2022+ISPAD临床实践指南:青春期糖尿病.pdf
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1、I S P A D G U I D E L I N E SISPAD Clinical Practice Consensus Guidelines 2022:Diabetesin adolescenceJohn W.Gregory1|Fergus J.Cameron2,3,4|Kriti Joshi5|Mirjam Eiswirth6|Christopher Garrett7|Katharine Garvey8|Shivani Agarwal9|Ethel Codner101Division of Population Medicine,School of Medicine,Cardiff U
2、niversity,Cardiff,UK2Royal Childrens Hospital,Melbourne,Australia3Murdoch Childrens Research Institute,Melbourne,Australia4Department of Paediatrics,University of Melbourne,Melbourne,Australia5Department of Endocrinology&Diabetes,Queensland Childrens Hospital,South Brisbane,Australia6Department of A
3、nglophone Studies,Universitt Duisburg Essen,Essen,Germany7Institute of Psychiatry,Psychology and Neuroscience,Barts Health and East London Foundation Trust,London,UK8Division of Endocrinology,Boston Childrens Hospital,Boston,Massachusetts,USA9Department of Medicine(Endocrinology),Albert Einstein Col
4、lege of Medicine,Montefiore Medical Center,Bronx,New York,USA10Instituto de Investigaciones Materno Infantil,Facultad de Medicina,University of Chile,Santiago,ChileCorrespondenceJohn W.Gregory,Division of Population Medicine,School of Medicine,Cardiff University,Heath Park,Cardiff CF14 4XN,Wales,UK.
5、Email:wchjwgcardiff.ac.ukKE Y WORD S:adolescence,diabetes,type 1 diabetes1|SUMMARY OF WHAT ISNEW/DIFFERENT Modern insulin therapy produces normal or minimally delayedpuberty.Despite recent technological advances in the care of diabetes,achieving optimal glycemic control during adolescence remainscha
6、llenging.Peer support through online social media is an increasingly impor-tant source of advice.Motivational interviewing by psychologists is effective in optimiz-ing outcomes in teenagers.Diabetes distress during adolescence may lead to less consistentuse of insulin and other self-care measures wi
7、th consequentincreased glycemic variability.Mental health needs during adolescence may supersede otherhealthcare needs,requiring other specialty team involvement andprioritizing interprofessional communication.Mental health assessment is complex in adolescents and screeningis recommended particularl
8、y for those experiencing recurrent dia-betic ketoacidosis(DKA).Preconception counseling should begin during early puberty.A care ambassador/patient navigator leads to better transitionoutcomes.Screening for social determinants of health should be standard carein adolescents.2|EXECUTIVE SUMMARY,RECOM
9、MENDATION&GRADING OFEVIDENCEAdolescence is the transitional phase of development betweenchildhood and emerging adulthood.Healthcare and emotionalneeds are distinctly different from younger children and matureadults.Received:23 August 2022Accepted:24 August 2022DOI:10.1111/pedi.13408This is an open a
10、ccess article under the terms of the Creative Commons Attribution-NonCommercial License,which permits use,distribution and reproduction in anymedium,provided the original work is properly cited and is not used for commercial purposes.2022 The Authors.Pediatric Diabetes published by John Wiley&Sons L
11、td.Pediatr Diabetes.2022;23: Puberty is a period of physiological insulin resistance,exaggeratedin adolescents with type 1 diabetes(T1D)(B).Pubertal developmental is normal or minimally delayed in the mod-ern insulin era(B).Worsening of glycemic control is commonly reported in pubertyand persists th
12、roughout adolescence(B).Diabetes identity and communication Consider directing young people toward relevant local peer sup-port groups and make them aware of the diabetes online commu-nity at diagnosis(B).Include asking in consultations about youth participation in peersupport communities online and
13、 offline(what they learn and howthese communities support them)(B).Supporting communication between the young persons family,their healthcare team,and school through individual health plansand school nurse support is advised(B).Encourage authoritative,helpful parenting styles with clear andrealistic
14、 expectations(C).Mental health Diabetes services should recognize the significant mental healthburden of young people with T1D and have mental health clini-cians trained in diabetes to support them(B).Screen to identify early markers of mental health problems requir-ing treatment(B).Episodes of DKA
15、and chronically very high HbA1c are red flags formental health problems(B).Sexual health In order to increase awareness of the risks of unplanned pregnancyand suboptimal glycemic control,pre-conceptional counselingshould begin in puberty in all girls(B).Hormonal contraception can be used,provided th
16、ere are no micro-vascular complications and less than 20 years of disease duration;morbid obesity,severe hypertension,or the presence of multiplecardiovascular risk factors are contraindications for using combinedhormonal contraception(E).Despite the absence of studies in teenagers with diabetes,lon
17、g-acting reversible contraception is the contraceptive of choice inadolescents(B).Becoming a young adult The transition from pediatric to adult care should be a planned,organized process(E).Youth mature at different rates and delay of transition based onthe developmental needs of the young person ma
18、y be appropriateto optimize outcomes(B).Transition planning,specifically utilizing care coordinators/patientnavigators,canenhancepost-transitionclinicattendanceandengage-ment(A).Screening for social needs should occur at least annually for allyouth with diabetes and their families(C).Diabetes care p
19、lans should accommodate unmet social needs,with appropriate referral to community resources when appro-priate(C).3|INTRODUCTIONAdolescence culminates in peak physical development,followed bypsychological and cognitive maturation,autonomy,and social inde-pendence.The combination of rapid physical and
20、 sexual maturationwith subsequent neuro-maturation creates a period of physiologicand behavioral vulnerability.This is especially relevant to the manage-ment of chronic illnesses such as diabetes in which the endocrinechanges of puberty impact directly upon the physiology of glycemiccontrol.All adol
21、escents vary in their adaptation and responses to change,and attitudes can be impulsive,questioning,and disruptive,oftenreceiving a negative response from adults.Similarly in pediatric diabe-tes practice,highlighting the“difficulties”in interactions with adoles-cents and their behaviors is widesprea
22、d.The clinical consequences ofthese behaviors are exemplified in data such as those from the T1DExchange in the United States(Figure 1),1which showed a markeddeterioration in glycemic control between the ages of 10 and20 years.These findings are not isolated to the United States and arecommon across
23、 many other health-care settings,although not univer-sal.2,3These disappointing outcomes have not arisen or persisted dueto clinical inertia.On the contrary,there is a plethora of medical litera-ture examining the issues around adolescents and diabetes,includingFIGURE 1Serial data from the T1D excha
24、nge1highlightingadolescence as a period of deteriorating glycemic control over twotime-intervals(20102012 in red and 20162018 in blue).858GREGORYET AL.textbooks and chapters dedicated to this topic,46special guidelines7and over 13,000 papers published since 2000 that can be found undera PubMed searc
25、h of“type 1 diabetes and adolescence.”There has also been a concomitant rise in the use of new strate-gies that promised increased ease of use and the potential forimproved adherence.Despite all this clinical activity,we are arguablynot making progress in improving diabetes-related outcomes for ado-
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