ADA儿童、青少年:糖尿病的医疗照护标准 (2022年).pdf
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1、14. Children and Adolescents:Standards of Medical Care inDiabetes2022Diabetes Care 2022;45(Suppl. 1):S208S231 | https:/doi.org/10.2337/dc22-S014American Diabetes AssociationProfessional Practice Committee*The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes”includes the ADA
2、s current clinical practice recommendations and is intended toprovide the components of diabetes care, general treatment goals and guidelines,and tools to evaluate quality of care. Members of the ADA Professional PracticeCommittee, a multidisciplinary expert committee (https:/doi.org/10.2337/dc22-SP
3、PC),are responsible for updating the Standards of Care annually, or more frequently as war-ranted. For a detailed description of ADA standards, statements, and reports, as well asthe evidence-grading system for ADAs clinical practice recommendations, please refertotheStandardsofCareIntroduction(http
4、s:/doi.org/10.2337/dc22-SINT).Readerswhowish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.The management of diabetes in children and adolescents cannot simply be derivedfrom care routinely provided to adults with diabetes.The epidemiology, pathophys-iolog
5、y, developmental considerations, and response to therapy in pediatric diabetesare often different from adult diabetes.There are also differences in recommendedcare for children and adolescents with type 1 diabetes, type 2 diabetes, and otherforms of pediatric diabetes. This section is divided into t
6、wo major parts: the firstpart addresses care for children and adolescents with type 1 diabetes, and the sec-ond part addresses care for children and adolescents with type 2 diabetes. Mono-genic diabetes (neonatal diabetes and maturity-onset diabetes in the youngMODY) and cystic fibrosisrelated diabe
7、tes, which are often present in youth, arediscussed in Section 2, “Classification and Diagnosis of Diabetes” (https:/doi.org/10.2337/dc22-S002). Table 14.1A and Table 14.1B provide an overview of the rec-ommendations for screening and treatment of complications and related conditionsin pediatric typ
8、e 1 diabetes and type 2 diabetes, respectively. In addition to compre-hensive diabetes care, youth with diabetes should receive age- and developmentallyappropriate pediatric care, including vaccines and immunizations as recommended bythe Centers for Disease Control and Prevention (CDC) (1). To ensur
9、e continuity of careas an adolescent with diabetes becomes an adult, guidance is provided at the end ofthis section on the transition from pediatric to adult diabetes care.Due to the nature of pediatric clinical research, the recommendations for chil-dren and adolescents with diabetes are less likel
10、y to be based on clinical trialevidence. However, expert opinion and a review of available and relevant experi-mental data are summarized in the American Diabetes Association (ADA) positionstatements “Type 1 Diabetes in Children and Adolescents” (2) and “Evaluation andManagement of Youth-Onset Type
11、2 Diabetes” (3). Finally, other sections in theStandards of Care may have recommendations that apply to youth with diabetesand are referenced in the narrative of this section.*A complete list of members of the AmericanDiabetes Association Professional Practice Com-mittee can be found at https:/doi.o
12、rg/10.2337/dc22-SPPC.Suggested citation: American Diabetes Asso-ciation Professional Practice Committee. 14.Children and adolescents: Standards of MedicalCare in Diabetes2022. Diabetes Care 2022;45(Suppl. 1):S208S231 2021 by the American Diabetes Association.Readers may use this article as long as t
13、hework is properly cited, the use is educationaland not for profit, and the work is not altered.Moreinformationisavailableathttps:/diabetesjournals.org/journals/pages/license.14. CHILDREN AND ADOLESCENTSS208Diabetes Care Volume 45, Supplement 1, January 2022Downloaded from http:/diabetesjournals.org
