Современные аспекты контроля гликемии при сахарном диабете у детей младшего возраста
Современные аспекты контроля гликемии при сахарном диабете у детей младшего возраста
Витебская А.В. Современные аспекты контроля гликемии при сахарном диабете у детей младшего возраста. Consilium Medicum. 2017; 19 (12): 106–108. DOI: 10.26442/2075-1753_19.12.106-108
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Vitebskaya A.V. Current aspects of glycemic control in young children with diabetes mellitus. Consilium Medicum. 2017; 19 (12): 106–108. DOI: 10.26442/2075-1753_19.12.106-108.
Современные аспекты контроля гликемии при сахарном диабете у детей младшего возраста
Витебская А.В. Современные аспекты контроля гликемии при сахарном диабете у детей младшего возраста. Consilium Medicum. 2017; 19 (12): 106–108. DOI: 10.26442/2075-1753_19.12.106-108
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Vitebskaya A.V. Current aspects of glycemic control in young children with diabetes mellitus. Consilium Medicum. 2017; 19 (12): 106–108. DOI: 10.26442/2075-1753_19.12.106-108.
В связи с ростом распространенности сахарного диабета 1-го типа среди детей младшего возраста Международным обществом по диабету у детей и подростков (International Society for Pediatric and Adolescent Diabetes) разработан новый консенсус по ведению диабета у детей дошкольного возраста. Уровень гликированного гемоглобина для детей дошкольного возраста рекомендуется поддерживать менее 7,5%. Основными причинами недостижения целевой гликемии считаются непредсказуемость приемов пищи и физических нагрузок у пациентов младшего возраста, страх родителей пациентов перед гипогликемиями, вариабельность гликемии. Достижению целей способствует позитивное отношение к процедурам самоконтроля, обучение родственников пациентов с учетом возраста ребенка, тщательный контроль гликемии с первых месяцев заболевания. Для удовлетворительного гликемического контроля рекомендуется измерять гликемию 7–10 раз в сутки; использовать только самые точные глюкометры; обучать членов семьи пациента правильному пользованию глюкометром. Взрослым следует поощрять самостоятельность ребенка, но все подобные манипуляции осуществлять под контролем. В статье приведены собственные данные – результаты опроса 30 пациентов по уровню гликированного гемоглобина, возрасту начала самостоятельного использования глюкометра, частоте контроля гликемии.
Ключевые слова: сахарный диабет, дошкольники, контроль гликемии.
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Due to growth of prevalence of diabetes mellitus type 1 (DM 1) among young children new ISPAD (International Society for Pediatric and Adolescent Diabetes) Consensus on Managing diabetes in preschool children was developed. Glycosylated hemoglobin A1c level for preschool children is recommended to keep below 7.5%. Basic causes of non-reaching of glycemic goals are considered unpredictability of meals and physical activity in young children, fear of parents in front of hypoglycemia, glycemic variability. Reaching the goals is supported by positive attitude to self-control procedures, education of patients’ relatives taking into account the age of a child, precise glycemic control from the first months of disease. For satisfactory glycemic control it is recommended to measure glycaemia 7–10 times per day; to use only the most precise glucometers; to teach patient family members correct exploitation of glucometer. Grownups should encourage self-dependence of a child, but all of such manipulations should be controlled by grownups. In the article own data are given – results of 30 patients questionnaire on glycosylated hemoglobin level, age when they stated to use glucometer themselves, frequency of glycaemia measurements.
1. Craig ME, Jefferies C, Dabelea D et al. ISPAD Clinical Practice Consensus Guidelines? 2014. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2014; 15 (Suppl. 20): 4–17. DOI: 10.1111/pedi.12186
2. Сахарный диабет у детей и подростков: консенсус ISPAD по клинической практике, 2014. Пер. с англ. под ред. В.А.Петерковой. М.: ГЭОТАР-Медиа, 2016. / Sakharnyi diabet u detei i podrostkov: konsensus ISPAD po klinicheskoi praktike, 2014. Per. s angl. pod red. V.A.Peterkovoi. M.: GEOTAR-Media, 2016. [in Russian]
3. Sundberg F, Barnard K, Cato A et al. Managing diabetes in preschool children. Pediatr Diabetes 2017; Jul 20. DOI: 10.1111/pedi.12554
4. Rewers MJ, Pillay K, de Beaufort C et al; ISPAD. ISPAD Clinical Practice Consensus Guidelines 2014. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 2014; 15 (Suppl. 20): 102–14. DOI: 10.1111/pedi.12190
5. Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care 2014; 37 (7): 2034–54. DOI: 10.2337/dc14-1140
