During recent years, the American Diabetes Association (ADA) has published detailed guidelines and recommendations for the management of diabetes in the form of technical reviews, position statements, and consensus statements. Recommendations regarding children and adolescents have generally been included as only a minor portion of these documents. For example, the most recent ADA position statement on “Standards of Medical Care for Patients With Diabetes Mellitus” (last revised October 2003) included “special considerations” for children and adolescents (1). Other position statements included age-specific recommendations for screening for nephropathy (2) and retinopathy (3) in children with diabetes. In addition, the ADA has published guidelines pertaining to certain aspects of diabetes that apply exclusively to children and adolescents, including care of children with diabetes at school (4) and camp (5) and a consensus statement on type 2 diabetes in children and adolescents (6).

The purpose of this document is to provide a single resource on current standards of care pertaining specifically to children and adolescents with type 1 diabetes. It is not meant to be an exhaustive compendium on all aspects of the management of pediatric diabetes. However, relevant references are provided and current works in progress are indicated as such. The information provided is based on evidence from published studies whenever possible and, when not, supported by expert opinion or consensus (7). Several excellent detailed guidelines and chapters on type 1 diabetes in pediatric endocrinology texts exist, including those by the International Society of Pediatric and Adolescent Diabetes (ISPAD) (8), by the Australian Pediatric Endocrine Group (www.chw.edu/au/prof/services/endocrinology/apeg), in Lifshitz’s Pediatric Endocrinology (9–11), and by Plotnick and colleagues (12,13).

Children have characteristics and needs that dictate different standards of care. The management of diabetes in children must take the major differences between children of various ages and …

/pdf/care-of-children-and-adolescents-with-type-1-diabetes-a-3dg1hpllcz.pdf

Care of Children and Adolescents With Type 1 Diabetes A statement of the American Diabetes Association

This clinical report replaces the 1998 policy statement from the American Academy of Pediatrics on cholesterol in childhood, which has been retired. This report has taken on new urgency given the current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults. The approach to screening children and adolescents with a fasting lipid profile remains a targeted approach. Overweight children belong to a special risk category of children and are in need of cholesterol screening regardless of family history or other risk factors. This report reemphasizes the need for prevention of cardiovascular disease by following Dietary Guidelines for Americans and increasing physical activity and also includes a review of the pharmacologic agents and indications for treating dyslipidemia in children.

/pdf/lipid-screening-and-cardiovascular-health-in-childhood-5f5vzh0ays.pdf

Lipid Screening and Cardiovascular Health in Childhood

INTRODUCTION In the past 25 years, numerous topical and systemic drugs have been developed for the treatment of acne vulgaris The voluminous amount of clinical trial information has become increasingly difficult for individual physicians to monitor Clinical trials are a science no different than any other aspect of medicine There has been improvement in the design and performance of clinical trials in the past several years Currently, most authoritative opinions fully support the need for studies to be performed under the CONSORT and Cochrane principles We accept that many studies have not been as rigorously performed in the past as trials done in 2002 But to discard such studies is inappropriate, because they were done well according to the standards of the time Thus, for the time being, clinical opinion, based in part on formal discussion among expert colleagues with an interest in acne and a logical analysis of the literature, is not unreasonable as the basis for a Consensus Recommendation Such recommendations highlight the indications for use of medications and the optimal approach to the management of specific clinical problems Overall, the goal is to provide a comprehensive overview of rational therapy, which can form the basis for more uniform therapeutic strategies throughout the world, enhanced patient compliance, and more effective use of healthcare resources Several sets of guidelines have been developed for the treatment of acne during the past decade, including a practice guideline for the Oral Treatment of Acne in France (1999), Canadian Acne Treatment Guidelines (1995), German Guidelines for Acne Treatment (2001), Treatment of Acne Vulgaris: Guidelines for Primary Care Physicians (1991), and Guidelines of Care for Acne Vulgaris from the American Academy of Dermatology (1990) However, advances in medicine occur relatively rapidly, and practice guidelines may be out of date shortly after they are issued Thus, there is a continuing need to update existing recommendations so that recent advances in therapy can be brought to the attention of physicians in a timely manner In recognition of this need, this supplement to the Journal of the American Academy of Dermatology has been developed by a panel of physicians and researchers in the field of acne, working together as a Global Alliance to Improve Outcomes in Acne The mission of this group is to develop consensus recommendations for the treatment of acne, which are evidence-based when possible, and which include input from numerous countries The members of the group represent a broad list of international dermatologists with a special interest in acne and reflect a wide range of experiences and opinions The activities of the group have been coordinated by Dimensional Healthcare, Inc, and funded by an educational grant from Galderma As might be expected, some of the physicians involved in the development of this document have past or current, direct or indirect financial

