2- : - |
|
2- (2) , . 2 . , 2 , . 2, , 2.
Dramatic rising prevalence of type 2 diabetes among children and adolescent required from health care prov >children and adolescent remain extremely limited. This review discussed modern data about pathogenesis diabetes type 2 and main risk-factors. Author presents an update on management of type 2 diabetes in young patients.
,
2- :
, , -,
: 119991, , , . 2/62, .: (495) 967-14-20
: 08.04.2011 ., : 11.07.2011 .
2- (2) , . 2 . , 2 , . 2, , 2.
: c 2- , , , , , .
, 2- (2) , . 2003 . 2- [1, 2].
1980 . 2 2% , 1%. 1982 1995 . 8-10% ( 0,4% 2) 5 (4-6% ). 2 20 . 2 20 37,5 . [3-5]. 2 , , , [6].
2, , . , , , . , , . , , .
( 90- ), ( ). , , fast food (, , , ). -
Scientific Center of Children's Health, Russian Academy of Medical Sciences, Moscow
Type 2 diabetes in children and adolescent: from pathogenesis to treatment
Dramatic rising prevalence of type 2 diabetes among children and adolescent required from health care providers to develop a new strategies for screening, treatment and prevention of diabetes at this age. Many medications have been developed for treatment of type 2 diabetes in adult. Despite on this, therapeutic modalities in children and adolescent remain extremely limited. This review discussed modern data about pathogenesis diabetes type 2 and main risk-factors. Author presents an update on management of type 2 diabetes in young patients.
Key words: diabetes type 2, prevalence, causes treatment, metformin, children.
. fast food , .
2 b- ( ) .
- :
;
;
- (GLUT 1-5);
, .
, , [7].
b- .
2. , [8]. , 2, 1, 12, 17 20- [9].
2 : . 2, , . , , , , , ( - (SDS ) > 2), 2 0,2%, , , 2 . 2 (4%) [1, 7]. , 2 13,5 , [5].
2 . , . Rosenbloom . [10], 2 1,7 , . , 2 [11]. 2- :
() > 85 ; SDS > 2 + :
, 2 / ;
(acanthosis nigricans, , , );
;
2.
2 : , , acanthosis nigricans, , , . , 2. 2 - , ( 20% ) ( 33% 2) [12].
(, 1999):
6,1 / ;
6,1
7.0 / ;
7.0 / ; ;
2 11 / (, ) 12,2 / (, ) ; .
2 , 10 (SDS > 2 > 85 ) (Tanner ^ 2) 2 (1 1-2- ).
. , . (HOMA, Caro, QUICKI) (.).
, , -, . .
1- 2 - (ICA), (IAA), - (GADA) - (ICA-512 - 2).
HOMA-IR ( X ) 0,3
QUICKI (logr + ^)'1 > 0,3
. /; ( /.
3 DY*.
2-
2 , , , .
, 2 .
, ( ) . , 2, , , . . , . , ( ). , 2, ( ), , . .
, ( ), .
, , .
3 1-1,5 . , 3-4 , 5-7 .
.
2 .
2 . / .
, , - . . :
, -, ;
;
- ^!), ;
;
, - ;
;
, , ;
, ;
- 1, ;
, .
* MODY- ( . maturity onset diabetes of the young), , , b- - . , , , . MODY , , ( 25 ) 2.
/2011/ 8/ 4
2 . 2001 2010 . 10 , 2, .
, , , , 95% 1,42 /2 ( 0,4 SD), (-^) 2,1 (0,6 SD) [13].
3 , - . , ( 0,26 SD), [14, 15].
, 2 , , , , , [14, 15].
( ) , .
, [16].
, ( 30-40% ). .
, , [14, 15].
50- , 3000 3,3 100 . , (4,8 100 . ) [17].
, , .
. , -
, 10 3000 , ().
, .
3- : 500, 850, 1000 . , .
, , ( ).
500-1000 2-3 ( 7-10 ) .
1000-1500 / 2-3 . , 1500-2000 /. 3000 /.
, , (. . , ; ). , , , , .
, , .
, 2- . , , . , 2 . .
- , 2 , .
, , .
1. Goran M. I., Ball G. D., Cruz M. L. Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents // J. Clin. Endocrinol. Metab. 2003; 88: 1417-1427.
2. Steinberger J., Daniels S. R. Obesity, insulin resistance, diabetes, and cardiovascular risk in children: an american heart association scientific statement from the atherosclerosis, hypertension, and obesity in the young committee (council on cardiovascular disease in theyoung) and the diabetes committee (council on nutrition, physical activity, and metabolism) // Circulation. 2003; 107: 1448-1453.
3. Cockram C. S. The epidemiology of diabetes mellitus in the Asia-Pacific region // Hong. Kong. Med. J. 2000; 6: 43-52.
4. Kitagawa T., Owada M., Urakami T., Yamauchi K. Increased incidence of non-insulin dependent diabetes mellitus among Japanese schoolchildren correlates with an increased intake of animal protein and fat // Clin. Pediatr. 1998; 37: 111-115.
