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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents
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Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents

机译：儿童和青少年新诊断的2型糖尿病（T2DM）的管理

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摘要

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.
机译：在过去的30年中，北美地区儿童肥胖的患病率急剧上升，带来了各种健康问题，包括2型糖尿病（T2DM），这种疾病以前通常在生命的后期才出现。童年期T2DM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足够的能力来治疗儿童中遇到的成人疾病。制定该临床实践指南的目的是为管理诊断为T2DM的10至18岁患者提供基于证据的建议。美国儿科学会（AAP）在美国糖尿病协会，儿科内分泌学会，美国家庭医师学会和营养与营养学学会（以前是美国糖尿病学会）的支持下召集了儿童和青少年T2DM管理小组委员会美国饮食协会）。这些小组合作开发了证据报告，这些报告是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方式。针对胰岛素或二甲双胍是患有T2DM的儿童和青少年的首选一线治疗的情况提出了建议。这些建议建议将生活方式的改变（即饮食和运动）与药物结合起来，而不是孤立的初始治疗方法。提出了监测血红蛋白A1c（HbA1c）和指尖血糖（BG）浓度的频率指南。在对证据质量和推荐强度进行系统分级的基础上做出决定。临床实践指南在获得AAP批准之前，经过同行评审。本临床实践指南并非旨在取代临床判断或建立护理所有T2DM儿童的方案，并且其建议可能并非提供治疗T2DM儿童的唯一适当方法。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T2DM儿童和青少年护理培训的专家。 AAP承认，由于孩子的年龄，并存的疾病和/或其他问题，一些初级保健临床医生可能对他们能否成功治疗孩子的T2DM充满信心。在任何情况下，如果临床医生觉得他或她没有得到足够的培训或不确定治疗方法，则应转介儿科医学专科医生。如果由儿科专科医生诊断为T2DM，则初级保健临床医生应与专科医生一起制定共同管理策略，以确保孩子继续接受与儿科医生与父母合作的医疗家庭模式相符的适当护理。满足所有健康需求。

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