Федеральные клинические рекомендации по диагностике и лечению сахарного диабета 2-го типа у детей и подростков

Частота сахарного диабета 2-го типа (СД2), в том числе и у лиц молодого возраста, резко возросла, и СД2 стал регистри- роваться у подростков и даже детей допубертатного возраста. Заболевание развивается на фоне ожирения и метаболического синдрома, однако длительно протекает бессимптомно, поэтому выявление требует активного диагностического поиска. Данные клинические рекомендации разработаны в ИДЭ ФГБУ ЭНЦ и освещают вопросы диагностики, лечения и тактики ведения пациентов с СД2.

СД2, дети и подростки, гиперинсулинемия, инсулинорезистентность, бигуаниды

1. Дедов И.И., Кураева Т.Л., Петеркова В.А. Сахарный диабет у детей и подростков. – М.: ГЭОТАР-Медиа; 2007. [Dedov II, Kuraeva TL, Peterkova VA. Diabetes mellitus in children and adolescence. Moscow: GEOTAR-Media; 2007.]

2. Дедов И.И., Ремизов О.В., Петеркова В.А. Генетическая гетерогенность и клинико-метаболические аспекты сахарного диабета с аутосомно-доминантным наследованием (тип MODY) у детей и подростков. // Педиатрия. Журнал им. Г.Н. Сперанского. – 2000. – Т.79. – №6 – С. 77-83. [Dedov II, Remizov OV, Peterkova VA. Pediatric and adolescent diabetes mellitus with autosomal dominant inheritance (MODY type): genetic geterogeneity, clinical and metabolic aspects. Pediatriia. 2000;79(6):77-83.]

3. Дедов И.И., Ремизов О.В., Петеркова В.А. Сахарный диабет 2 типа у детей и подростков. // Сахарный диабет. – 2001. – №4 – С. 26-32. [Dedov II, Remizov OV, Peterkova VA. Sakharnyy diabet 2 tipa u detey i podrostkov. Diabetes Mellitus. 2001;(4):26-32.]

4. Еремина И.А., Зильберман Л.И., Дубинина И.А., и др. Особенности сахарного диабета 2 типа без ожирения у детей и подростков. – Материалы VI всероссийского диабетологического конгресса, 19-22 мая 2013 г. – с. 299. [Eremina IA, Zil'berman LI, Dubinina IA, et al. Osobennosti sakharnogo diabeta 2 tipa bez ozhireniya u detey i podrostkov. Proceedings of the VI Russian Diabetology Congress, 2013 May 19-22.]

5. Еремина И.А., Кураева Т.Л. Метформин в лечении сахарного диабета 2-го типа у детей и подростков. // Проблемы эндокринологии. – 2013. – Т. 59. – №1 – С. 8-13. [Eremina IA, Kuraeva TL. The use of metformin for the treatment of type 2 diabetes mellitus in children and adolescents. Problemy Endokrinologii. 2013;59(1):8-13.] doi: 10.14341/probl20135918-13

6. Adelman RD, Restaino IG, Alon US, Blowey DL. Proteinuria and focal segmental glomerulosclerosis in severely obese adolescents. The Journal of Pediatrics. 2001;138(4):481-485. doi: 10.1067/mpd.2001.113006

7. Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care. 2000;23(3):381-389. doi: 10.2337/diacare.23.3.381

8. Banerjee S, Raghavan S, Wasserman EJ, Linder BL, Saenger P, DiMartino-Nardi J. Hormonal Findings in African-American and Caribbean Hispanic Girls With Premature Adrenarche: Implications for Polycystic Ovarian Syndrome. Pediatrics. 1998;102(3):e36-e36. doi: 10.1542/peds.102.3.e36

9. Banerji MA. Diabetes in African Americans: Unique pathophysiologic features. Current Diabetes Reports. 2004;4(3):219-223. doi: 10.1007/s11892-004-0027-3

10. Berenson GS, Srnivasan SR. Cardiovascular risk factors in youth with implications for aging: The Bogalusa Heart Study. Neurobiology of Aging. 2005;26(3):303-307. doi: 10.1016/j.neurobiolaging.2004.05.009

11. Braun B, Zimmermann MB, Kretchmer N, Spargo RM, Smith RM, Gracey M. Risk Factors for Diabetes and Cardiovascular Disease in Young Australian Aborigines: A 5-year follow-up study. Diabetes Care. 1996;19(5):472-479. doi: 10.2337/diacare.19.5.472

12. Chan JC, Cheung CK, Swaminathan R, Nicholls MG, Cockram CS. Obesity, albuminuria and hypertension among Hong Kong Chinese with non-insulin-dependent diabetes mellitus (NIDDM). Postgraduate Medical Journal. 1993;69(809):204-210. doi: 10.1136/pgmj.69.809.204

