美國兒科學(xué)會(huì)（AAP）聯(lián)合美國糖尿病學(xué)會(huì)（ADA）、兒童內(nèi)分泌學(xué)會(huì)（PES）、美國家庭醫(yī)師學(xué)會(huì)（AAFP）及美國營養(yǎng)與飲食學(xué)會(huì)（AND）公布了首個(gè)針對(duì)兒童與青少年的2型糖尿病管理指南?！吨改稀酚?013年1月28日在線發(fā)表于《兒科學(xué)》雜志。

過去兒科醫(yī)生處理的病例類型多為1型糖尿病，他們通常認(rèn)為2型糖尿病僅在成人中發(fā)生。隨著兒童肥胖率的日益增高，這種“成人病”在兒童中越來越多見。

新指南推薦在肥胖兒童中篩查2型糖尿病，鼓勵(lì)健康飲食并進(jìn)行體育鍛煉，并指出部分兒童糖尿病患者需進(jìn)行早期強(qiáng)化胰島素治療。

對(duì)于酮癥酸中毒、糖化血紅蛋白顯著升高或無法確定糖尿病分類的患兒，指南推薦其糖尿病確診時(shí)即開始胰島素治療。

對(duì)于所有患兒均推薦二甲雙胍作為一線治療藥物，同時(shí)進(jìn)行生活方式調(diào)整（包括飲食與運(yùn)動(dòng)改變）。

指南推薦進(jìn)行患兒血糖控制的監(jiān)測(cè)，以達(dá)到胰島素計(jì)劃、飲食與運(yùn)動(dòng)的推薦目標(biāo)。

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.