CE/CME
Diabetes Screening, Diagnosis and Management
Welcome to the training on Diabetes Screening, Diagnosis and Management provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Credit Hours: 1.75 CE
EnrollTo enroll in this course, please log in or create a new account if you are not already registered.
NOTE: In this module, the term “children” refers to children and adolescents, except when differentiation is needed. In addition, the term “parent” also refers to guardians and caregivers.
Goal
The goal of this module is to equip Texas Health Steps providers and other interested health-care professionals to provide age-based testing and anticipatory guidance for children and adolescents, apply current standards of medical care and promote medication adherence and effective management.
Target Audience
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Apply Texas Health Steps guidelines for routine and age- and risk-based diabetes evaluation and age-appropriate anticipatory guidance.
- Differentiate the disease characteristics of various forms of diabetes, primarily type 1 and type 2 diabetes.
- Apply the American Diabetes Association’s Standards of Medical Care in Diabetes for children and adolescents.
- Integrate communication strategies that promote medication adherence, caregivers’ support and effective management, including nutrition and physical activity modification.
All data cited in the module reflect the most recent year for available data.
Please note this module expires on 3/16/2024.
This module was released on 3/16/2021.
Featured
- American Academy of Pediatrics. (2016). Policy Statement: Media and Young Minds. Pediatrics, 138(5): e20162591.
- American Diabetes Association. Standards of Medical Care in Diabetes—2020.
- American Diabetes Association. (2013). Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care, 36(4): 1033–1046. (Abstract).
- Butwicka, A., Frisén, L., Almqvist, C., Zethelius, B., & Lichtenstein, P. (2015). Risks of Psychiatric Disorders and Suicide Attempts in Children and Adolescents With Type 1 Diabetes: A Population-Based Cohort Study. Diabetes Care 38(3): 453-459.
- Callaghan, T., Ferdinand, A. O., Akinlotan, M. A., Towne, S. D., & Bolin, J. (2019). The Changing Landscape of Diabetes Mortality in the United States Across Region and Rurality, 1999‐2016. Journal of Rural Health, 36(3), 410-415. [Abstract]
- Centers for Disease Control and Prevention. (2020). National Diabetes Statistical Report, 2020.
- Centers for Disease Control and Prevention. (2017). Disparities in Diabetes Deaths Among Children and Adolescents — United States, 2000–2014. Morbidity and Mortality Weekly Report (MMWR), 66(19), 502–505.
- Chiang, J. L., Kirkman, M. S., Laffel, L. M. B., & Peters, A. L., on behalf of the Type 1 Diabetes Sourcebook Authors. (2014). Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association. Diabetes Care, 37(7), 2034-2054.
- Dabelea, D., Stafford, J. M., & Mayer-Davis, E. J., D’Agustino Jr., A., Dolan, L., Imperatore, G., . . . Pihoker, C. (2017). Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood. JAMA: The Journal of the American Medical Association, 317(8): 825-835.
- Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J., … Hamman, R. F. (2014). Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009. [Abstract]. JAMA: The Journal of the American Medical Association, 311(17), 1778-1786.
- ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatric Diabetes, 19(S27): 155-177.
- Nwosu, B. N. (2013). Double Diabetes: The Search for a Treatment Paradigm in Children and Adolescents. Hot Topics in Endocrine and Endocrine-Related Diseases, M. Fedele (Ed.), DOI: 10.5772/53314.
- Spiegel, G., Bortsov, A., Bishop, F. K., Owen, D., Kingensmith, G. J., Mayer-Davis, E. J., & Maahs, D.M. (2012). Randomized nutrition education intervention to improve carbohydrate counting in adolescents with type 1 diabetes study: is more intensive education needed? Journal of the Academy of Nutrition and Dietetics, 112(11): 1736-46.
- Southwest Rural Health Research Center. (2018). The Burden of Diabetes in Rural America.
- Texas Department of Licensing and Regulation. (2016). Dietitians Administrative Rules.
- Texas Health and Human Services Commission, Vendor Drug Program. Glucagon 1 mg Emergency Kit general information.
- Texas Health and Human Services Commission. (2018). Texas Medicaid and Texas Diabetes Council Coordination Report.
Additional
- Academy of Nutrition and Dietetics. (n.d.). Find an Expert.
- Association of Diabetes Care and Education Specialists (formerly American Association of Diabetes Educators. (2020). Find a Diabetes Education Program.
- American Diabetes Association. (2020). Diabetes Food Hub.
- Anderson, B. J., Holmbeck, G., Iannotti, R. J., McKay, S. V., Lochrie, A., Volkening, L. K., & Laffel, L. (2009). Dyadic measures of the parent-child relationship during the transition to adolescence and glycemic control in children with type 1 diabetes. Families, Systems, & Health, 27(2), 141-152.
- Barbara Davis Center for Diabetes, University of Colorado College of Medicine. (n.d.).
- Berg, C. A., King, P. S., Butler, J. M., Pham, P., Palmer, D., & Wiebe, D. J. (2010). Parental Involvement and Adolescents’ Diabetes Management: The Mediating Role of Self-Efficacy and Externalizing and Internalizing Behaviors. Journal of Pediatric Psychology, 36(3).
