A 12-year-old girl diagnosed with type 1 diabetes 3 years prior presents for a routine examination. She is on a basal bolus regime which she manages well. The total daily insulin d... A 12-year-old girl diagnosed with type 1 diabetes 3 years prior presents for a routine examination. She is on a basal bolus regime which she manages well. The total daily insulin dose is 32 units. Physical examination shows no abnormal findings and no signs of puberty. Her weight is 40 kg (<50th percentile) and height is 156 cm (t5th percentile). Glucose is 6.0 (3.5-5.5 mmol/L). Which screening tests should be performed annually?
Understand the Problem
The question describes a 12-year-old girl with type 1 diabetes and asks which annual screening test is most appropriate for her, given her clinical information. The focus is on managing diabetes-related complications and other associated conditions.
Answer
Annual screening tests for a 12-year-old with type 1 diabetes should include: Urine Albumin-to-Creatinine Ratio (UACR), Lipid Profile, Dilated Fundus Examination, Thyroid-stimulating hormone (TSH), Comprehensive Foot Exam, and Assessment of Glycemic Control.
Based on the information provided and standard guidelines for managing type 1 diabetes in children, the following annual screening tests should be performed:
- Urine Albumin-to-Creatinine Ratio (UACR): To screen for early signs of diabetic kidney disease (albuminuria).
- Lipid Profile: To assess for dyslipidemia, a common comorbidity in individuals with diabetes.
- Dilated Fundus Examination: To screen for diabetic retinopathy. Since she has had diabetes for 3 years, annual screening is recommended.
- Thyroid-stimulating hormone (TSH): To screen for autoimmune thyroid disease, which is more common in individuals with type 1 diabetes.
- Comprehensive Foot Exam: To assess for any foot abnormalities, and provide education on proper foot care.
- Assessment of Glycemic Control: Including HbA1c, frequency of self-monitoring of blood glucose (SMBG), pattern management and downloads of glucose monitoring devices.
Answer for screen readers
Based on the information provided and standard guidelines for managing type 1 diabetes in children, the following annual screening tests should be performed:
- Urine Albumin-to-Creatinine Ratio (UACR): To screen for early signs of diabetic kidney disease (albuminuria).
- Lipid Profile: To assess for dyslipidemia, a common comorbidity in individuals with diabetes.
- Dilated Fundus Examination: To screen for diabetic retinopathy. Since she has had diabetes for 3 years, annual screening is recommended.
- Thyroid-stimulating hormone (TSH): To screen for autoimmune thyroid disease, which is more common in individuals with type 1 diabetes.
- Comprehensive Foot Exam: To assess for any foot abnormalities, and provide education on proper foot care.
- Assessment of Glycemic Control: Including HbA1c, frequency of self-monitoring of blood glucose (SMBG), pattern management and downloads of glucose monitoring devices.
More Information
Screening for complications and comorbidities is crucial in managing type 1 diabetes, even in the absence of obvious symptoms or abnormal physical exam findings.
Tips
The duration of diabetes is significant, so the recommendations will change as the person gets older and has lived with diabetes for longer. Be aware of the patient's age.
Sources
- Type 1 Diabetes in Children and Adolescents - guidelines.diabetes.ca
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