Pediatric practice; with focus on; diabetes, Münster; University Children's; Hospital Tübingen.
Dtsch Arztebl Int. 2018 Mar 2;115(9):146-156. doi: 10.3238/arztebl.2018.0146.
The incidence of type 1 diabetes mellitus in childhood and adolescence is steadily rising and now stands at 22.9 new cases per year per 100 000 persons up to age 15.
This review is based on pertinent publications retrieved by a selective literature search, with special attention to the current German S3 guideline on diabetes in childhood and adolescence.
Polydipsia, polyuria, and weight loss are the characteristic presenting symptoms of diabetes mellitus. The acutely presenting patient needs immediate stabilization because of the danger of rapid metabolic decompensation (risk of keto - acidosis, 21.1%). Long-term insulin therapy can be delivered either by subcutaneous injection or by an insulin pump. The goals of treatment are the near-normalization of glucose metabolism (HbA1c <7.5%), the avoidance of acute complications (hypoglycemia and ketoacidosis), the reduction of diabetes-specific sequelae (retinopathy, nephropathy, neuropathy, hypertension, and hyperlipidemia), unrestricted participation in age-appropriate everyday activities, and normal physical and psychosocial development. Children and adolescents with diabetes need individualized treatment with frequent adjustments and holistic overall care so that these goals can be effectively met.
Every physician must be able to diagnose the initial presentation of diabetes and to initiate the first steps in its management. The patient should be referred as soon as possible to a diabetes team that has experience in the treatment of children and adolescents.
儿童和青少年 1 型糖尿病的发病率稳步上升，目前每 100000 名 15 岁以下人群中每年有 22.9 例新发病例。
本综述基于通过选择性文献检索获得的相关出版物，特别关注当前德国儿童和青少年糖尿病 S3 指南。
多饮、多尿和体重减轻是糖尿病的特征性表现症状。急性发作的患者需要立即稳定病情，因为快速代谢失代偿的危险（酮症酸中毒风险为 21.1%）。长期胰岛素治疗可以通过皮下注射或胰岛素泵进行。治疗的目标是使葡萄糖代谢接近正常化（HbA1c＜7.5%），避免急性并发症（低血糖和酮症酸中毒），减少糖尿病特异性后遗症（视网膜病变、肾病、神经病变、高血压和高脂血症），不受限制地参与适合年龄的日常活动，以及正常的身体和心理社会发展。儿童和青少年糖尿病患者需要个体化治疗，频繁调整，并进行全面的整体护理，以便有效实现这些目标。
每位医生都必须能够诊断糖尿病的初始表现，并启动其管理的第一步。应尽快将患者转介给有儿童和青少年治疗经验的糖尿病团队。