5. Bloomgarden Z. T. Type 2 diabetes in the young: the evolving epidemic // Diabetes Care. Apr. 2004; 27 (4): 998-1010.
6. . ., . ., . . 2 // . 2001; 4: 26-32.
7. Arslanian S. Type 2 diabetes in children: clinical aspects and risk factors // Horm. Res. 2002; 57 (Suppl. 1): 19-28.
8. Gloyn A. L., Weedon M. N., Owen K. R. et al. Large-scale association studies of variants in genes encoding the pancreatic P-cell KATP channel subunits Kir6.2 (KCNJ11) and SUR1 (ABCC8) confirm that the KCNJ11 E23K variant is associated with type 2 diabetes // Diabetes. 2003; 52: 568-572.
9. Horikawa Y. Genetic variation in the gene encoding calpain-10 is associated with type 2 diabetes mellitus // Nat. Genet. 2000; 26: 163-175.
10. Rosenbloom A. L., Joe J. R., Young R. S., Winter W. E. Emerging epidemic of type 2 diabetes in youth // Diabetes. Care. 1999; 22: 345-354.
11. . ., . . : . .: -, 2006. 600 .
12. Flint A., Arslanian S. Treatment of type 2 diabetes in youth // Diabetes. Care. 2011; 5 (Suppl. 2).
13. Park M. H., Kinra S., Ward K. J. et al. Metformin for obesity in children and adolescents: A systematic review // Diabetes. Care. 2009; 32 (9): 1743-1745.
14. Freemark M., Bursey D. The effects of metformin on body mass index and glucose tolerance in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes // Pediatrics. 2001; 107: 55.
15. Jones K. L., Arslanian S., Peterokova V. A. et al. Effect of metformin in pediatric patients with type 2 diabetes: a randomized controlled trial // Diabetes. Care. 2002; 25: 89-94.
16. Lewy V. D., Danadian K., Witchel S. F., Arslanian S. Early metabolic abnormalities in adolescent girls with polycystic ovarian syndrome // J. Pediatr. 2001; 138: 38-44.
17. Bodmer M., Meier C., Krahenbuhl S. Metformin, sulfonilureas, or other antidiabetes drugs and the risk of lactic acidosis or hypoglycemia a nested case-control analysis // Diabetes. Care. 2008; 31: 2086-2091.
|
|
|
. , , , , . , . . , , , . . . , . . , .
, 22 100 . , 90 %. , :
, , .
. . , . T .
A . E, , . . , , . , . , .
. . . . , - . . . , A .
. . . , .
, . , . , . . . , , . , .
. , . , . , , . - . .
, , .
, .
, .
. , , , . , . , . . , (, ). .
. . , . , . , . , . , .
. 3-4- , .
, . .
.
(, ). , . , .
- . . . 60 . , . , . .
. (200 ) (50) (50). . (1.) . 1 . 10 .
. 50 (1). , .
. . . 30 . .
.
. 100 1.5 . . .
, .
. . .
.
, . 2 . . . , . .
, , . .
(). 200 3. , 2. . 1
, . , .
. , . , . . . , , , , .
, , .
, , . . , . , , . .
.
, . . (, , ) .
540 100 , . , . : , -3, 6. , A, B1, B2, B3, B4, B5, B6, B9, C, E, D, PP , . - . , :
, , , . , . .
:
, . , , , . . !
" . , "
, . , , .
, , . ,
, , .
, )) , .
! , : , ! ) ! : ! !
. . .
, . , , . , , .
.
. =)
, ! , .
|
: |
|
, .
, . , , 12 . , , .
(, , , , , ) (, , , , , ). , , , . , , .
, , , . , , . , 200 .
, . ,
, . ,
, .
, . , ,
""( , ).
|
-121 , |
|
: , , : ,
( ): ( ), (, , , ), ( ), , , ( , , , , ), ; : , , , .
( ): ( ), , , , , , - (, ), ( ).
( ): , , , , , , , .
, - . , 24 -121 (. , . 27, - 6- ). 16:30, .
- 121
|
: 2 , |
|
. . , , . , , . , , . , , .
, , . , . , . , , . , , .
. 1 . 2 . , . .
. . . , .
, , , . . . , , , 50 . 15 , , .
:
:
.
, . , , , , , , .
, . :
, . , , , , , , .
. , . , -6, , -9.
, . . . 552 . , , . 50 .
. . , , . , , .
. , , . .
, , . , :
, , .
. , , .
- . . , . , , .
, , :
, .
. . . , . , .
|
|
|
|
|
|
"" .
1 2 , , .
, , , , , , .
, , .
, , . , , - . "" , . . , . , - 9 () , , . , .
, . - , - , . , , . , , , , - , , - , .. , , .
, , , , .
|
9 , |
|
9 ( 9) , . .
, , , , . , . . 9 .
9 . , , . , .
, . 2 . . - , . 1 .
, . 5-6 . (). , 60 .
9 :
, , . .
9 :
|
: | [1] |