 1 diabetes is primarily managed by a pediatric endocrinologist.
Starting doses of insulin for children and adolescents are based on age and body weight and must be adjusted based on individual response and glucose levels over time.
Tight control must be carefully balanced with the risk of hypoglycemia.
Recognizing hypoglycemia in children can be difficult and depends on the child’s age, cognitive abilities, and communication skills. Providers and families must be alert to behaviors and complaints that may signal hypoglycemia. Shakiness, irritability or tearfulness, hunger, headache, drowsiness, and dizziness are common.
Puberty can significantly alter insulin needs and participation in self-management. Management must include developmentally appropriate education, an emphasis on transition to adult diabetes care, and screening for long-term complications.
Due to increased risk of autoimmune thyroid disease, screen TSH and anti-thyroperoxidase (TPO) antibodies soon after diagnosis; repeat screening every 1-2 years if TSH is normal and more often if symptoms develop or presence of thyroid antibodies. Coordinate management of abnormal results with the endocrinologist.
Elicit smoking history at initial and follow-up visits and discourage its use.

Endocrine

Basics of Diabetes Technology

Continuous glucose monitor (CGM) - a device that monitors glucose continuously in real-time and can detect glucose rise, fall, and rate of change. All pediatric patients are candidates for CGM therapy, although currently not FDA-approved in very young children. In addition, it is important to consider the financial resources needed to cover the CGM and supplies.
Insulin pump therapy - uses a small, computerized device to deliver rapid-acting insulin continuously throughout the day via a small catheter that remains under the skin. The pump delivers basal insulin (in place of long-acting insulin) and patient-initiated insulin boluses to cover meals and correction doses. Successful pump therapy requires the patient and family to be engaged and direct the pump dosing. Pump therapy also requires education on pump therapy in general from a certified diabetes educator as well as on specifics of the insulin pump chosen.
Closed-loop system - allows integration of CGM data with insulin delivery via pump. Insulin delivery is partially automated as patients still must enter all carbohydrates.

Insulin Therapy

A basal-bolus regimen led by the pediatric endocrinologist is the standard of care for most pediatric patients with type 1 diabetes. A basal-bolus insulin regimen mimics physiologic insulin production.

Insulin Profiles for New Onset Pediatric Type 1 Diabetes

Diagnosis and Treatment of Pediatric Type 1 Diabetes (Intermountain Healthcare) ( PDF Document

) lists on page 5 the types and brands of insulin commonly used with pediatric populations. The patient’s family will need to call their insurance company to determine their coverage (e.g., preferred insulin brand and method).

Family

Pediatric patients often rely on their parents or guardians to manage treatment. Providing diabetes self-management education and support (DSMES) for caregivers and children as they become more independent is paramount to effectively managing their disease. In addition, effective management requires coordination with other caregivers in the patient’s sphere, including teachers, school nurses, coaches, etc. Primary care clinicians should be aware of what services and support are offered through their patient’s pediatric endocrinology team.

This process starts with an individualized baseline assessment of barriers to readiness. This assessment includes but is not limited to medical and general literacy, prior experience with chronic illness, family and social support, and cultural competence. Diabetes care and education specialists generally recommend starting with survival skills (skills, supplies, simple pathophysiology, simple meal planning, and whom to call for help) and then progressing to more advanced content. As the patient becomes more independent, greater responsibility for their treatment can be shared; however, depending on developmental readiness, this should be individualized on a case-by-case basis. [Beck: 2019]

Gastroenterology

Due to the increased risk of comorbid celiac disease, check a celiac reflexive panel with IgA and tissue transglutaminase (TTG) soon after diagnosis of Type 1 diabetes; repeat screening within 2 years of diabetes diagnosis and then again after 5 years and consider more frequent screening in children who have symptoms or a first-degree relative with celiac disease. (TTG <4U/mL).

Cardiology

Monitor for dyslipidemia: fasting lipid panel after diagnosis once glycemia has improved and age ≥2 years; if initial LDL cholesterol is ≤100 mg/dL, subsequent testing should be performed at 9-11 years of age. Screen every 3 years if normal (goal LDL <100mg/dL).

