儿童1型糖尿病的诊治与展望

Diagnosis,treatment and future of childhood type 1 diabetes mellitus

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。

Type 1 diabetes mellitus(T1DM)is the major type of pediatric diabetes.According to the longitudinal epidemiology surveys in our national large metropolitans,the average annual incidence increasing rate is about three times higher than the average in the world,and the incidence increase in children under five years ranks the top,which indicates the younger trend in the onset of T1DM.The etiology and underlying mechanism of T1DM is complicated,with genetic susceptibility and environmental trigger factors as the main causes of T1DM.Early onset,long-term of disease course and poor glycemic control result in high incidence of chronic diabetic complications,and affect psychomotor development.Drug therapy,blood glucose monitoring,diabetes education,exercise and nutritional therapy are the fundamental measures for good glycemic control in pediatric T1DM.Artificial pancreas,stem cell islet differentiation and transplantation,and immune intervention may fundamentally improve the treatment and prognosis of T1DM in the future.