Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents
Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents
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DOI：
10.1542/peds.2012-3494
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发表时间：
2013-02-01
期刊：
影响因子：
8
通讯作者：
Flinn, Susan K.
中科院分区：
文献类型：
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作者：
Copeland, Kenneth C.;Silverstein, Janet;Flinn, Susan K.
在过去的30年中，儿童肥胖症的患病率在北美急剧增加，引发了各种健康问题，包括2型糖尿病（T2 DM），这在以前通常直到生命后期才被发现。儿童T2 DM的迅速出现给许多医生带来了挑战，他们发现自己通常没有能力治疗儿童中遇到的成人疾病。本临床实践指南旨在为10至18岁确诊为T2 DM的患者的管理提供循证建议。美国儿科学会（AAP）在美国糖尿病协会、儿科内分泌学会、美国家庭医生学会和营养与饮食学会（前身为美国饮食协会）的支持下，召集了儿童和青少年T2 DM管理小组委员会。这些小组合作开发了一份证据报告，作为这些实践指南建议的主要信息来源。该指南强调使用已被证明会影响该儿科人群临床结局的管理模式。建议将胰岛素或二甲双胍作为儿童和青少年T2 DM首选一线治疗。这些建议建议将生活方式的改变（即饮食和运动）与药物治疗相结合，而不是作为一种孤立的初始治疗方法。提供了监测血红蛋白A1 c（HbA 1c）和手指针刺血糖（BG）浓度的频率指南。根据证据质量和建议强度的系统分级做出决定。临床实践指南在获得AAP批准之前进行了同行评审。本临床实践指南并非旨在取代临床判断或建立所有T2 DM儿童的护理方案，其建议可能不是T2 DM儿童管理的唯一适当方法。当未达到治疗目标或开始胰岛素治疗时，提供者应咨询接受过T2 DM儿童和青少年护理培训的专家。AAP承认，由于儿童的年龄、共存疾病和/或其他问题，一些初级保健临床医生可能对他们成功治疗儿童T2 DM的能力没有信心。在任何时候，临床医生认为他或她没有得到充分的培训或不确定的治疗，应转介给儿科医学专科医生。如果T2 DM的诊断是由儿科医学专科医生做出的，初级保健临床医生应与专科医生制定一个共同的策略，以确保儿童继续接受与家庭医疗模式一致的适当护理，其中儿科医生与父母合作，以确保满足所有健康需求。儿科2013;131：364-382
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. Pediatrics 2013;131:364-382