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: 1.50 CE

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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:

  1. Apply Texas Health Steps guidelines for routine and age- and risk-based diabetes evaluation and age-appropriate anticipatory guidance.
  2. Differentiate the disease characteristics of various forms of diabetes, primarily type 1 and type 2 diabetes.
  3. Apply the American Diabetes Association’s Standards of Medical Care in Diabetes for children and adolescents.
  4. 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 3/22/2027.

This module was released on 3/22/2024.

Featured

American Diabetes Association Publications. Diabetes. (2020). Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel. Perspectives in Diabetes: Volume 69, Issue 10. 

Centers for Disease Control and Prevention. Diabetes. (2023). National Diabetes Statistics Report.

Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Prevalence & Trends Data. (2023). Diabetes.

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.

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. 

Diabetes.co.uk. Conditions. (2023). Rheumatoid Arthritis and Diabetes.

Harvard Health Publishing, Harvard Medical School. Staying Healthy. (2023). The importance of exercise when you have diabetes.

Kaiser Family Foundation. (2023). Key Data on Health and Health Care by Race and Ethnicity.

National Library of Medicine. National Center for Biotechnology Information. Mother To Baby | Fact Sheets [Internet]. (2023). Gestational Diabetes.

Rodriquez, I.M., O’Sullivan, K.L. (2023). Youth-Onset Type 2 Diabetes: Burden of Complications and Socioeconomic Cost. Current Diabetes Reports. 23(5): 59–67.

Medical Definitions

The medical definitions provided in this module were obtained from the American Diabetes Association (ADA), Mayo Clinic, Merck Manual, U.S. National Library of Medicine and WebMD.

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 1.50 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 1.50 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 1.50 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.50 hour(s) for attendance.

Certified Community Health Worker

The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.50 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.

Disclosure - DIAB 2021

One of the requirements of continuing education is disclosure of the following information to the learner:

  1. 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.
  2. Commercial Support.
    The THSTEPS Web-based Continuing Education Series has received no commercial support.
  3. 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."
  4. 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.
  5. 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).

Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.

Health-Care Providers

American Academy of Nutrition and Dietetics. Eatright.org. Locate a registered dietitian nutritionist by using the red Find a Nutrition Expert button.

American Diabetes Association. Diabetes Care. (2023). Children and Adolescents: Standards of Care in Diabetes—2024.

American Diabetes Association. Press Release. (2021). International Experts Outline Diabetes Remission Diagnosis Criteria. 

American Diabetes Association. About Diabetes. (n.d.). CGM & Time in Range.

American Diabetes Association. Treatment & Care. (n.d.). Hypoglycemia (Low Blood Glucose).

American Diabetes Association. Health and Wellness. (n.d.). Insulin Basics.

American Diabetes Association. Diabetes Spectrum. (2019). A Developmental Milestones Map of Type 1 Diabetes Self-Management Transition From Parents to Adolescents. v.32(1): 21-29.

American Diabetes Association. About Diabetes. (2023.) Statistics about Diabetes.

Association of Diabetes Care & Education Specialists. (n.d.) Find an Accredited Diabetes Self-Management Education and Support Program in Your Area.

Centers for Disease Control and Prevention. Diabetes. (2022). Gestational Diabetes. 

Centers for Disease Control and Prevention. Diabetes. Living With Diabetes. (2022).

Centers for Disease Control and Prevention. Diabetes. (2023). National Diabetes Statistics Report.

Centers for Disease Control and Prevention. Diabetes. (2022). Prevent Type 2 Diabetes in Kids.

Centers for Disease Control and Prevention. Diabetes. (2022). The Surprising Truth About Prediabetes.

Centers for Disease Control and Prevention. Diabetes. (2023). Trends in New Diabetes Cases Among Young People.

Centers for Disease Control and Prevention. Diabetes. (2022). Types of Insulin.

Centers for Disease Control and Prevention. Diabetes. (2023). What Is Type 1 Diabetes?

Children’s Health. (n.d.). The importance of ketones in children with diabetes.

Children with Diabetes. (2022). Glucagon Options for People with Diabetes.

Cleveland Clinic. (2022). Type 1 Diabetes.

Current Diabetes Reports. (2023). Youth-Onset Type 2 Diabetes: Burden of Complications and Socioeconomic Cost.

Diabetes in America, 3rd edition. (2018). Chapter 17. Acute Metabolic Complications in Diabetes.

The University of California at San Francisco. (n.d.). Diabetes Center at UCSF. 

Endocrine Society. (2022). Monogenic Diabetes.

Evidence Synthesis, No. 216. (2022). Screening for Prediabetes and Type 2 Diabetes Mellitus in Children and Adolescents: An Evidence Review for the U.S. Preventive Services Task Force.

Frontiers in Endocrinology. (2022). The Prevalence of Islet Autoantibodies in Children and Adolescents With Type 1 Diabetes Mellitus: A Global Scoping Review.

Healthline. (2023). Side Effects of Metformin: What You Should Know.

Healthline. (2022). All About Metformin Oral Tablet.

