Diabetes in the young:: a paediatric and epidemiological perspective
Diabetes in the young:: a paediatric and epidemiological perspective
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DOI：
10.1007/s00125-003-1101-0
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发表时间：
2003-04-01
期刊：
影响因子：
8.2
通讯作者：
Soltész, G
中科院分区：
文献类型：
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作者：
Soltész, G
糖尿病在年轻人中的范围已经扩大;它现在包括单基因疾病，例如各种形式的永久性和短暂性新生儿糖尿病和MODY以及儿童后期出现的肥胖相关的2型糖尿病，但主要形式仍然是1型糖尿病。与糖尿病相关的主要医疗、生理、社会和情感问题使得儿童和青少年糖尿病的临床管理成为医生和家庭的一项艰巨任务。尽管有治疗方案，但总体血糖控制仍为中度或较差，这干扰了“正常”儿童期的几个要素。在欧洲，儿童I型糖尿病的发病率存在高达10倍的地理差异，在一些国家，发病率相对稳定（主要是北方），但在其他国家，许多非遗传（环境）因素与1型糖尿病的风险相关。其中，围产期因素，早期营养，生长和疫苗接种，特应性疾病和维生素D进行了详细讨论。新的遗传数据说明了基因、生物体和环境之间的重要相互作用，支持环境压力在这一主要疾病演变中的重要性。尽管1型糖尿病通常只占糖尿病对人群总影响的一小部分，但它是大多数发达国家年轻年龄组疾病的主要形式。据估计，全世界每年有近10万名15岁以下的儿童患I型糖尿病。1型糖尿病中胰腺β细胞的自身免疫性破坏导致绝对胰岛素依赖和通常在相对年轻的年龄发生的高并发症率。因此，1型糖尿病给个人、家庭和卫生服务带来了特别沉重的负担。
The spectrum of diabetes in the young has widened; it now includes monogenic diseases, for example the various forms of permanent and transient neonatal diabetes and MODY as well as the emerging obesity-associated Type 2 diabetes in late childhood, but the main form is still Type 1 diabetes. Age-related major medical, physiological, social and emotional problems make the clinical management of diabetes in children and adolescents a difficult task for the physician and the family. Overall glycaemic control remains moderate or poor despite a treatment schedule, which interferes with several elements of "normal" childhood.There is an up to tenfold geographical variation in the incidence of childhood Type I diabetes within Europe with relatively stable incidence rates in some countries (mainly northern), but dynamic increases in incidence in other countries (mainly central European).A number of nongenetic (environmental) factors have been associated with the risk of Type 1 diabetes. Among these, perinatal factors, early nutrition, growth and vaccinations, atopic diseases and vitamin D are discussed in detail. The important interplay between genes, organism and environment is illustrated with new genetic data supporting the importance of environmental pressures in the evolution of this major disease.Although Type 1 diabetes usually accounts for only a minority of the total impact of diabetes in a population, it is the predominant form of the disease in younger age-groups in most developed countries. It is estimated that on an annual basis almost 100 000 children younger than 15 years of age develop Type I diabetes worldwide. The autoimmune destruction of the pancreatic beta cells in Type 1 diabetes leads to absolute insulin dependence and a high rate of complications typically occuring at a relatively young age. Therefore, Type 1 diabetes places a particulary heavy burden on the individual, the family and health services.