6. NICE (National Institute for Clinical Excellence). Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults. National Institute for Clinical Excellence, 2015. http://www.nice.org.uk/guidance/ng18. Accessed 18 June 2017
7. Wood JR, Miller KM, Maahs DM et al; T1D Exchange Clinic Network. Most youth with type 1 diabetes in the T1D Exchange Clinic Registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes clinical guidelines. Diabetes Care 2013; 36 (7): 2035–7. DOI: 10.2337/dc12-1959
8. American Diabetes Association. Standards of medical care in diabetes, 2012. Diabetes Care 2012; 35 (Suppl. 1): S11–63. DOI: 10.2337/dc12-s011. DOI: 10.2337/dc12-s011
9. Bailey TS, Grunberger G, Bode BW et al; AACE; ACE. American association of clinical endocrinologists and American college of endocrinology 2016 outpatient glucose monitoring statement. Endocr Pract 2016; 22 (2): 231–61. DOI: 10.4158/EP151124.CS
10. Cengiz E, Xing D, Wong JC et al. Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry. Pediatr Diabetes 2013; 14 (6): 447–54. DOI: 10.1111/pedi.12030
11. Mauras N, Mazaika P, Buckingham B et al. Longitudinal assessment of neuroanatomical and cognitive differences in young children with type 1 diabetes: association with hyperglycemia. Diabetes 2015; 64 (5): 1770–9. DOI: 10.2337/db14-1445
12. Soupal J, Skrha JJr, Fajmon M et al. Glycemic variability is higher in type 1 diabetes patients with microvascular complications irrespective of glycemic control. Diabetes Technol Ther 2014; 16 (4): 198–203. DOI: 10.1089/dia.2013.0205
13. Lange K, Swift P, Pankowska E, Danne T. ISPAD Clinical Practice Consensus Guidelines, 2014. Diabetes education in children and adolescents. Pediatr Diabetes 2014; 15 (Suppl. 20): 77–85. DOI: 10.1111/pedi.12187
14. DCCT Research Group (Diabetes Control and Complications Trial Research Group). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86.
15. Donaghue KC, Wadwa RP, Dimeglio LA et al. ISPAD Clinical Practice Consensus Guidelines 2014. Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2014; 15 (Suppl. 20): 257–69. DOI: 10.1111/pedi.12180
16. Sundberg F, Forsander G. Detection and treatment efficacy of hypoglycemic events in the everyday life of children younger than 7 yr. Pediatr Diabetes 2014; 15: 34–40. DOI: 10.1111/pedi.12057. Epub 2013 Jun 27
17. Maahs DM, Hermann JM, DuBose SN et al. Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries. Diabetologia 2014; 57: 1578–85. DOI: 10.1007/s00125-014-3272-2
18. ISO-15197-2013. In vitro diagnostic test systems – Requirements for blood-glucose monitoring systems for self-testing in managing diabetes mellitus (15.05.2013).
19. ГОСТ Р ИСО-15197-2015. Тест-системы для диагностики in vitro. Требования к системам мониторинга глюкозы в крови для самоконтроля при лечении сахарного диабета.
20. Caswell M, Frank J, Viggiani MT et al. Morin R Accuracy and User Performance Evaluation of a Blood Glucose Monitoring System. Diabetes Technol Ther 2015; 3: 1–7. DOI: 10.1089/dia.2014.0129
21. Tansey M, Laffel L, Cheng J et al. Satisfaction with continuous glucose monitoring in adults and youths with type 1 diabetes. Diabet Med 2011; 28 (9): 1118–22. DOI: 10.1111/j.1464-5491.2011.03368.x
22. Tsalikian E, Fox L, Weinzimer S et al. Feasibility of prolonged continuous glucose monitoring in toddlers with type 1 diabetes. Pediatr Diabetes 2012; 13 (4): 301–7. DOI: 10.1111/j.1399-5448.2011.00837.x
23. Mauras N, Beck R, Xing D et al; Diabetes Research in Children Network (DirecNet) Study Group. A randomized clinical trial to assess the efficacy and safety of real-time continuous glucose monitoring in the management of type 1 diabetes in young children aged 4 to 10 years. Diabetes Care 2012; 35 (2): 204–10. DOI: 10.2337/dc11-1746
24. Tsalikian E, Fox L, Weinzimer S et al. Feasibility of prolonged continuous glucose monitoring in toddlers with type 1 diabetes. Pediatr Diabetes 2012; 13: 301–7. DOI: 10.1111/j.1399-5448.2011.00837.x
________________________________________________
1. Craig ME, Jefferies C, Dabelea D et al. ISPAD Clinical Practice Consensus Guidelines? 2014. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2014; 15 (Suppl. 20): 4–17. DOI: 10.1111/pedi.12186
2. Sakharnyi diabet u detei i podrostkov: konsensus ISPAD po klinicheskoi praktike, 2014. Per. s angl. pod red. V.A.Peterkovoi. M.: GEOTAR-Media, 2016. [in Russian]
3. Sundberg F, Barnard K, Cato A et al. Managing diabetes in preschool children. Pediatr Diabetes 2017; Jul 20. DOI: 10.1111/pedi.12554
4. Rewers MJ, Pillay K, de Beaufort C et al; ISPAD. ISPAD Clinical Practice Consensus Guidelines 2014. Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 2014; 15 (Suppl. 20): 102–14. DOI: 10.1111/pedi.12190
5. Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care 2014; 37 (7): 2034–54. DOI: 10.2337/dc14-1140
6. NICE (National Institute for Clinical Excellence). Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults. National Institute for Clinical Excellence, 2015. http://www.nice.org.uk/guidance/ng18. Accessed 18 June 2017
7. Wood JR, Miller KM, Maahs DM et al; T1D Exchange Clinic Network. Most youth with type 1 diabetes in the T1D Exchange Clinic Registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes clinical guidelines. Diabetes Care 2013; 36 (7): 2035–7. DOI: 10.2337/dc12-1959
8. American Diabetes Association. Standards of medical care in diabetes, 2012. Diabetes Care 2012; 35 (Suppl. 1): S11–63. DOI: 10.2337/dc12-s011. DOI: 10.2337/dc12-s011
9. Bailey TS, Grunberger G, Bode BW et al; AACE; ACE. American association of clinical endocrinologists and American college of endocrinology 2016 outpatient glucose monitoring statement. Endocr Pract 2016; 22 (2): 231–61. DOI: 10.4158/EP151124.CS
10. Cengiz E, Xing D, Wong JC et al. Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry. Pediatr Diabetes 2013; 14 (6): 447–54. DOI: 10.1111/pedi.12030
11. Mauras N, Mazaika P, Buckingham B et al. Longitudinal assessment of neuroanatomical and cognitive differences in young children with type 1 diabetes: association with hyperglycemia. Diabetes 2015; 64 (5): 1770–9. DOI: 10.2337/db14-1445
12. Soupal J, Skrha JJr, Fajmon M et al. Glycemic variability is higher in type 1 diabetes patients with microvascular complications irrespective of glycemic control. Diabetes Technol Ther 2014; 16 (4): 198–203. DOI: 10.1089/dia.2013.0205
13. Lange K, Swift P, Pankowska E, Danne T. ISPAD Clinical Practice Consensus Guidelines, 2014. Diabetes education in children and adolescents. Pediatr Diabetes 2014; 15 (Suppl. 20): 77–85. DOI: 10.1111/pedi.12187
14. DCCT Research Group (Diabetes Control and Complications Trial Research Group). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86.
15. Donaghue KC, Wadwa RP, Dimeglio LA et al. ISPAD Clinical Practice Consensus Guidelines 2014. Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2014; 15 (Suppl. 20): 257–69. DOI: 10.1111/pedi.12180
16. Sundberg F, Forsander G. Detection and treatment efficacy of hypoglycemic events in the everyday life of children younger than 7 yr. Pediatr Diabetes 2014; 15: 34–40. DOI: 10.1111/pedi.12057. Epub 2013 Jun 27
17. Maahs DM, Hermann JM, DuBose SN et al. Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries. Diabetologia 2014; 57: 1578–85. DOI: 10.1007/s00125-014-3272-2
18. ISO-15197-2013. In vitro diagnostic test systems – Requirements for blood-glucose monitoring systems for self-testing in managing diabetes mellitus (15.05.2013).
19. ГОСТ Р ИСО-15197-2015. Тест-системы для диагностики in vitro. Требования к системам мониторинга глюкозы в крови для самоконтроля при лечении сахарного диабета.
20. Caswell M, Frank J, Viggiani MT et al. Morin R Accuracy and User Performance Evaluation of a Blood Glucose Monitoring System. Diabetes Technol Ther 2015; 3: 1–7. DOI: 10.1089/dia.2014.0129
21. Tansey M, Laffel L, Cheng J et al. Satisfaction with continuous glucose monitoring in adults and youths with type 1 diabetes. Diabet Med 2011; 28 (9): 1118–22. DOI: 10.1111/j.1464-5491.2011.03368.x
22. Tsalikian E, Fox L, Weinzimer S et al. Feasibility of prolonged continuous glucose monitoring in toddlers with type 1 diabetes. Pediatr Diabetes 2012; 13 (4): 301–7. DOI: 10.1111/j.1399-5448.2011.00837.x
23. Mauras N, Beck R, Xing D et al; Diabetes Research in Children Network (DirecNet) Study Group. A randomized clinical trial to assess the efficacy and safety of real-time continuous glucose monitoring in the management of type 1 diabetes in young children aged 4 to 10 years. Diabetes Care 2012; 35 (2): 204–10. DOI: 10.2337/dc11-1746
24. Tsalikian E, Fox L, Weinzimer S et al. Feasibility of prolonged continuous glucose monitoring in toddlers with type 1 diabetes. Pediatr Diabetes 2012; 13: 301–7. DOI: 10.1111/j.1399-5448.2011.00837.x
Авторы
А.В.Витебская
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2;
Университетская детская клиническая больница ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119435, Россия, Москва, ул. Большая Пироговская, д. 19, стр. 1 dr.vitebskaya@gmail.com
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A.V.Vitebskaya
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2;
University Children‘s Clinical Hospital I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119435, Russian Federation, Moscow, ul. Bolshaia Pirogovskaya, d. 19, str. 1 dr.vitebskaya@gmail.com