临床儿科杂志 ›› 2022, Vol. 40 ›› Issue (5): 321-327.doi: 10.12372/jcp.2022.22e0411
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罗飞宏
收稿日期:
2022-03-27
出版日期:
2022-05-15
发布日期:
2022-05-13
LUO Feihong
Received:
2022-03-27
Online:
2022-05-15
Published:
2022-05-13
摘要:
儿童糖尿病主要为儿童1型糖尿病(T1DM),根据我国大中城市的大样本纵向调查,其年发病率增幅约为世界平均增幅的3倍,5岁以下儿童增幅较高,提示我国儿童T1DM低龄化趋势。T1DM的病因机制复杂,遗传易感和环境因素促发是其发病的主要原因。年幼起病、长病程、血糖控制欠佳除导致糖尿病慢性并发症高发外,还影响患儿精神运动发育。药物治疗、血糖监测、健康教育、运动和营养管理是儿童T1DM良好血糖控制的根本举措。人工胰腺、干细胞胰岛分化与移植、免疫干预未来有可能从根本上改善未来T1DM的治疗和预后。
罗飞宏. 儿童1型糖尿病的诊治与展望[J]. 临床儿科杂志, 2022, 40(5): 321-327.
LUO Feihong. Diagnosis, treatment and future of children type 1 diabetes mellitus[J]. Journal of Clinical Pediatrics, 2022, 40(5): 321-327.
表2
美国糖尿病协会2022年度儿童糖尿病标准化管理指南[38](节选)"
糖尿病自我管理教育与支持方面 | 建议T1DM患儿和父母/照料者定期接受糖尿病管理国家标准中的有关糖尿病个性化 自我管理和支持方面的教育 |
---|---|
营养治疗建议 | 建议对患有T1DM的儿童青少年进行个体化医学营养治疗,作为整体治疗计划的重要 组成部分;监测碳水化合物摄入,无论是通过碳水化合物计数还是基于经验的估计, 都是优化血糖管理的关键组成部分 建议由经验丰富的注册营养师进行诊断时的全面营养教育,并每年更新,以评估与体重 状况和心血管疾病风险因素相关的热量和营养摄入是否合理,并告知宏量营养素的选择 |
体育活动和锻炼建议 | 建议T1DM患儿进行体育锻炼,目标是每天进行60分钟中到高强度的有氧运动,每周至少3天进行高强度肌肉和骨骼强化锻炼 运动前、中和后,通过血糖仪或连续血糖监测进行频繁的血糖监测,预防和处理运动相关的低血糖和高血糖症 青少年及其父母/照料者应在体育活动之前、期间和之后接受关于血糖目标和管理的教育,并根据计划体育活动的类型和强度进行个性化安排 应教育青年及其父母/照料者在体育活动和锻炼期间、之后和夜间预防低血糖的策略, 包括锻炼前后膳食、加餐及相应胰岛素的调整 |
社会心理问题建议 | 在诊断和常规随访期间,评估可能影响糖尿病管理的心理社会问题和家庭压力,并向受过培训的、最好是有儿童糖尿病关联经验的心理健康专业人员转诊 儿童糖尿病多学科团队应包含心理健康专业人员 询问青少年和他们的父母/照顾者关于社会适应(同伴关系)和学校表现,以确定是否需要进一步的干预 对10~12岁的T1DM进行饮食紊乱筛查 |
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