Diabetes Care:美国糖尿病协会声明,超重或肥胖儿童青少年若应筛查糖尿病

2018-11-21 卢芳 中国循环杂志

近日,美国糖尿病协会(ADA)就青年2型糖尿病的管理发表了一项声明。该声明由六位儿科内分泌学和心理学家,回顾分析了260多篇文献、共识等后进行了撰写。


近日,美国糖尿病协会(ADA)就青年2型糖尿病管理发表了一项声明。该声明由六位儿科内分泌学和心理学家,回顾分析了260多篇文献、共识等后进行了撰写。

声明指出,青年2型糖尿病与成人2型糖尿病发病机制、发展过程等有很大差异,病情发展更为激进,β细胞功能恶化更快,对降糖药物反应更差,而且并发症风险更高。

声明指出,对于10岁以上的儿童青少年,或已经进入青春期的青少年,如果超重或肥胖,就应考虑进行基于风险的筛查

其他需要考虑的风险因素包括母亲罹患妊娠糖尿病或糖尿病,近亲有2型糖尿病病史,非裔、拉美或其他非白种人背景,或存在胰岛素抵抗。

诊断而言,声明认为,当前基于实验室的糖尿病前期和糖尿病的诊断标准是从成人中得来,但这对于儿童青少年的确切相关性却仍不清楚。糖尿病前期和糖尿病年轻患者和成人患者胰岛素敏感性和β细胞功能存在较大差异。

此外,声明还指出,应该使用胰腺自身抗体来明确糖尿病类型,以排除自身免疫性1型糖尿病。

糖尿病患者教育是糖尿病管理重要一环,声明指出,患者及其家人均应该接受全面的与文化背景相匹配的糖尿病自我管理教育

儿童青少年也正值心理敏感期,声明指出,应该考虑相关影响儿童青少年患者的精神或行为健康。

治疗方面,除了注重教育外、体重管理、运动、营养等,就药物而言,超重或肥胖者应考虑药物依从性以及治疗对体重的影响,此外,育龄期青年女性应该将孕期咨询纳入门诊就诊内容。

声明还提出了一套基于风险因素的超重青年新发2型糖尿病的管理原则,并提出适宜的药物治疗方法。

减重手术对于肥胖者会极大改善代谢状况,指南指出,对于体重指数(BMI)>35 kg/m2且血糖及合并症控制较差的年轻2型糖尿病患者,如果生活方式和药物干预均不理想,可考虑接受减重手术。

声明还讨论了年轻2型糖尿病向成人过渡管理的问题,并指出,只有医患认为合适,才能转为成人治疗。

原始出处:

Arslanian S, Bacha F, Grey M, et al. Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association. Diabetes Care. 2018 Nov 13. doi: 10.2337/dci18-0052.

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    2018-11-22 misszhang

    谢谢MedSci提供最新的资讯

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