Nephrology

Monitor for nephropathy: annually check urine microalbumin/creatinine ratio, beginning at age 10 or puberty (whichever is earlier) and once the child has had diabetes for 5 years. For hypertension, measure blood pressure at each routine visit; goal <90th percentile for age, sex, and height.

Neurology

Perform a neurologic foot exam with monofilament or tuning fork annually, beginning at age 10, once the child has had diabetes for 5 years.

Ophthalmology

Due to the risk of developing retinopathy, refer to Optometry (or Pediatric Ophthalmology) as described below in Services & Referrals.

Mental Health & Behavior

Screen for depression and anxiety quarterly at visits. Manage depression and anxiety in the primary care medical home whenever possible. Communicate concerns with the endocrinology team to see what therapy and interventions they offer. For diagnosis and management information, see Depression and Anxiety Disorders.

Services & Referrals

Pediatric Endocrinology (see RI providers [12])
Type 1 diabetes is primarily managed by a pediatric endocrinologist. For autoimmune thyroid disease, coordinate care with Pediatric Endocrinology.

Diabetes Clinics (see RI providers [1])
The clinic may include a certified diabetes educator, a dietician, and a licensed care social worker. Refer when available for multidisciplinary management of type 1 diabetes.

Pediatric Gastroenterology (see RI providers [18])
Refer for abnormal reflexive celiac panel results. [Rubio-Tapia: 2013]

Pediatric Cardiology (see RI providers [17])
Refer to Pediatric Nephrology or Pediatric Cardiology, based on local referral patterns, if blood pressure is persistently abnormal despite lifestyle and dietary interventions. If fasting lipid panel is persistently abnormal despite lifestyle and dietary interventions, consult Pediatric Cardiology or Pediatric Endocrinology (depending on local practice) for assistance with dyslipidemia management (based on local treatment patterns).

Pediatric Nephrology (see RI providers [10])
Refer if urine microalbumin/creatinine ratio is persistently abnormal or for abnormal blood pressure despite lifestyle and dietary interventions.

Pediatric Ophthalmology (see RI providers [8])
Due to the risk of developing retinopathy, refer to Optometry or Pediatric Ophthalmology for younger patients, those with significant developmental delays, or those in whom an exam is difficult for a dilated eye exam every 2 years beginning at age 11 once the child has had diabetes for 3-5 years. [Draznin: 2022]

Pediatric Neurology (see RI providers [18])
Consider referral for more testing if neuropathy is noted on screening. [Draznin: 2022]

General Counseling Services (see RI providers [30])
Consider referral to a behavioral health specialist who has expertise in managing mental health conditions in the setting of chronic illness.

ICD-10 Coding

E10.9, Type 1 diabetes without complications
E10.65, Type 1 diabetes with hyperglycemia
E10.10, Type 1 diabetes mellitus with ketoacidosis without coma

ICD-10 includes 113 specific codes specifying Type 1 diabetes, associated complications, and location, most of which will not be relevant in children.ICD-10 Coding for Type 1 Diabetes (icd10data.com) has details.

Resources

Information & Support

Related Portal Content
Obesity in Children &Teens
Celiac Disease
Pediatric Type 2 Diabetes Screening & Management Care Process Model (Diabetes Type 2)
Tables 5 and 6 list Patient Education materials: Diagnosis and Treatment of Pediatric Type 1 Diabetes (Intermountain Healthcare) ( PDF Document )

For Professionals

American Diabetes Association
Extensive information about genetics, diagnosis, management, research, and possible complications of Type 1, Type 2, and gestational diabetes.

Tools

Diagnosis and Treatment of Pediatric Type 1 Diabetes (Intermountain Healthcare) ( PDF Document )
This 2021 care process model (CPM) provides guidance for identifying and managing type 1 diabetes in children, educating and supporting patients and their families in every phase of treatment and development, and preparing our pediatric patients to successfully manage their diabetes and transition to adulthood; Intermountain Healthcare’s Pediatric Clinical Specialties Program.

