The precautionary principle and children's health

The American Public Health Association,Observing that epidemiological studies have shown that the prevalence of diagnosed diabetes has increased dramatically in the last 30 years; 1-5 and Noting that diabetes has reached epidemic proportions, with more than 20 million Americans of every age, gender, and race now afflicted; 5,6 and Recognizing that diabetes is a serious public health concern, with a prevalence in minority populations of African-Americans, Hispanic-Americans and Native-Americans that is two to three times that of non-Hispanic whites; [7][8][9] and Noting that type 2 diabetes is also emerging as a problem among minority children and adolescents; 10-13, 47,48 and Realizing that the increasing prevalence of diabetes among all groups has lead to an increase in the microvascular and macrovascular complications, including blindness, 14,15 lower extremity amputation, [16][17][18][19][20] and destructive periodontitis and tooth loss; [44][45][46] and Understanding that the lower extremity, periodontal and visual complications of diabetes are generally a function of the duration of diabetes 21- 23 and the level of glycemic control; 23-28 and Recognizing that approximately 67,000 amputations occur among the diabetic population annually, an incidence of at least 15 times greater than non-diabetic populations; 5,20 and Noting that foot ulcers precede amputation in 85 percent of cases; 16 and Recognizing that the 5-year mortality rate of diabetic patients increases by 39 to 68 percent following lower extremity amputation; 16 and Understanding that periodontal complications may lead directly to tooth loss and chronic infection.This adversely affects glycemic contol; 44-46 and Recognizing that diabetic retinopathy is the new leading cause of blindness among workingage Americans, accounting for approximately 8% of all cases of legal blindness and 12% of all new cases of blindness in the United States each year; 29 and Knowing the health benefit and cost-effectiveness of well established strategies of prevention and treatment in diabetic foot and vision care; 30,31,26,28,32 and Knowing that much of the vision loss, periodontal disease, and lower extremity amputation in diabetes mellitus is preventable through early detection and timely treatment; 33,34,20,32,[35][36][37][38] and Recognizing that annual foot examinations by podiatrists and other foot care providers, 39,26,28,40 vision examinations through a dilated pupil by opthalmologists and optometrists, 39,26 and dental examinations by oral health providers are the accepted standards of care for all persons with diabetes; therefore,The American Public Health Association urges health care professionals to 1. Promote awareness of the need for annual foot screening and examinations for individuals with diabetes and make appropriate referrals to podiatrists and other foot care providers; 2. Promote awareness of the need for annual dilated fundus exams for all individuals with diabetes and to make appropriate referrals to ophthalmologists and optometrists; 3. Promote awareness of the need for at least annual oral health examinations for all individuals with diabetes and to make appropriate referrals to oral health providers; and 4. Encourages federal, state, and privately funded health care organizations to target highrisk minority populations, including African-American, Hispanic-Americans, and Native-Americans, for annual foot and vision care. 5. Promote interdisciplinary diabetes management and appropriately timed referrals.