PDF(Pubmed)
Abstract：
BACKGROUND: Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes.
METHODS: Multidisciplinary professionals from The Association of Children\'s Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology.
CONCLUSIONS: Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events.
CONCLUSIONS: This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.
METHODS: Multidisciplinary professionals from The Association of Children\'s Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology.
CONCLUSIONS: Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events.
CONCLUSIONS: This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.
摘要：
背景：年轻人的2型糖尿病是一种侵袭性疾病，具有更大的并发症风险，导致在生命中最有生产力的年份发病率和死亡率增加。英国和全球的患病率正在上升，但管理这种情况的经验有限。在英国，对于儿科2型糖尿病的评估和管理没有共识的指南。
方法：来自儿童糖尿病临床医师协会（ACDC）和国家2型糖尿病工作组的多学科专业人员审查了证据基础，并通过建议分级提出了建议，评估,开发和评估(等级)方法。
结论：青少年2型糖尿病患者应与成人糖尿病专家密切合作，由儿科糖尿病团队管理。初级保健和其他儿科专科。糖尿病类型的诊断可能具有许多重叠特征的挑战性。可能需要糖尿病抗体来帮助诊断。诊断时经常出现合并症和并发症，应进行全面管理。生活方式的改变和二甲双胍是早期治疗的主要手段,有些人需要额外的基础胰岛素。一旦早期酮症和症状得到控制，GLP1激动剂应用作二线药物。血糖控制可以改善微血管风险，但不能改善心血管风险。减少过度肥胖，预防吸烟,增加体力活动和减少高血压和血脂异常对减少主要不良心血管事件至关重要.
结论：本基于证据的指南旨在提供一种在英国管理这种情况的实用方法。
方法：来自儿童糖尿病临床医师协会（ACDC）和国家2型糖尿病工作组的多学科专业人员审查了证据基础，并通过建议分级提出了建议，评估,开发和评估(等级)方法。
结论：青少年2型糖尿病患者应与成人糖尿病专家密切合作，由儿科糖尿病团队管理。初级保健和其他儿科专科。糖尿病类型的诊断可能具有许多重叠特征的挑战性。可能需要糖尿病抗体来帮助诊断。诊断时经常出现合并症和并发症，应进行全面管理。生活方式的改变和二甲双胍是早期治疗的主要手段,有些人需要额外的基础胰岛素。一旦早期酮症和症状得到控制，GLP1激动剂应用作二线药物。血糖控制可以改善微血管风险，但不能改善心血管风险。减少过度肥胖，预防吸烟,增加体力活动和减少高血压和血脂异常对减少主要不良心血管事件至关重要.
结论：本基于证据的指南旨在提供一种在英国管理这种情况的实用方法。
