Reinehr Thomas
Thomas Reinehr, Vestische Kinder- und Jugendklinik, University of Witten- Herdecke, 45711 Datteln, Germany.
World J Diabetes. 2013 Dec 15;4(6):270-81. doi: 10.4239/wjd.v4.i6.270.
Type 2 diabetes mellitus is emerging as a new clinical problem within pediatric practice. Recent reports indicate an increasing prevalence of type 2 diabetes mellitus in children and adolescents around the world in all ethnicities, even if the prevalence of obesity is not increasing any more. The majority of young people diagnosed with type 2 diabetes mellitus was found in specific ethnic subgroups such as African-American, Hispanic, Asian/Pacific Islanders and American Indians. Clinicians should be aware of the frequent mild or asymptomatic manifestation of type 2 diabetes mellitus in childhood. Therefore, a screening seems meaningful especially in high risk groups such as children and adolescents with obesity, relatives with type 2 diabetes mellitus, and clinical features of insulin resistance (hypertension, dyslipidemia, polycystic ovarian syndrome, or acanthosis nigricans). Treatment of choice is lifestyle intervention followed by pharmacological treatment (e.g., metformin). New drugs such as dipeptidyl peptidase inhibitors or glucagon like peptide 1 mimetics are in the pipeline for treatment of youth with type 2 diabetes mellitus. However, recent reports indicate a high dropout of the medical care system of adolescents with type 2 diabetes mellitus suggesting that management of children and adolescents with type 2 diabetes mellitus requires some remodeling of current healthcare practices.
2型糖尿病正成为儿科临床中的一个新问题。最近的报告显示，全球所有种族的儿童和青少年中2型糖尿病的患病率都在上升，即便肥胖率不再上升。被诊断为2型糖尿病的大多数年轻人来自特定的种族亚组，如非裔美国人、西班牙裔、亚裔/太平洋岛民和美洲印第安人。临床医生应意识到2型糖尿病在儿童期常表现为轻度或无症状。因此，筛查似乎很有意义，尤其是对于肥胖儿童和青少年、2型糖尿病亲属以及有胰岛素抵抗临床特征（高血压、血脂异常、多囊卵巢综合征或黑棘皮病）等高危人群。首选治疗方法是生活方式干预，其次是药物治疗（如二甲双胍）。诸如二肽基肽酶抑制剂或胰高血糖素样肽1类似物等新药正在研发中，用于治疗青少年2型糖尿病。然而，最近的报告表明，2型糖尿病青少年的医疗保健系统存在高失访率，这表明管理儿童和青少年2型糖尿病需要对当前的医疗实践进行一些重塑。
