儿童和青少年2型糖尿病的临床特点与治疗策略

Clinical features and treatment strategy of type 2 diabetes in children and adolescents

目前儿童和青少年的2型糖尿病发病率逐年增加,因此对其进行规范的诊断和治疗显得日益重要。儿童和青少年2型糖尿病的诊断包括糖尿病的诊断和其后的分型。糖尿病自身抗体检测,胰岛素和C肽释放试验均可帮助分型诊断,有时会出现分型困难的情况,这时要把重点放在有效控制血糖上。一旦确诊,必须马上开始改变生活方式,包括饮食、运动、控制体重等。药物治疗包括二甲双胍和胰岛素的单用或联用,治疗要根据高血糖的严重程度、有无酮症和(或)酮症酸中毒来选择。不同于1型糖尿病,2型糖尿病诊断伊始就要进行并发症和合并症的评估,同时在以后的随访中也要定期复查血脂、肝酶、尿白蛋白/肌酐比值,要监测血压,筛查阻塞性睡眠呼吸暂停(OSA)、糖尿病眼病等。

Type 2 diabetes in children and adolescents has be-come an increasingly important public health concern.The di-agnosis of type 2 diabetes requires confirmation of the pres-ence of diabetes, followed by determination of diabetes typeaccording to the diabetes autoantibody testing. Insulin and C-peptide release test is also helpful. Diagnosis of diabetes typein some patients can be confusing while emphasis should beput on the normalizing of blood glucose regardless of the ＇ type＇ of diabetes. Lifestyle change should be initiated at the timeof diagnosis of type 2 diabetes.Initial pharmacologic treatmentshould include metformin and insulin alone or in combination.The treatment is determined by symptoms, severity of hyper-glycemia, and presence or absence of ketosis/ketoacidosis.The presence of complications and comorbidities should be as-sessed at the time of diagnosis. Triglycerides, liver enzymesand urine albumin/creatinine ratio （ACR） should be obtained,and BP monitoring, and screening for obstructive sleep apnea（OSA） and diabetic retinopathy should also be done at thetime of diagnosis and during the follow-up.