14、/care/article-pdf/45/Supplement_1/S208/668184/dc22s014.pdf by guest on 10 July 2022Table 14.1ARecommendations for screening and treatment of complications and related conditions in pediatric type 1 diabetesThyroid diseaseCeliac diseaseHypertensionDyslipidemiaNephropathyRetinopathyNeuropathyCorrespon
15、dingrecommendations14.29 and 14.3014.3114.3314.3414.3714.3814.4214.45 and 14.4614.4714.4914.50MethodThyroid-stimulatinghormone; considerantithyroglobulin andantithyroidperoxidase antibodiesIgA tTG if total IgAnormal; IgG tTG anddeamidated gliadinantibodies if IgAdeficientBlood pressuremonitoringLipi
16、d profile, nonfastingacceptable initiallyAlbumin-to-creatinineratio; random sampleacceptable initiallyDilated fundoscopy orretinal photographyFoot exam with footpulses, pinprick, 10-gmonofilamentsensation tests,vibration, and anklereflexesWhen to startSoon after diagnosisSoon after diagnosisAt diagn
17、osisSoon after diagnosis;preferably afterglycemia hasimproved and $2years oldPuberty or 10 yearsold, whichever isearlier, and diabetesduration of 5 yearsPuberty or $11 years old,whichever is earlier, anddiabetes duration of 35yearsPuberty or $10 yearsold, whichever isearlier, and diabetesduration of
18、 5 yearsFollow-upfrequencyEvery 12 years ifthyroid antibodiesnegative; more oftenif symptoms developor presence ofthyroid antibodiesWithin 2 years andthen at 5 years afterdiagnosis; sooner ifsymptoms developEvery visitIf LDL #100 mg/dL,repeat at 911 yearsold; then, if 100mg/dL, every 3 yearsIf norma
19、l, annually; ifabnormal, repeatwith confirmation intwo of three samplesover 6 monthsIf normal, every 2 years;consider less frequently(every 4 years) if A1C8% and eyeprofessional agreesIf normal, annuallyTargetNANA90th percentile forage, sex, and height;if $13 years old,120/80 mmHgLDL 100 mg/dLAlbumi
20、n-to-creatinineratio 30 mg/gNo retinopathyNo neuropathyTreatmentAppropriate treatmentof underlying thyroiddisorderAfter confirmation,start gluten-freedietLifestyle modification forelevated bloodpressure (90th to95th percentile forage, sex, and height or,if $13 years old,120129/160mg/dL or 130 mg/dL
21、with cardiovascularrisk factor(s), initiatestatin therapy (forthose aged 10years)*Optimize glucose andblood pressurecontrol; ACEinhibitor* if albumin-to-creatinine ratio iselevated in two ofthree samples over 6monthsOptimize glucose control;treatment perophthalmologyOptimize glucosecontrol; referral
22、 toneurologyARB, angiotensin receptor blocker; NA, not applicable; tTG, tissue transglutaminase. *Due to the potential teratogenic effects, females should receive reproductive counseling and medication should beavoided in females of childbearing age who are not using reliable contraception.care.diab
23、etesjournals.orgChildren and AdolescentsS209Downloaded from http:/diabetesjournals.org/care/article-pdf/45/Supplement_1/S208/668184/dc22s014.pdf by guest on 10 July 2022Table 14.1BRecommendations for screening and treatment of complications and related conditions in pediatric type 2 diabetesHyperten
24、sionNephropathyNeuropathyRetinopathyNonalcoholicfatty liver diseaseObstructive sleepapneaPolycystic ovariansyndrome (foradolescent females)DyslipidemiaCorrespondingrecom-mendations14.7714.8014.8114.8614.87 and 14.8814.8914.9214.93 and 14.9414.9514.9614.9814.10014.104MethodBlood pressuremonitoringAlb
25、umin-to-creatinineratio; randomsample acceptableinitiallyFoot exam with footpulses, pinprick,10-g monofilamentsensation tests,vibration, andankle reflexesDilated fundoscopyAST and ALTmeasurementScreening forsymptomsScreening forsymptoms;laboratoryevaluation ifpositivesymptomsLipid profileWhen to sta
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