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ADA 推荐强化T1DM儿童血糖控制目标
——科罗拉多大学儿童糖尿病中心David Maahs 教授访谈
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作者:D.Maahs 2014/6/25 17:00:00    加入收藏
内容概要:编者按:2014年6月16日,美国糖尿病协会(ADA)在其年会期间首次发布专门针对1型糖尿病管理的立场声明,该声明受到了广泛关注和欢迎。在ADA年会上,来自美国科罗拉多大学儿童糖尿病中心的David Maahs 教授发表了对这一新声明观点。
  T1DM血糖控制目标改变
  我认为,美国糖尿病协会发布的这份最新的立场声明主要包括两个要点:
  第一,推荐儿童和青少年糖尿病患者的HbA1c控制目标<7.5%;这与其他国际组织(例如国际青少年糖尿病协会[ISPAD]、国际儿童青少年糖尿病协会)的观点相一致。此外,这份立场声明强调应从每个家庭和每个孩子的具体情况,制定个体化的血糖控制目标。
  第二,有史以来首次要求收集1型糖尿病患者的终身信息。这在过去几十年内可能比较困难。但是,现在越来越多的1型糖尿病患者可以活到60岁、70岁、甚至80岁,随着这些1型糖尿病患者逐渐衰老,在他们从童年过渡到中年、甚至到老年过程中,有一个指南明确地告诉我们该如何照顾这些患者显得尤为重要。这些患者的最佳治疗方法是什么?最佳证据是什么?我们一直期待关于这一方面更多的数据和更多的研究。现在我们有了这份立场声明,在这份20页的文件里面收集了关于1型糖尿病管理方面最好的资料。
  T1DM立场声明的临床意义
  我们希望这份立场声明通过更好地控制HbA1c,能为患者带来更好的结局,降低1型糖尿病患者长期并发症的发生。同时,我们也认为,使用当前的治疗方法,我们可以在不增加不良反应(例如长期以来一直受关注、且会继续受关注的低血糖事件)的情况下做到这一点。此外,我们也认为现在比过去有更好的治疗方法,可以达到更佳的HbA1c目标。
  The new position statement that came out from the American Diabetes Association today has I believe 2 main points; one is that the A1c targets for children and adolescents with diabetes is now recommended to be less than 7.5%.  This now harmonizes with other groups such as ISPAD, the International Society for Pediatric and Adolescent Diabetes group.  Additionally they emphasize that we should individualize these goals from each family and for each child.  A second important point is that now for the first time ever there is the gathering of information about type 1 diabetes across the lifespan.  What may be different in the past few decades is that now we have more and more people with type 1 diabetes who are living into their 60s, 70s, and 80s and it is very important that we have clear guidance on how to take care of these people as they get older and as they transition from pediatrics to adults and even into the geriatric population.  What are the best practices, what is the best evidence and certainly we await additional data and additional studies going forward but for now we do have a document, a 20 page document that does gather the best information in this position statement.
  We hope that this position statement leads to better outcomes with better A1c which we know will reduce long term complications of type 1 diabetes.  Also we think that with the current therapeutics that we can do this without increasing adverse effects such as hypoglycemia which have been, and continues to be a concern, but we think we have better therapeutics to achieve better a1c goals now than in the past.
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