13. Dahlquist G, Blom L, Tuvemo T, Nystrom L, Sandstrom A, Wall S. The Swedish childhood diabetes study -- results from a nine year case register and a one year case-referent study indicating that Type 1 (insulin-dependent) diabetes mellitus is associated with both Type 2 (non-insulin-dependent) diabetes mellitus and autoimmune disorders. Diabetologia. 1989;32(1). doi: 10.1007/bf00265396

14. Dietz WH, Gross WL, Kirkpatrick JA. Blount disease (tibia vara): Another skeletal disorder associated with childhood obesity. The Journal of Pediatrics. 1982;101(5):735-737. doi: 10.1016/s0022-3476(82)80305-3

15. Drake AJ. Type 2 diabetes in obese white children. Archives of Disease in Childhood. 2002;86(3):207-208. doi: 10.1136/adc.86.3.207

16. Druet C, Tubiana-Rufi N, Chevenne D, Rigal O, Polak M, Levy-Marchal C. Characterization of Insulin Secretion and Resistance in Type 2 Diabetes of Adolescents. The Journal of Clinical Endocrinology & Metabolism. 2006;91(2):401-404. doi: 10.1210/jc.2005-1672

17. Duncan GE. Prevalence of Diabetes and Impaired Fasting Glucose Levels Among US Adolescents. Archives of Pediatrics & Adolescent Medicine. 2006;160(5):523. doi: 10.1001/archpedi.160.5.523

18. Ehtisham S. First UK survey of paediatric type 2 diabetes and MODY. Archives of Disease in Childhood. 2004;89(6):526-529. doi: 10.1136/adc.2003.027821

19. Eppens MC, Craig ME, Jones TW, Silink M, Ong S, Ping YJ. Type 2 diabetes in youth from the Western Pacific region: glycaemic control, diabetes care and complications. Current Medical Research and Opinion. 2006;22(5):1013-1020. doi: 10.1185/030079906x104795

20. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of Childhood Obesity to Coronary Heart Disease Risk Factors in Adulthood: The Bogalusa Heart Study. Pediatrics. 2001;108(3):712-718. doi: 10.1542/peds.108.3.712

21. Goldberg IJ. Diabetic Dyslipidemia: Causes and Consequences. The Journal of Clinical Endocrinology & Metabolism. 2001;86(3):965-971. doi: 10.1210/jcem.86.3.7304

22. Goran MI, Bergman RN, Avila Q, Watkins M, Ball GDC, Shaibi GQ, et al. Impaired Glucose Tolerance and Reduced β-Cell Function in Overweight Latino Children with a Positive Family History for Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism. 2004;89(1):207-212. doi: 10.1210/jc.2003-031402

23. Gottlieb MS. Diabetes in offspring and siblings of juvenile- and maturity-onset-type diabetics. Journal of Chronic Diseases. 1980;33(6):331-339. doi: 10.1016/0021-9681(80)90042-9

24. Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL. Hypertension and Antihypertensive Therapy as Risk Factors for Type 2 Diabetes Mellitus. New England Journal of Medicine. 2000;342(13):905-912. doi: 10.1056/nejm200003303421301

25. Hathout EH, Thomas W, El-Shahawy M, Nahab F, Mace JW. Diabetic Autoimmune Markers in Children and Adolescents With Type 2 Diabetes. Pediatrics. 2001;107(6):e102-e102. doi: 10.1542/peds.107.6.e102

26. Ibáñez L, Potau N, Marcos MV, de Zegher F. Exaggerated Adrenarche and Hyperinsulinism in Adolescent Girls Born Small for Gestational Age. The Journal of Clinical Endocrinology & Metabolism. 1999;84(12):4739-4741. doi: 10.1210/jcem.84.12.6341

27. Invitti C, Guzzaloni G, Gilardini L, Morabito F, Viberti G. Prevalence and Concomitants of Glucose Intolerance in European Obese Children and Adolescents. Diabetes Care. 2003;26(1):118-124. doi: 10.2337/diacare.26.1.118

28. Juonala M, Järvisalo MJ, Mäki-Torkko N, Kähönen M, Viikari JS, Raitakari OT. Risk Factors Identified in Childhood and Decreased Carotid Artery Elasticity in Adulthood: The Cardiovascular Risk in Young Finns Study. Circulation. 2005;112(10):1486-1493. doi: 10.1161/circulationaha.104.502161

29. Kadiki OA, Reddy MRS, Marzouk AA. Incidence of insulin-dependent diabetes (IDDM) and non-insulin-dependent diabetes (NIDDM) (0–34 years at onset) in Benghazi, Libya. Diabetes Research and Clinical Practice. 1996;32(3):165-173. doi: 10.1016/0168-8227(96)01262-4

