JULY 8 TH 2010 Good Morning!

Risk Factors Obesity Positive Family History Specific Ethnic Groups Gender Conditions with Insulin Resistance  Puberty  PCOS

Presentation DKA  Or with only ketonuria Symptomatic without ketonuria or acidosis Asymptomatic

Diagnosis HbA1C  ≥6.5% FPG  ≥126 mg/dL OGTT 2 hour  ≥ 200mg/dL Random  ≥ 200mg/dL

A1C Fasting IFG OGTT

Comorbidities Hypertension Dyslipidemia Nonalcoholic fatty liver disease

Hypertension Pre-Hypertension  ≥90 th and 120/80 Hypertension  > 95 th %ile or >130/80 Systolic and/or diastolic 3 separate occasions Goal <90%ile

Dyslipidemia Increased triglycerides  Goal <150 Decreased HDL  Goal >35 Increased LDL  Goal <100

Other NAFLD  Most common cause of liver disease in children Vascular  Not known yet in children  Retinopathy, nephropathy, neuropathy

Treatment Goals To achieve and maintain near-normal glycemic control To improve insulin sensitivity and secretion, which results in improved glycemic control. To identify and treat, if necessary, comorbidities, such as hypertension, dyslipidemia, and nonalcoholic fatty liver disease To prevent the vascular complications of type 2 diabetes