Rami-Merhar Birgit, Fröhlich-Reiterer Elke, Hofer Sabine E, Fritsch Maria
Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für allgemeine Pädiatrie, Medizinische Universität Graz, Graz, Österreich.
Wien Klin Wochenschr. 2023 Jan;135(Suppl 1):106-114. doi: 10.1007/s00508-023-02169-5. Epub 2023 Apr 20.
In contrast to adults, type 1 diabetes mellitus (T1D) is the most frequent form of diabetes in childhood and adolescence (> 90%). After diagnosis the management of children and adolescents with T1D should take place in highly specialized pediatric units experienced in pediatric diabetology. The lifelong substitution of insulin is the cornerstone of treatment whereby modalities need to be individually adapted for patient age and the family routine. In this age group the usage of diabetes technology (glucose sensors, insulinpumps and recently hybrid-closed-loop-systems) is recommended. An optimal metabolic control right from the start of therapy is associated with an improved long-term prognosis. Diabetes education is essential in the management of patients with diabetes and their families and needs to be performed by a multidisciplinary team consisting of a pediatric diabetologists, diabetes educator, dietitian, psychologist and social worker. The Austrian working group for pediatric endocrinology and diabetes (APEDÖ) and the ISPAD (International Society for Pediatric and Adolescent Diabetes) recommend a metabolic goal of HbA1c ≤ 7.0%, ((IFCC) < 53 mmol/mol), and a "Time in range" > 70% for all pediatric age groups without the presence of severe hypoglycemia. Age-related physical, cognitive and psychosocial development, screening for associated diseases, avoidance of acute diabetes-related complications (severe hypoglycemia, diabetic ketoacidosis) and prevention of diabetes-related late complications to ensure high quality of life are the main goals of diabetes treatment in all pediatric age groups.
与成人不同，1型糖尿病（T1D）是儿童和青少年中最常见的糖尿病类型（>90%）。确诊后，患有T1D的儿童和青少年的管理应在小儿糖尿病方面经验丰富的高度专业化儿科单位进行。胰岛素的终身替代是治疗的基石，治疗方式需要根据患者年龄和家庭日常情况进行个体化调整。在这个年龄组中，建议使用糖尿病技术（葡萄糖传感器、胰岛素泵以及最近的混合闭环系统）。从治疗开始就实现最佳代谢控制与改善长期预后相关。糖尿病教育对于糖尿病患者及其家庭的管理至关重要，需要由一个多学科团队进行，该团队由小儿糖尿病专家、糖尿病教育者、营养师、心理学家和社会工作者组成。奥地利儿科内分泌学和糖尿病工作组（APEDÖ）和国际小儿和青少年糖尿病学会（ISPAD）建议，对于所有儿科年龄组，在无严重低血糖的情况下，糖化血红蛋白（HbA1c）的代谢目标为≤7.0%（（IFCC）<53 mmol/mol），“血糖达标时间”>70%。与年龄相关的身体、认知和社会心理发展、相关疾病的筛查、避免急性糖尿病相关并发症（严重低血糖、糖尿病酮症酸中毒）以及预防糖尿病相关晚期并发症以确保高质量生活是所有儿科年龄组糖尿病治疗的主要目标。
