Pediatrics:首部儿童2型糖尿病防治指南

2013-01-29 Pediatrics CMT 晓东 编译

美国儿科学会(AAP)联合美国糖尿病学会(ADA)、儿童内分泌学会(PES)、美国家庭医师学会(AAFP)及美国营养与饮食学会(AND)公布了首个针对儿童与青少年的2型糖尿病管理指南。《指南》于2013年1月28日在线发表于《儿科学》杂志。 过去儿科医生处理的病例类型多为1型糖尿病,他们通常认为2型糖尿病仅在成人中发生。随着儿童肥胖率的日益增高,这种“成人病”在儿童中越来越多见。 新指

美国儿科学会(AAP)联合美国糖尿病学会(ADA)、儿童内分泌学会(PES)、美国家庭医师学会(AAFP)及美国营养与饮食学会(AND)公布了首个针对儿童与青少年的2型糖尿病管理指南。《指南》于2013年1月28日在线发表于《儿科学》杂志。

过去儿科医生处理的病例类型多为1型糖尿病,他们通常认为2型糖尿病仅在成人中发生。随着儿童肥胖率的日益增高,这种“成人病”在儿童中越来越多见。

新指南推荐在肥胖儿童中筛查2型糖尿病,鼓励健康饮食并进行体育锻炼,并指出部分儿童糖尿病患者需进行早期强化胰岛素治疗。

对于酮症酸中毒、糖化血红蛋白显著升高或无法确定糖尿病分类的患儿,指南推荐其糖尿病确诊时即开始胰岛素治疗。

对于所有患儿均推荐二甲双胍作为一线治疗药物,同时进行生活方式调整(包括饮食与运动改变)。

指南推荐进行患儿血糖控制的监测,以达到胰岛素计划、饮食与运动的推荐目标。


Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents 

ABSTRACT
Over the past 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. The rapid emergence of childhood T2DM poses challenges to many physicians who find themselves generally ill-equipped to treat adult diseases encountered in children. This clinical practice guideline was developed to provide evidence-based recommendations on managing 10- to 18-year-old patients in whom T2DM has been diagnosed. The American Academy of Pediatrics (AAP) convened a Subcommittee on Management of T2DM in Children and Adolescents with the support of the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). These groups collaborated to develop an evidence report that served as a major source of information for these practice guideline recommendations. The guideline emphasizes the use of management modalities that have been shown to affect clinical outcomes in this pediatric population. Recommendations are made for situations in which either insulin or metformin is the preferred first-line treatment of children and adolescents with T2DM. The recommendations suggest integrating lifestyle modifications (ie, diet and exercise) in concert with medication rather than as an isolated initial treatment approach. Guidelines for frequency of monitoring hemoglobin A1c (HbA1c) and finger-stick blood glucose (BG) concentrations are presented. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent peer review before it was approved by the AAP. This clinical practice guideline is not intended to replace clinical judgment or establish a protocol for the care of all children with T2DM, and its recommendations may not provide the only appropriate approach to the management of children with T2DM. Providers should consult experts trained in the care of children and adolescents with T2DM when treatment goals are not met or when therapy with insulin is initiated. The AAP acknowledges that some primary care clinicians may not be confident of their ability to successfully treat T2DM in a child because of the child’s age, coexisting conditions, and/or other concerns. At any point at which a clinician feels he or she is not adequately trained or is uncertain about treatment, a referral to a pediatric medical subspecialist should be made. If a diagnosis of T2DM is made by a pediatric medical subspecialist, the primary care clinician should develop a comanagement strategy with the subspecialist to ensure that the child continues to receive appropriate care consistent with a medical home model in which the pediatrician partners with parents to ensure that all health needs are met.

    

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