DigiBete. ISPAD Clinical Practice Consensus Guidelines 2022: Definition, epidemiology, and classification of diabetes in children and adolescents.

DigiBete. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state.

Pediatric Diabetes. (2022) ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. p. 1145-1724

Jonas, D.E., Vander Schaaf, E.B., Riley, S., et al. (2022). Book. Screening for Prediabetes and Type 2 Diabetes Mellitus in Children and Adolescents: An Evidence Review for the U.S. Preventive Services Task Force [Internet] 

Juvenile Diabetes Research Foundation (JDRF). (2023). Type 1 Diabetes and other autoimmune conditions.

Juvenile Diabetes Research Foundation (JDRF). (n.d.). Honeymoon Phase.

Mayo Clinic. (2023). Diabetes diet: Create your healthy-eating plan.

Mayo Clinic. Diseases & Conditions. (2022). Fetal macrosomia.

Mayo Clinic. Diseases & Conditions. (2022). Hyperglycemia in diabetes.

Mayo Clinic. Diseases & Conditions. (2023). Type 1 diabetes in children.

Mayo Clinic. Diseases & Conditions. (2022). Type 2 diabetes in children.

Mayo Clinic. Drugs and Supplements. (2023). Metformin (Oral Route).

MedlinePlus. (2022). Lactic acidosis.

National Institute of Diabetes and Digestive and Kidney Diseases. Managing Diabetes. (2023.) Continuous Glucose Monitoring.

Nemours KidsHealth. (2022). Carbohydrates and Diabetes.

Nemours KidsHealth. (2022). Eating Smart When Your Child Has Diabetes.

Rosenfeld, E., Thornton, P.S. Endotext [Internet]. (2023). Hypoglycemia in Neonates, Infants, and Children

StatPearls. (2023). Hyperglycemia.

Texas Diabetes Council and Department of State Health Services: 6th Edition. (2012). Diabetes Tool Kit: A Practitioner’s Reference.

Texas Health and Human Services Commission, Department of State Health Services. (n.d.). Managing Diabetes.

Texas Health and Human Services Commission: Health Information Designs. Texas Prior Authorization Program Clinical Criteria. (2023). Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists.

Texas Health and Human Services Commission. (2023). Vendor Drug Program. 

Texas Health and Human Services Commission. Vendor Drug Program. (2023). Formulary Search. 

Texas Health and Human Services Commission. (n.d.). Health Services Providers.

Texas Health and Human Services Commission. (2021). Medical Providers: Periodicity Schedule.

Texas Medicaid & Healthcare Partnership. (2023). Prior Authorization Criteria for Teplizumab-mzwv (Tzield) Effective August 1, 2023.

Texas Medicaid & Healthcare Partnership. (2023). Texas Medicaid Provider Procedures Manual.

Texas Medicaid & Healthcare Partnership (TMHP). Texas Medicaid Provider Procedures Manual. (2023) Volume 2: Provider Handbooks, Telecommunication Services Handbook.

Texas Risk Assessment for Type 2 Diabetes in Children: Risk Factor Electronic System. (n.d.). About TRAT2DC.

University of California San Francisco. Benioff Children’s Hospitals. (2023). Glucose tolerance test - non-pregnant.

U.S. Food and Drug Administration. (2023). FDA Approves New Class of Medicines to Treat Pediatric Type 2 Diabetes.

Parents and Family

American Diabetes Association. Tools & Resources. (n.d.). For Caregivers.

American Diabetes Association. Advocacy. (n.d.). Safe at School.

Association of Diabetes Care & Education Specialists. (n.d.) Find an Accredited Diabetes Self-Management Education and Support Program in Your Area

Centers for Disease Control and Prevention. Diabetes. (2022). Living with Diabetes.

Dartmouth Health Children’s. (n.d.). Managing Sick Days.

Diabetes.co.uk. Living with Diabetes. (2019). Blood Sugar Level Ranges.

Kaiser Permanente. (2023). Pattern management for better blood sugar control.

KidsHealth. (2021). Healthy Eating For Children With Diabetes.

National Institute of Diabetes and Digestive and Kidney Diseases. Managing Diabetes. (2023). Continuous Glucose Monitoring.

Navigate Life Texas. Resources & Support. (2023) For families raising children with disabilities.

Nemours KidsHealth. (2022). Kids and Diabetes: Healthy Eating at Restaurants.

Nemours KidsHealth. (2022). Eating Smart When Your Child Has Diabetes.

Nemours KidsHealth. (2021). Managing Blood Sugars When Your Child Has Type 1 Diabetes.

Texas Health and Human Services Commission. Children with Special Health Care Needs (CSHCN) Services Program (n.d.). Family Support Services.

Texas Health and Human Services Commission. (2021). Medical Transportation Program. 

Texas Health and Human Services Commission. Texas Department of State Health Services. Diabetes in Children.

Texas Parent to Parent. (n.d.). Peer support, information, and education for families of children and adults with disabilities, chronic and mental health care conditions and other health-care needs.