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Until the 1970s, the care of childhood diabetes was pursued by internists, pediatricians, nephrologists, and general physicians. In 1971 it was estimated that visits for diabetes by those 0 to 15 years of age were equally divided among internists, general physicians, and general pediatricians.1 At that time there were few pediatric endocrinologists, and most of them did not consider diabetes to be an endocrine disorder. By 1993, pediatricians accounted for two thirds of all visits of 0- to 21-year-old diabetes patients, and over half of these were to pediatric endocrinologists; the remainder were to internists (most likely the older adolescents and young adults).2 The contemporary epidemic of obesity-related type 2 diabetes (T2D) in youth has confronted pediatricians and pediatric diabetes specialists with responsibility for a condition that was previously rare in the pediatric age group. This obesity/T2D epidemic has had pediatricians dealing with various comorbidities of insulin resistance that were formerly the exclusive domain of physicians treating adults.3

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The diagnosis of diabetes includes a wide variety of diseases characterized by hyperglycemia. Because insulin is the only physiologically important hypoglycemic hormone, hyperglycemia is the result of either impaired secretion of insulin from the beta cells of the pancreas (type 1 diabetes) or resistance to the effect of insulin in the liver, muscle, and fat cells exceeding a limited capacity of the pancreas to compensate (type 2 diabetes). Criteria for the diagnosis of diabetes were revised in 2005 and prediabetes categories of impaired glucose tolerance and impaired fasting glucose added; this change reflected the recognition that these preclinical glucose intolerance states are associated with increased cardiovascular morbidity.4 The information in Table 544-1 is based on the current recommendations of the American Diabetes Association.4

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Table 544-1. Criteria for the Diagnosis of Diabetes

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