The American Diabetes Association has released their 2013 Standards of Medical Care. Not too much changed this year in the Standards of Care for children and adolescents, with only four revisions to cover.
One of the most important changes was the statement by ADA that children should engage in 60 minutes of physical activity a day. The change in the guidelines was made to be consistent with federal recommendations. This recommendation stresses how important physical activity is for all children with and without diabetes. Exercise for all people with diabetes can help reduce blood glucose levels acutely; but far more important for children, consistent physical activity can help prevent many of the chronic diseases of aging that are so devastating for a significant portion of our adult population. Developing good habits in youth makes it much easier to carry them through into old age.
The next change is in the category of blood pressure. The wording of the recommendation was modified to make it stand out specifically and clearly. The guideline states that blood pressure should be measured on each visit to the health care provider’s office, and, if high-normal or in the hypertensive range, it should be repeated on a separate day for confirmation.
Celiac disease is prevalent in children with type 1 diabetes. In the past, the gold standard of diagnosis for celiac is a biopsy of the intestine lining. This procedure is surgical and requires the use of sedation. The new guidelines indicate that not all children require a biopsy for celiac diagnosis. The standard now reads that a referral to a gastroenterologist for evaluation and possible biopsy for confirmation of celiac in asymptomatic children with positive antibodies should be considered. This is because the advances in serology and histology have allowed much greater accuracy of diagnosis based on antibody levels.
The last change is regarding cystic fibrosis. Diabetes is often a complication of cystic fibrosis. The ADA has clarified its position that A1C cannot be used as a diagnostic test for diabetes in this population.