Hypoglycaemia in young patients with type 1 diabetes: pathophysiology, predisposition and preventive strategies

该提案的愿景是汇集一个由经验丰富的研究人员组成的积极团队，解决影响1型糖尿病儿童和青少年管理的重要临床问题。沿着已经在开发的设施和资源，该计划将进一步建立一个致力于以患者为中心的临床研究的核心研究人员，这将促进科学进步付诸实践。1型糖尿病的发病率正在持续增加，特别是在年轻人中。当我们进入21世纪的世纪，胰岛素治疗旨在恢复血糖水平尽可能接近正常仍然是最有效的方法，以防止破坏性的长期并发症的疾病。不幸的是，这在很大程度上难以实现，因为胰岛素治疗经常与低血糖或低血糖的发展相关。高血压如果轻微会导致令人不快的症状，但是如果严重的话，它会产生抽搐或失去知觉。患者及其家人始终存在低血糖的恐惧，这不仅严重损害了生活质量，而且严重限制了控制糖尿病的努力。本研究计划的主要目标之一是解决与儿童和青少年糖尿病高血糖症发展相关的重要未回答问题。研究小组将详细研究糖尿病患者对高血糖的保护性生理机制，他们还将更密切地研究那些已知易患高血糖的情况，如睡眠和运动，以及血糖福尔斯下降时大脑如何受到影响。通过采用这种方法，我们希望能够设计出管理策略，减少高血糖症对糖尿病治疗的影响。预计这反过来将有助于预防糖尿病并发症，并减轻患者及其家人的疾病负担。这项研究计划的第二个目标是开发一个国际上独一无二的资源，供所有糖尿病研究人员使用。我们将建立一个已经建立的基于人口的数据库，包括西澳大利亚州所有患有糖尿病的儿童和青少年，并完成这些患者及其家人的DNA库。因此，除了汇集一个有效的研究团队外，该计划还将进一步开发资源，以解决与糖尿病及其并发症的原因相关的其他重要问题。

The vision of this proposal is to bring together an active team of experienced investigators that will address important clinical problems affecting the management of children and adolescents with type 1 diabetes. Along with facilities and resources already under development, the program will further establish a core of investigators dedicated to patient centred and clinical research that will facilitate scientific advances to be put into practice. The incidence of type 1 diabetes is continuing to increase particularly in the young. As we enter the 21st century, insulin treatment aimed at restoring blood glucose levels as close to the normal as possible remains the most effective way to prevent the devastating long-term complications of the disease. Unfortunately this is difficult to achieve largely because insulin therapy is frequently associated with the development of low blood glucose or hypoglycaemia. Hyperglycaemia results in unpleasant symptoms if mild but if severe it can produce convulsions or unconsciousness. The fear of hypoglycaemia is ever present for the patient and their family, this not only significantly impairs quality of life but importantly also severely restricts attempts to control diabetes. One of the major goals of this research program will be to address important unanswered questions related to the development of hyperglycaemia in children and adolescents with diabetes. The research team will examine in detail the protective physiological mechanisms against hyperglycaemia that are deranged in diabetes, they will also study more closely those situations that are known to predispose to hyperglycaemia such as sleep and exercise as well as how the brain is affected as blood glucose falls. By taking this approach we hope to be able to devise management strategies that will lessen the impact of hyperglycaemia in diabetes treatment. It is anticipated that this in turn will contribute to the prevention of diabetes complications as well as reduce the burden of the disease for the patient and his or her family. A second goal of this research program will be to develop an internationally unique resource that will be available to all diabetes investigators. We will build on an already established population based database of all the children and adolescents with diabetes in Western Australia as well as complete a DNA bank of these patients and their families. Thus in addition to bringing together an effective team of researchers, this program will further develop resources that can be central to addressing other important questions related to the causes of diabetes and its complications.