- Billings, L, K., & Florez, J. C. (2010). The genetics of type 2 diabetes: What have we learned from GWAS? Annals of the New York Academy of Sciences, 1212(1), Blackwell Publishing Inc.
- Bishop, F. K., Maahs, D. M., Spiegel, G., Owen, D., Klingensmith, G. J., Bortsov, A., Thomas, J., & Mayer-Davis, E. J. (2009). The carbohydrate counting in adolescents with type 1 diabetes study. Diabetes Spectrum, 22(1), 56-62.
- Brink, S., Joel, D., Laffel, L., Lee, W. W. R., Olsen, B., Phelan, H., & Hanas, R. (2014). Sick day management in children and adolescents with diabetes. Pediatric Diabetes, 15(Suppl. 20): 193–202
- Centers for Disease Control and Prevention. (2020). Diabetes Public Health Resources.
- Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report Estimate of Diabetes and its Burden in the United States.
- Centers for Disease Control and Prevention. (2020). National Diabetes Education Program. (2020).
- Chase, H. P., & Maahs, D. (2012). Understanding diabetes. Children’s Diabetes Foundation at Denver.
- Children with Diabetes, Inc. (2017). Glucagon Emergency Kit.
- Copeland, K, C., Silverstein, J., Moore, K. R., Prazar, G. E., Raymer, T., Shiffman, R. N., … Flinn, S. K. (2013). AAP Clinical Practice Guideline: Management of newly diagnosed type 2 Diabetes Mellitus (T2DM) in children and adolescents. Pediatrics, 131(2), 364-382.
- Dabelea, D., Rewers, A., Stafford, J. M., Standiford, D. A., Lawrence, J. M., Saydah, S., …. Pihoker, C. (2014). Trends in the Prevalence of Ketoacidosis in Diabetes Diagnosis: The SEARCH for Diabetes in Youth Study. Pediatrics, 133(4): e938-e945.
- Delahanty, L. M., & Halford, B. N. (1993). The Role of Diet Behaviors in Achieving Improved Glycemic Control in Intensively Treated Patients in the Diabetes Control and Complications Trial. [Abstract]. Diabetes Care, 16(11), 1453-8.
- DeSisto, C. L., Kim, S. Y., & Sharma, A. J. (2014). Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. [Abstract]. Preventing Chronic Disease, 11:130415.
- Endotext. (2013).
- Entringer, S., Buss, C., Swanson, J. M., Cooper, D. M., Wing, D. A., Waffarn, F., & Wadhwa, P. D. (2012). Fetal programming of body composition, obesity, and metabolic function: The role of intrauterine stress and stress biology. Journal of Nutrition and Metabolism, doi:10.1155/2012/632548.
- Fedewa, M. V., Gist, N. H., Evans, E. M., & Dishman, R. K. (2014). Exercise and Insulin Resistance in Youth: A Meta-Analysis. [Abstract]. Pediatrics, 133(1): e163-e174.
- Hill-Briggs, F., Lazo, M., Peyrot, M., Doswell, A., Chang, Y., Hill, M. N., Levine, D., Wang, N., & Brancati, F. L. (2011). Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample. Journal of General Internal Medicine, 26(9), 972-978.
- Joslin Diabetes Center. (2020).
- JDRF. (2020)
- Mayer-Davis, E. J., Lawrence, J. M., Dabelea, D., Divers, J., Isom, S., Dolan, L., Imperatore, G., Linder, B., Marcovina, S., Pettitt, D. J., Pihoker, C., Saydah, S., & Wagenknecht, L. (2017). Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012. New England Medical Journal, 376:1419-1429.
- Miller, R. G., Secrest, A. M., Sharma, R. K., Songer, T. J., & Orchard, T. J. (2012). Improvements in the Life Expectancy of Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications Study Cohort. Diabetes, 61(11), 2987-2992.
- Nadella, S., Indyk, J. A., & Kamboj, M. K. (2017). Management of diabetes mellitus in children and adolescents: engaging in physical activity. Translational Pediatrics, 6(3): 215-224.
- National Diabetes Information Clearinghouse. (2020).
- National Health and Nutrition Examination Survey (NHANES). (2007). Oral Glucose Tolerance Test (OGTT) Procedures Manual.
- Rewers, A., Klingensmith, G., Davis, C., Petitti, D. B., Pihoker, C., Rodriguez, B., … Dabelea, D. (2008). Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. [Abstract]. Pediatrics, 121(5): e1258-66.
- Scheiner, G. & Schwartz, S. (2013). The Role of Continuous Glucose Monitoring in the Management of Type-1 and Type-2 Diabetes. In J. Vora & J. Buse (Eds.), Evidence-Based Management of Diabetes (pp. 91-110).
- Seifert, S. M., Schaechter, J. L., Hershorin, E. R., & Lipshultz, S. E. (2011). Health Effects of Energy Drinks on Children, Adolescents, and Young Adults. Pediatrics, 127(3), 511-52.
