Screening Children for Complications of Diabetes and Associated Disorders

Type 1 diabetes

Hypertension

Upon diagnosis

Every visit

Blood pressure measurement

Dyslipidemia

Soon after diagnosis (once diabetes stabilized), age recommendations vary:

• ADA recommendation: ≥ 2 years old

• ISPAD recommendation: ≥ 11 years or ≥ 2 years if there is a family history of early cardiovascular disease or hypercholesterolemia

ADA: If LDL ≤ 100 mg/dL (2.59 mmol/L), repeat at 9 to 11 years; then, if < 100 mg/dL, repeat every 3 years

If abnormal, optimize glycemia control and nutritional therapy. For children > 10 years, if after 6 months LDL > 160 mg/dL (4.14 mmol/L) or > 130 mg/dL (3.37 mmol/L) with cardiovascular risk factors, initiate statin therapy.

ISPAD: Every 3 years if results are normal

Low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride levels

Nephropathy

After 2 to 5 years of diabetes, start at puberty or at age 10 to 11 years (whichever is earlier)

If normal, 1 year

ADA: If abnormal, repeat with confirmation in 2 of 3 samples over 6 months

Urine albumin:creatinine ratio

Neuropathy

After 2 to 5 years of diabetes, start at puberty or at age 10 to 11 years (whichever is earlier)

At regular visits, at least annually

Foot examination with foot pulses, pinprick, 10-g monofilament sensation tests, vibration, and ankle reflexes

Retinopathy

After 2 to 5 years of diabetes, start at puberty or at age 10 to 11 years (whichever is earlier)

2 to 4 years

Dilated examination by an ophthalmologist or other trained, experienced clinician

Celiac disease

Upon diagnosis

2 years

Celiac antibodies

Thyroid disease

Upon diagnosis

1 to 2 years if thyroid antibodies are negative, sooner if symptoms of hypothyroidism develop or thyroid antibodies are positive

At diagnosis: Thyroid-stimulating hormone (TSH) and free thyroxine (T4) levels, thyroid antibodies

Serial monitoring: TSH with reflex to free T4 (done if TSH is abnormal)

Psychosocial issues

Upon diagnosis

At least annually

Evaluation for diabetes distress, depression, disordered eating

Type 2 diabetes

Hypertension

Upon diagnosis

Every visit

Blood pressure measurement

Dyslipidemia

Upon diagnosis

1 year

Same as type 1

Nephropathy

Upon diagnosis

1 year

Same as type 1

Neuropathy

Upon diagnosis

At regular visits, at least annually

Same as type 1

Retinopathy

Upon diagnosis

1 year

Same as type 1

Psychosocial issues

Upon diagnosis

At least annually

Same as type 1