CSII (Insulin Pump Therapy)
ÎCSII is useful in motivated and DM-educated patients with T1DM and in certain insulinopenic patients with T2DM who are unable to achieve optimal glycemic control with MDI. Thorough education and periodic re-evaluation of CSII users, as well as CSII expertise of the prescribing physician, is necessary to ensure patient safety (D-4).
ÎSensor-augmented CSII should be considered in patients in whom it is deemed appropriate (B-2).
Children and Adolescents
ÎThe pharmacologic treatment of any form of DM in children does not, at this stage of our knowledge, differ in substance from treatment in adults (D-4).
ÎIn children or adolescents with T1DM, insulin regimens should be MDI or CSII (D-4), but injection frequencies may become problematic in some school settings.
> Higher insulin to carbohydrate ratios may be needed during puberty (D-4). > In children or adolescents with T2DM, diet and lifestyle modification are implemented first. Addition of metformin and/or insulin should be considered when glycemic targets are not achievable with lifestyle measures alone (C-3). Note: An extensive review of guidelines for the care of children with DM from the International Society of Pediatric and Adolescent Diabetes was published in 2009 and is available on their Web site (http://www.ispad.org/FileCenter.html?CategoryID=5).
Pregnancy
ÎAll women with pre-existing DM (T1DM, T2DM, or previous GDM) should have access to preconception care to ensure adequate nutrition and glucose control before conception, during pregnancy, and in the postpartum period (B-2).
ÎRegular or rapid-acting insulin analogues are the preferred treatment for postprandial hyperglycemia in pregnant women. Basal insulin needs can be provided by using rapid-acting insulin via CSII or by using long-acting insulin (eg, NPH; US Food and Drug Administration [FDA] pregnancy category B) (B-2).
> Although insulin is the preferred treatment approach, metformin and glyburide have been shown to be effective alternatives and without adverse effects in some women.
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