Services for Patients & Families in Rhode Island (RI)

Service Categories	RI	NW		NM	NV
Diabetes Clinics	1		3	2	18
General Counseling Services	30	1	10	211	260
Pediatric Cardiology	17		3	4	4
Pediatric Endocrinology	12	1	4	6	7
Pediatric Gastroenterology	18		2	5	2
Pediatric Nephrology	10		2	2	1
Pediatric Neurology	18		5	5	8
Pediatric Ophthalmology	8	1	6	6	4

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Studies

Type 1 Diabetes (TrialNet)
An international network of leading academic institutions, endocrinologists, physicians, scientists, and healthcare teams at the forefront of type 1 diabetes research who offer risk screening for relatives (meeting certain criteria) of people with type 1 diabetes.

Type 1 Diabetes in Children and Adolescents (ClinicalTrials)

Helpful Articles

Heile M, Hollstegge B, Broxterman L, Cai A, Close K.
Automated Insulin Delivery: Easy Enough to Use in Primary Care?.
Clin Diabetes. 2020;38(5):474-485. PubMed abstract / Full Text

Hill RM, Gallagher KAS, Eshtehardi SS, Uysal S, Hilliard ME.
Suicide Risk in Youth and Young Adults with Type 1 Diabetes: a Review of the Literature and Clinical Recommendations for Prevention.
Curr Diab Rep. 2021;21(12):51. PubMed abstract / Full Text

Lyons SK, Becker DJ, Helgeson VS.
Transfer from pediatric to adult health care: effects on diabetes outcomes.
Pediatr Diabetes. 2014;15(1):10-7. PubMed abstract / Full Text

Zajec A, Trebušak Podkrajšek K, Tesovnik T, Šket R, Čugalj Kern B, Jenko Bizjan B, Šmigoc Schweiger D, Battelino T, Kovač J.
Pathogenesis of Type 1 Diabetes: Established Facts and New Insights.
Genes (Basel). 2022;13(4). PubMed abstract / Full Text

Sims EK, Besser REJ, Dayan C, Geno Rasmussen C, Greenbaum C, Griffin KJ, Hagopian W, Knip M, Long AE, Martin F, Mathieu C, Rewers M, Steck AK, Wentworth JM, Rich SS, Kordonouri O, Ziegler AG, Herold KC.
Screening for Type 1 Diabetes in the General Population: A Status Report and Perspective.
Diabetes. 2022;71(4):610-623. PubMed abstract

Ware J, Hovorka R.
Recent advances in closed-loop insulin delivery.
Metabolism. 2022;127:154953. PubMed abstract / Full Text

Authors & Reviewers

Initial publication: August 2022; last update/revision: December 2022

Current Authors and Reviewers:

Author:	Jose Morales Moreno, MD
Senior Author:	Allison Smego, MD
Reviewer:	Halley M. Wasserman, MD, MS

Authoring history

2022: first version: Jose Morales Moreno, MD^A; Allison Smego, MD^SA

^AAuthor; ^CAContributing Author; ^SASenior Author; ^RReviewer

Page Bibliography

American Diabetes Association.
13. Children and Adolescents: Standards of Medical Care in Diabetes-2020.
Diabetes Care. 2020;43(Suppl 1):S163-S182. PubMed abstract / Full Text
Includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, update the Standards of Care annually, or more frequently as warranted.

Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, Cypress M, Faulkner P, Fischl AH, Francis T, Kolb LE, Lavin-Tompkins JM, MacLeod J, Maryniuk M, Mensing C, Orzeck EA, Pope DD, Pulizzi JL, Reed AA, Rhinehart AS, Siminerio L, Wang J.
2017 National Standards for Diabetes Self-Management Education and Support.
Diabetes Educ. 2019;45(1):34-49. PubMed abstract

Dahlquist G, Blom L, Holmgren G, Hägglöf B, Larsson Y, Sterky G, Wall S.
The epidemiology of diabetes in Swedish children 0-14 years--a six-year prospective study.
Diabetologia. 1985;28(11):802-8. PubMed abstract

Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group.
Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up.
Diabetes Care. 2016;39(5):686-93. PubMed abstract / Full Text

Edge JA, Roy Y, Bergomi A, Murphy NP, Ford-Adams ME, Ong KK, Dunger DB.
Conscious level in children with diabetic ketoacidosis is related to severity of acidosis and not to blood glucose concentration.
Pediatr Diabetes. 2006;7(1):11-5. PubMed abstract

Heile M, Hollstegge B, Broxterman L, Cai A, Close K.
Automated Insulin Delivery: Easy Enough to Use in Primary Care?.
Clin Diabetes. 2020;38(5):474-485. PubMed abstract / Full Text

Hwang JL, Weiss RE.
Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment.
Diabetes Metab Res Rev. 2014;30(2):96-102. PubMed abstract / Full Text

Klingensmith GJ, Tamborlane WV, Wood J, Haller MJ, Silverstein J, Cengiz E, Shanmugham S, Kollman C, Wong-Jacobson S, Beck RW.
Diabetic ketoacidosis at diabetes onset: still an all too common threat in youth.
J Pediatr. 2013;162(2):330-4.e1. PubMed abstract

Lifshitz.
Pediatric Endocrinology: Obesity, Diabetes Mellitus, Insulin Resistance, and Hypoglycemia.
5th, volume 1, chapter 4 ed. CRC Press; 2006. 978-0849340680

Lyons SK, Becker DJ, Helgeson VS.
Transfer from pediatric to adult health care: effects on diabetes outcomes.
Pediatr Diabetes. 2014;15(1):10-7. PubMed abstract / Full Text

Pociot F, Lernmark Å.
Genetic risk factors for type 1 diabetes.
Lancet. 2016;387(10035):2331-2339. PubMed abstract

Quinn M, Fleischman A, Rosner B, Nigrin DJ, Wolfsdorf JI.
Characteristics at diagnosis of type 1 diabetes in children younger than 6 years.
J Pediatr. 2006;148(3):366-71. PubMed abstract

Regnell SE, Lernmark Å.
Early prediction of autoimmune (type 1) diabetes.
Diabetologia. 2017;60(8):1370-1381. PubMed abstract / Full Text

Roche EF, Menon A, Gill D, Hoey H.
Clinical presentation of type 1 diabetes.
Pediatr Diabetes. 2005;6(2):75-8. PubMed abstract

Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA.
ACG clinical guidelines: diagnosis and management of celiac disease.
Am J Gastroenterol. 2013;108(5):656-76; quiz 677. PubMed abstract / Full Text

Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL.
One-Year Outcomes of Diabetes Self-Management Training Among Medicare Beneficiaries Newly Diagnosed With Diabetes.
Med Care. 2017;55(4):391-397. PubMed abstract

Umpierrez G, Korytkowski M.
Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.
Nat Rev Endocrinol. 2016;12(4):222-32. PubMed abstract

Vellanki P, Umpierrez GE.
Increasing Hospitalizations for DKA: A Need for Prevention Programs.
Diabetes Care. 2018;41(9):1839-1841. PubMed abstract / Full Text

Virk SA, Donaghue KC, Cho YH, Benitez-Aguirre P, Hing S, Pryke A, Chan A, Craig ME.
Association Between HbA1c Variability and Risk of Microvascular Complications in Adolescents With Type 1 Diabetes.
J Clin Endocrinol Metab. 2016;101(9):3257-63. PubMed abstract

Ware J, Hovorka R.
Recent advances in closed-loop insulin delivery.
Metabolism. 2022;127:154953. PubMed abstract / Full Text

Weiss SL, Alexander J, Agus MS.
Extreme stress hyperglycemia during acute illness in a pediatric emergency department.
Pediatr Emerg Care. 2010;26(9):626-32. PubMed abstract / Full Text

Wolfsdorf J, Glaser N, Sperling MA.
Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association.
Diabetes Care. 2006;29(5):1150-9. PubMed abstract