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Good Morning!. July 8 th 2010. Risk Factors. Obesity Positive Family History Specific Ethnic Groups Gender Conditions with Insulin Resistance Puberty PCOS. Presentation. DKA Or with only ketonuria Symptomatic without ketonuria or acidosis Asymptomatic. Diagnosis. HbA1C ≥6.5%
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Good Morning! July 8th 2010
Risk Factors • Obesity • Positive Family History • Specific Ethnic Groups • Gender • Conditions with Insulin Resistance • Puberty • PCOS
Presentation • DKA • Or with only ketonuria • Symptomatic without ketonuria or acidosis • Asymptomatic
Diagnosis • HbA1C • ≥6.5% • FPG • ≥126 mg/dL • OGTT 2 hour • ≥ 200mg/dL • Random • ≥ 200mg/dL
A1C • Fasting • 100-125 IFG • OGTT
Comorbidities Hypertension Dyslipidemia Nonalcoholic fatty liver disease
Hypertension • Pre-Hypertension • ≥90th and <95th %ile or >120/80 • Hypertension • > 95th %ile or >130/80 • Systolic and/or diastolic • 3 separate occasions • Goal <90%ile
Dyslipidemia • Increased triglycerides • Goal <150 • Decreased HDL • Goal >35 • Increased LDL • Goal <100
Other • NAFLD • Most common cause of liver disease in children • Vascular • Not known yet in children • Retinopathy, nephropathy, neuropathy
Treatment Goals To achieve and maintain near-normal glycemic control To improve insulin sensitivity and secretion, which results in improved glycemic control. To identify and treat, if necessary, comorbidities, such as hypertension, dyslipidemia, and nonalcoholic fatty liver disease To prevent the vascular complications of type 2 diabetes