Table 14.1B.

Recommendations for screening and treatment of complications and related conditions in pediatric type 2 diabetes

	Hypertension	Nephropathy	Neuropathy	Retinopathy	Nonalcoholic fatty liver disease	Obstructive sleep apnea	Polycystic ovarian syndrome (for adolescent female individuals)	Dyslipidemia
Corresponding recommendations	14.77–14.80	14.81–14.86	14.87 and 14.88	14.89–14.92	14.93 and 14.94	14.95	14.96–14.98	14.100–14.104
Method	Blood pressure monitoring	Albumin-to-creatinine ratio; random sample acceptable initially	Foot exam with foot pulses, pinprick, 10-g monofilament sensation tests, vibration, and ankle reflexes	Dilated fundoscopy	AST and ALT measurement	Screening for symptoms	Screening for symptoms; laboratory evaluation if positive symptoms	Lipid profile
When to start	At diagnosis	At diagnosis	At diagnosis	At/soon after diagnosis	At diagnosis	At diagnosis	At diagnosis	Soon after diagnosis, preferably after glycemia has improved
Follow-up frequency	Every visit	If normal, annually; if abnormal, repeat with confirmation in two of three samples over 6 months	If normal, annually	If normal, annually	Annually	Every visit	Every visit	Annually
Target	<90th percentile for age, sex, and height; if ≥13 years old, <130/80 mmHg	<30 mg/g	No neuropathy	No retinopathy	NA	NA	NA	LDL <100 mg/dL, HDL >35 mg/dL, triglycerides <150 mg/dL
Treatment	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, ≥130/80 mmHg)	Optimize glycemia and blood pressure; ACE inhibitor* if albumin-to-creatinine ratio is elevated in two of three samples over 6 months	Optimize glycemia; referral to neurology	Optimize glycemia; treatment per ophthalmology	Refer to gastroenterology for persistently elevated or worsening transaminases	If positive symptoms, refer to sleep specialist and polysomnogram	If no contraindications, oral contraceptive pills; medical nutrition therapy; metformin	If abnormal, optimize glycemia and medical nutrition therapy; if after 6 months, LDL >130 mg/dL, initiate statin therapy (for those aged >10 years)*; if triglycerides >400 mg/dL fasting or >1,000 mg/dL nonfasting, begin fibrate

ARB, angiotensin receptor blocker; NA, not applicable.

^*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.