Rao Goutham, Jensen Elizabeth T
University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA.
Wake Forest School of Medicine, Winston-Salem, NC, USA.
Glob Pediatr Health. 2021 May 6;7:2333794X20981343. doi: 10.1177/2333794X20981343. eCollection 2020.
The incidence of type 2 diabetes in children and adolescents in the United States rose at an annual rate of 4.8% between 2002-2003 and 2014-2015. Type 2 diabetes progresses more aggressively to complications than type 1 diabetes. For example, in one large epidemiological study, proliferative retinopathy affected 5.6% and 9.1% of children with type 1 and type 2 diabetes, respectively. Screening begins at age 10 or at onset of puberty, and is recommended among children with a BMI% ≥85 with risk factors such as a family history and belonging to a high risk racial or ethnic or racial group. HbA1C% is preferred for screening as it does not require fasting. As distinguishing between type 1 and type 2 diabetes is not straightforward, all children with new onset disease should undergo autoantibody testing. Results of lifestyle interventions for control of type 2 diabetes have been disappointing, but are still recommended for their educational value and the potential impact upon some participants. There is limited evidence for the benefit of newer mediations. Liraglutide, a GLP-1 agonist, however, has been shown to significantly reduce HbA1C% in one study and is now approved for children. Liraglutide should be considered as second line therapy.
2002年至2003年与2014年至2015年期间，美国儿童及青少年2型糖尿病的发病率以每年4.8%的速度上升。相较于1型糖尿病，2型糖尿病进展为并发症的速度更快。例如，在一项大型流行病学研究中，增殖性视网膜病变在1型和2型糖尿病患儿中的发生率分别为5.6%和9.1%。筛查从10岁或青春期开始，对于BMI%≥85且有家族史等危险因素或属于高危种族或族裔群体的儿童建议进行筛查。糖化血红蛋白百分比（HbA1C%）是筛查的首选指标，因为它无需空腹检测。由于区分1型和2型糖尿病并非易事，所有新发疾病的儿童都应进行自身抗体检测。控制2型糖尿病的生活方式干预效果不佳，但因其具有教育价值以及对部分参与者可能产生的影响，仍被推荐采用。关于新型药物益处的证据有限。然而，在一项研究中，胰高血糖素样肽-1受体激动剂利拉鲁肽已显示能显著降低HbA1C%，目前已获批用于儿童。利拉鲁肽应被视为二线治疗药物。