https://www.jaad.org/article/S0190-9622(03)01563-9/pdf

Management of Acne: A Report From a Global Alliance to Improve Outcomes in Acne

Summary
Acne is estimated to affect 9·4% of the global population, making it the eighth most prevalent disease worldwide. Epidemiological studies have demonstrated that acne is most common in postpubescent teens, with boys most frequently affected, particularly with more severe forms of the disease. This paper aims to provide an update on the epidemiology of acne worldwide. Recent general and institutional studies from around the world have shown that the prevalence of acne is broadly consistent globally (with the exception of specific populations, which are discussed). However, this review highlights that there is a wide range of disparate outcome measures being applied in epidemiology studies, and we emphasize the need to develop a widely accepted, credible, standard assessment scale to address this in the future. In addition we discuss special populations, such as those devoid of acne, as well as the impact of potential determinants of acne on disease epidemiology.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjd.13462

A global perspective on the epidemiology of acne.

Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy.

https://www.medpagetoday.com/upload/2007/3/22/kidlipid.pdf

Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents A Scientific Statement From the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, With the Council on Cardiovascular Nursing

Background: This study examined the relationships of pubertal maturation and sex steroid hormones to the development of acne in young girls. Black (n=317) and white (n=306) premenarchal girls with a mean age of 9.97±0.62 years were evaluated for acne prevalence and severity, pubic hair and areolar maturation, and sex steroid hormone levels. Results: Overall, 77.8% of the girls had some acne; of the whole group, 48.3% had only comedonal acne, 2.2% had only inflammatory acne, and 27.3% had both types. Although black girls matured at an earlier age than white girls, racial differences in acne were minimal when adjusted for pubertal maturation. Acne increased with advancing maturation; at Tanner pubic hair stages 1, 2, and 3, the prevalence of acne rose from 73.1% to 84.0% and to 90.6%, respectively. Acne lesion counts at seven facial locations revealed a predominance of midfacial acne on the middle aspect of the forehead, nose, and chin. Sex steroid hormone levels measured in 365 of the girls were found to increase significantly during maturation from prepuberty to early puberty. Testosterone-estrogen—binding globulin and the ratio of testosterone to estradiol decreased. In 118 prepubertal girls, estradiol, total and free testosterone, progesterone, testosterone to estradiol ratio, and testosterone-estrogen—bindingglobulin levels were no different whether in subjects with acne or without acne. However, the level of dehydroepiandrosterone sulfate, an androgen of adrenal origin, was significantly higher in prepubertal girls with acne. Conclusion: Acne, especially the comedonal type, can be the first sign of pubertal maturation in girls, even preceding pubic hair and areolar development. Concentration of dehydroepiandrosterone sulfate is significantly and specifically associated with the initiation of acne in young girls. (Arch Dermatol. 1994;130:308-314)

https://jamanetwork.com/journals/DERM/articlepdf/555640/archderm_130_3_006.pdf

Acne Vulgaris in Premenarchal Girls: An Early Sign of Puberty Associated With Rising Levels of Dehydroepiandrosterone

Definition and application of the discretionary screening indicators according to the National Cholesterol Education Program for Children and Adolescents

Acne Vulgaris in Premenarchal Girls

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Acne Vulgaris in Premenarchal Girls: An Early Sign of Puberty Associated With Rising Levels of Dehydroepiandrosterone

Definition and application of the discretionary screening indicators according to the National Cholesterol Education Program for Children and Adolescents

Acne Vulgaris in Premenarchal Girls