- Silverstein, J., Klingensmith, G., Copeland, K., Plotnick, L., Kaufman, F., Laffel, L., Deeb, L., Grey, M., Anderson, B., Holzmeister, L. A., & Clark, N. (2005). Care of Children and Adolescents with Type 1 Diabetes: A Statement of the American Diabetes Association. Diabetes Care; 28(1): 186-212.
- Texas Department of State Health Services. (2018). FAQs: Implementation of Laws on Screening for Type 2 Diabetes.
- Texas Diabetes Council. (2020).
- Texas Diabetes Council. (2017). Texas Diabetes Council Tool Kit: Algorithms & Guidelines.
- TODAY Study Group. (2012). A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes. New England Journal of Medicine, 366, 2247-2256.
- Tripathi, A., Rizvi, A. A., Knight, L. M., & Jerrell, J. M. (2012). Prevalence and impact of initial misclassification of pediatric type 1 diabetes mellitus. [Abstract]. Southern Medical Journal, 105(10), 513-7.
- University of Washington and Washington State Oral Health Program. (2010). Oral Health Fact Sheet for Dental Professionals: Children with Type 1 Diabetes.
- U.S. Department of Health and Human Services. (2020). Helping the Student with Diabetes Succeed.
Definitions
The medical definitions provided in this module were obtained from the American Diabetes Association, Mayo Clinic, Merck Manual, U.S. National Library of Medicine, and WebMD.
Helpful Resources
- Aging and Disability Resource Centers (ADRCs) operated by the Texas Health and Human Services Commission (HHSC). The centers are welcoming and offer information about state and federal health benefits as well as local programs and services. The trained staff can connect caregivers with services such as home care, meals, transportation, legal help, attendant care, respite support and housing. Visit the ADRC website for a list of resource center locations in Texas.
- American Diabetes Association. Loved Ones: Managing Diabetes, a web page with educational resources for families.
- American Diabetes Association. Help for Parents web page.
- Association of Diabetes Care & Education Specialists. Resources for People Living with Diabetes
- Centers for Disease Control and Prevention. Living with Diabetes website, which offers a variety of educational information.
- Centers for Disease Control and Prevention, National Diabetes Education Program. Resources for Children and Teens.
- National Alliance for Caregiving.
- Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. This site offers comprehensive, relevant and reliable information for families, professionals, advocates and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.
- Texas Health and Human Services Commission. Family Support Services, a program to help families care for children with special health-care needs at home. Services are provided by the Children with Special Health Care Needs (CSHCN) Services Program.
- Texas Department of State Health Services. Diabetes in Children website.
- Texas Health and Human Services Commission. Take Time Texas, provides assistance with respite care.
- Texas Parent to Parent, a parent-led organization that offers peer support for parents of children with special health-care needs.
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.75 contact hour(s) of Continuing Nursing Education.
Social Workers
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.75 hours of credit.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.75 hour(s) for attendance.
Disclosure - DIAB 2021
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support. - Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee has the following relevant financial relationships to disclose:- Sarah Lyons - Physician - Volunteer Member of the American Diabetes Association's Professional Practice Committee - Receives Royalty from McGraw-Hill Education Inc. for "Vanderbilt Med-Peds Outpatient Curriculum."
- Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center. - Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
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Health-Care Providers
- American Academy of Nutrition and Dietetics. Locate a registered dietitian nutritionist by using the red Find an Expert button.
- American Diabetes Association. Standards of Medical Care in Diabetes—2020.
- American Diabetes Association, Diabetes Food Hub. What is the Diabetes Plate Method?
- Association of Diabetes Care and Education Specialists (formerly American Association of Diabetes Educators), Make a Referral web page assists health-care providers in making referrals for diabetes self-management education and support.
- Association of Diabetes Care and Education Specialists (formerly American Association of Diabetes Educators). Find a Diabetes Education Program in your area.
- ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatric Diabetes, 19(S27): 155-177.
- National Health and Nutrition Examination Survey (NHANES). (2007). Oral Glucose Tolerance Test (OGTT) Procedures Manual.
- National Heart, Lung, and Blood Institute. Meal Plan: Food exchange list.
- Texas Diabetes Council. (2017). Texas Diabetes Council Tool Kit Algorithms and Guidelines. (Developed by the Texas Diabetes Council and the Texas Department of State Health Services [DSHS].)
- Texas Health and Human Services Commission, Vendor Drug Program. Glucagon 1 mg Emergency Kit general information.
- Texas Health and Human Services Commission. Locate an accredited or recognized diabetes self-management education program on the HHSC web page titled Diabetes Self-Management Education.
- Texas Medicaid & Healthcare Partnership. (2018). Texas Medicaid Provider Procedures Manual (TMPPM)
- University of California, San Francisco, Diabetes Teaching Center. (2017). Diabetes Education Online: Types of Insulin.
- University of Washington and Washington State Oral Health Program. (2010). Oral Health Fact Sheet for Dental Professionals: Children with Type 1 Diabetes.