Table 14.1A.

Recommendations for screening and treatment of complications and related conditions in pediatric type 1 diabetes

	Thyroid disease	Celiac disease	Hypertension	Dyslipidemia	Nephropathy	Retinopathy	Neuropathy
Corresponding recommendations	14.29 and 14.30	14.31–14.33	14.34–14.37	14.38–14.42	14.45 and 14.46	14.47–14.49	14.50
Method	Thyroid-stimulating hormone; consider antithyroglobulin and antithyroid peroxidase antibodies	IgA tTG if total IgA normal; IgG tTG and deamidated gliadin antibodies if IgA deficient	Blood pressure monitoring	Lipid profile, nonfasting acceptable initially	Albumin-to-creatinine ratio; random sample acceptable initially	Dilated fundoscopy or retinal photography	Foot exam with foot pulses, pinprick, 10-g monofilament sensation tests, vibration, and ankle reflexes
When to start	Soon after diagnosis	Soon after diagnosis	At diagnosis	Soon after diagnosis; preferably after glycemia has improved and ≥2 years old	Puberty or >10 years old, whichever is earlier, and diabetes duration of 5 years	Puberty or ≥11 years old, whichever is earlier, and diabetes duration of 3–5 years	Puberty or ≥10 years old, whichever is earlier, and diabetes duration of 5 years
Follow-up frequency	Every 1–2 years if thyroid antibodies negative; more often if symptoms develop or presence of thyroid antibodies	Within 2 years and then at 5 years after diagnosis; sooner if symptoms develop	Every visit	If LDL ≤100 mg/dL, repeat at 9–11 years old; then, if <100 mg/dL, every 3 years	If normal, annually; if abnormal, repeat with confirmation in two of three samples over 6 months	If normal, every 2 years; consider less frequently (every 4 years) if A1C <8% and eye professional agrees	If normal, annually
Target	NA	NA	<90th percentile for age, sex, and height; if ≥13 years old, <120/80 mmHg	LDL <100 mg/dL	Albumin-to-creatinine ratio <30 mg/g	No retinopathy	No neuropathy
Treatment	Appropriate treatment of underlying thyroid disorder	After confirmation, start gluten-free diet	Lifestyle modification for elevated blood pressure (90th to <95th percentile for age, sex, and height or, if ≥13 years old, 120–129/<80 mmHg); lifestyle modification and ACE inhibitor or ARB* for hypertension (≥95th percentile for age, sex, and height or, if ≥13 years old, ≥130/80 mmHg)	If abnormal, optimize glycemia and medical nutrition therapy; if after 6 months LDL >160 mg/dL or >130 mg/dL with cardiovascular risk factor(s), initiate statin therapy (for those aged >10 years)*	Optimize glycemia and blood pressure; ACE inhibitor* if albumin-to-creatinine ratio is elevated in two of three samples over 6 months	Optimize glycemia; treatment per ophthalmology	Optimize glycemia; referral to neurology

ARB, angiotensin receptor blocker; NA, not applicable; tTG, tissue transglutaminase.

^*Due to the potential teratogenic effects, individuals of childbearing age should receive reproductive counseling, and medication should be avoided in individuals of childbearing age who are not using reliable contraception.