Diabetic Vascular Complications Clinical Practice Consensus Guidelines (2018)

International Society for Pediatric and Adolescent Diabetes

Reviewed and summarized by Medscape editors

October 18, 2018

Clinical practice consensus guidelines on diabetic microvascular and macrovascular complications in children and adolescents were released in August 2018 by the International Society for Pediatric and Adolescent Diabetes (ISPAD).[1]

Screening, Prevention, and Lifestyle Changes

Commence screening for microvascular complications at age 11 years.

Screening for microvascular disease should be performed preconception and during each trimester of pregnancy.

Intensive education and treatment should be provided to children and adolescents to prevent or delay the onset and progression of vascular complications.

Achievement of target glycemic control will reduce the risk for onset and progression of diabetic vascular complications.

Prevention or cessation of smoking will reduce progression of albuminuria and cardiovascular disease (CVD).

Retinopathy and Renal Disease

Screening for diabetic retinopathy should start at age 11 years with 2 to 5 years' diabetes duration.

Screening for diabetic retinopathy should be performed by an ophthalmologist or optometrist or a trained, experienced observer, through dilated pupils, with assessment carried out via biomicroscopic examination or fundal photography.

Laser treatment and intravitreal injections of anti–vascular endothelial growth factor (VEGF) agents reduce the rate of vision loss for individuals in vision-threatening stages of retinopathy (severe nonproliferative retinopathy or worse and/or diabetic macular edema).

Screen for renal disease using first morning albumin/creatinine ratio as the preferred method.

Hypertension and Dyslipidemia

Blood pressure (BP) should be measured at least annually. Hypertension is defined as average systolic BP (SBP) and/or diastolic BP (DBP) that is at or above the 95th percentile for gender, age, and height on three or more occasions.

Angiotensin-converting enzyme (ACE) inhibitors are recommended for use in children with diabetes and hypertension. They have been effective and safe in children in short-term studies but are not safe during pregnancy.

Screen for lipid abnormalities in the nonfasting state.

Macrovascular Disease

Screening of BP and lipids is recommended, as above. The benefit of routine screening for other markers of macrovascular complications outside the research setting is unclear.

Type 2 Diabetes

Complications screening should commence at diagnosis. Attention to risk factors should be escalated because of the increased chance of complications and mortality.

For more information, please go to Type 1 Diabetes Mellitus.

For more Clinical Practice Guidelines, please go to Guidelines.

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