30. Kirpichnikov D, Sowers JR. Diabetes mellitus and diabetes-associated vascular disease. Trends in Endocrinology and Metabolism. 2001;12(5):225-230. doi: 10.1016/s1043-2760(01)00391-5

31. 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. Clinical Pediatrics. 1998;37(2):111-115. doi: 10.1177/000992289803700208

32. Laakso M. Lipids in Type 2 Diabetes. Seminars in Vascular Medicine. 2002;2(1):059-066. doi: 10.1055/s-2002-23096

33. Landin-Olsson M. Latent Autoimmune Diabetes in Adults. Annals of the New York Academy of Sciences. 2006;958(1):112-116. doi: 10.1111/j.1749-6632.2002.tb02953.x

34. Lee S, Bacha F, Gungor N, Arslanian SA. Waist circumference is an independent predictor of insulin resistance in black and white youths. The Journal of Pediatrics. 2006;148(2):188-194. doi: 10.1016/j.jpeds.2005.10.001

35. Lewy VD, Danadian K, Witchel SF, Arslanian S. Early metabolic abnormalities in adolescent girls with polycystic ovarian syndrome. The Journal of Pediatrics. 2001;138(1):38-44. doi: 10.1067/mpd.2001.109603

36. Loder RT, Aronson DD, Greenfield ML. The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. Journal of Bone and Joint Surgery (American Volume). 1993 Aug;75(8):1141-1147.

37. McGrath NM, Parker GN, Dawson P. Early presentation of type 2 diabetes mellitus in young New Zealand Maori. Diabetes Research and Clinical Practice. 1999;43(3):205-209. doi: 10.1016/s0168-8227(99)00003-0

38. Miller J, Silverstein J, Rosenbloom AL. Type 2 diabetes in the child and adolescent. In: Endocrinology: Fifth edition. NY: Marcel Dekker; 2007. V. 1, pp. 169-88.

39. Misra A, Vikram NK, Arya S, Pandey RM, Dhingra V, Chatterjee A, et al. High prevalence of insulin resistance in postpubertal Asian Indian children is associated with adverse truncal body fat patterning, abdominal adiposity and excess body fat. International Journal of Obesity. 2004;28(10):1217-1226. doi: 10.1038/sj.ijo.0802704

40. Morales AE, Rosenbloom AL. Death caused by hyperglycemic hyperosmolar state at the onset of type 2 diabetes. The Journal of Pediatrics. 2004;144(2):270-273. doi: 10.1016/j.jpeds.2003.10.061

41. Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. The Lancet. 2007;370(9588):685-697. doi: 10.1016/s0140-6736(07)61345-2

42. Pinhas-Hamiel O, Zeitler P. The global spread of type 2 diabetes mellitus in children and adolescents. The Journal of Pediatrics. 2005;146(5):693-700. doi: 10.1016/j.jpeds.2004.12.042

43. Pinhas-Hamiel O, Zeitler P. Acute and chronic complications of type 2 diabetes mellitus in children and adolescents. The Lancet. 2007;369(9575):1823-1831. doi: 10.1016/s0140-6736(07)60821-6

44. Plourde G. Impact of obesity on glucose and lipid profiles in adolescents at different age groups in relation to adulthood. BMC Family Practice. 2002;3:18-18. doi: 10.1186/1471-2296-3-18

45. Poredo, scaron, P. Endothelial dysfunction and cardiovascular disease. Pathophysiology of Haemostasis and Thrombosis. 2002;32(5-6):274-277. doi: 10.1159/000073580

46. Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Type 2 Diabetes in Asian-Indian Urban Children. Diabetes Care. 2003;26(4):1022-1025. doi: 10.2337/diacare.26.4.1022

47. Reinehr T, Schober E, Wiegand S, Thon A, Holl R. β-cell autoantibodies in children with type 2 diabetes mellitus: subgroup or misclassification? Archives of Disease in Childhood. 2006;91(6):473-477. doi: 10.1136/adc.2005.088229

48. Rosenbloom AL. Obesity, Insulin Resistance, Beta-Cell Autoimmunity, and the Changing Clinical Epidemiology of Childhood Diabetes. Diabetes Care. 2003;26(10):2954-2956. doi: 10.2337/diacare.26.10.2954

49. Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care. 1999;22(2):345-354. doi: 10.2337/diacare.22.2.345

50. Salomaa VV, Strandberg TE, Vanhanen H, Naukkarinen V, Sarna S, Miettinen TA. Glucose tolerance and blood pressure: long term follow up in middle aged men. BMJ. 1991;302(6775):493-496. doi: 10.1136/bmj.302.6775.493

51. Sayeed MA, Hussain MZ, Banu A, Rumi MAK, Khan AKA. Prevalence of diabetes in a suburban population of Bangladesh. Diabetes Research and Clinical Practice. 1997;34(3):149-155. doi: 10.1016/s0168-8227(96)01337-x

