Urakami Tatsuhiko
Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
Clin Pediatr Endocrinol. 2023;32(3):125-136. doi: 10.1297/cpe.2023-0007. Epub 2023 Mar 21.
The principles of treatment for children and adolescents with type 2 diabetes include dietary and exercise management. For dietary management, a relatively modest dietary regimen with an appropriate energy source composition is recommended. Moderate- to vigorous-intensity aerobic activity is recommended for at least 60 min/d. Family members are encouraged to modify their lifestyles. Some patients fail to improve hyperglycemia through dietary and exercise management and eventually require pharmacological treatment. If the patient is metabolically stable (HbA1c level < 8.5% [69 mmol/mol]), metformin is the first-line treatment of first choice. In a case with ketosis or HbA1c of more than 8.5% (69 mmol/mol), insulin will be required initially with once daily basal insulin (0.25-0.5 units/kg). The goal of the initial treatment is to attain an HbA1c level < 7.0% (53 mmol/mol). If the glycemic goal is not attained, the addition of a second agent should be considered. However, the use of antihyperglycemic drugs in pediatric patients is limited in most countries. Therefore, the efficacy and safety of these drugs used in adult patients, including GLP-1 receptor agonists and SGLT2 inhibitors, should be evaluated in pediatric patients worldwide.
2型糖尿病儿童和青少年的治疗原则包括饮食和运动管理。对于饮食管理，建议采用能量来源组成合适的相对适度的饮食方案。建议进行至少60分钟/天的中等至高强度有氧运动。鼓励家庭成员改变他们的生活方式。一些患者通过饮食和运动管理未能改善高血糖，最终需要药物治疗。如果患者代谢稳定（糖化血红蛋白水平<8.5%[69 mmol/mol]），二甲双胍是一线首选治疗药物。对于出现酮症或糖化血红蛋白超过8.5%（69 mmol/mol）的情况，最初需要每日一次基础胰岛素（0.25 - 0.5单位/千克）治疗。初始治疗的目标是使糖化血红蛋白水平<7.0%（53 mmol/mol）。如果未达到血糖目标，应考虑加用第二种药物。然而，在大多数国家，儿科患者使用降糖药物受到限制。因此，包括胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白2抑制剂在内的这些药物在成人患者中的疗效和安全性，应在全球范围内的儿科患者中进行评估。
