1. JULY 8 TH 2010 Good Morning!

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

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

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

9. A1C Fasting 100-125 IFG OGTT

10. Comorbidities Hypertension Dyslipidemia Nonalcoholic fatty liver disease

11. 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

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

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

14. 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