52. Shalitin S, Abrahami M, Lilos P, Phillip M. Insulin resistance and impaired glucose tolerance in obese children and adolescents referred to a tertiary-care center in Israel. International Journal of Obesity. 2005;29(6):571-578. doi: 10.1038/sj.ijo.0802919

53. Smith JC, Field C, Braden DS, Gaymes CH, Kastner J. Coexisting Health Problems in Obese Children and Adolescents that Might Require Special Treatment Considerations. Clinical Pediatrics. 1999;38(5):305-307. doi: 10.1177/000992289903800510

54. Baranowski T, Cooper DM, Harrell J, Hirst K, Kaufman FR, Goran M. Presence of Diabetes Risk Factors in a Large U.S. Eighth-Grade Cohort. Diabetes Care. 2006;29(2):212-217. doi: 10.2337/diacare.29.02.06.dc05-1037

55. Strauss RS, Barlow SE, Dietz WH. Prevelance of abnormal serum aminotransferase values in overweight and obese adolescents. The Journal of Pediatrics. 2000;136(6):727-733. doi: 10.1016/s0022-3476(00)24645-3

56. Sugihara S, Sasaki N, Kohno H, Amemiya S, Tanaka T, Matsuura N. Survey of Current Medical Treatments for Childhood-Onset Type 2 Diabetes Mellitus in Japan. Clinical Pediatric Endocrinology. 2005;14(2):65-75. doi: 10.1297/cpe.14.65

57. Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, et al. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. The Lancet. 2001;358(9291):1400-1404. doi: 10.1016/s0140-6736(01)06525-4

58. Tresaco B, Bueno G, Moreno LA, Garagorri JM, Bueno M. Insulin resistance and impaired glucose tolerance in obese children and adolescents. Journal of Physiology and Biochemistry. 2003;59(3):217-223. doi: 10.1007/bf03179918

59. Turner R, Stratton I, Horton V, Manley S, Zimmet P, Mackay IR, et al. UKPDS 25: autoantibodies to islet-cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in type 2 diabetes. The Lancet. 1997;350(9087):1288-1293. doi: 10.1016/s0140-6736(97)03062-6

60. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The Lancet. 1998;352(9131):837-853. doi: 10.1016/s0140-6736(98)07019-6

61. Umpaichitra V, Banerji MA, Castells S. Autoantibodies in children with type 2 diabetes mellitus. Journal of Pediatric Endocrinology & Metabolism: JPEM. 2002;15 Suppl 1:525-530.

62. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Low-Grade Systemic Inflammation in Overweight Children. Pediatrics. 2001;107(1):e13-e13. doi: 10.1542/peds.107.1.e13

63. Wabitsch M, Hauner H, Hertrampf M, Muche R, Hay B, Mayer H, et al. Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany. International Journal of Obesity. 2004. doi: 10.1038/sj.ijo.0802555

64. Wei JN, Sung FC, Li CY, Chang CH, Lin RS, Lin CC, et al. Low Birth Weight and High Birth Weight Infants Are Both at an Increased Risk to Have Type 2 Diabetes Among Schoolchildren in Taiwan. Diabetes Care. 2003;26(2):343-348. doi: 10.2337/diacare.26.2.343

65. Weiss R, Dufour S, Taksali SE, Tamborlane WV, Petersen KF, Bonadonna RC, et al. Prediabetes in obese youth: a syndrome of impaired glucose tolerance, severe insulin resistance, and altered myocellular and abdominal fat partitioning. The Lancet. 2003;362(9388):951-957. doi: 10.1016/s0140-6736(03)14364-4

66. Wiegand S, Maikowski U, Blankenstein O, Biebermann H, Tarnow P, Gruters A. Type 2 diabetes and impaired glucose tolerance in European children and adolescents with obesity -- a problem that is no longer restricted to minority groups. European Journal of Endocrinology. 2004;151(2):199-206. doi: 10.1530/eje.0.1510199

67. Wierzbicki AS, Nimmo L, Feher MD, Cox A, Foxton J, Lant AF. Association of angiotensin converting enzyme DD genotype with hypertension in diabetes. Journal of Human Hypertension. 1995;9(8):671-673.

68. Winter WE, Maclaren NK, Riley WJ, Clarke DW, Kappy MS, Spillar RP. Maturity-Onset Diabetes of Youth in Black Americans. New England Journal of Medicine. 1987;316(6):285-291. doi: 10.1056/nejm198702053160601

69. Dabelea D, Bell RA, D'Agostino Jr RB, Imperatore G, Johansen JM, Linder B, et al. Incidence of diabetes in youth in the United States. JAMA: The Journal of the American Medical Association. 2007;297(24):2716-2724. doi: 10.1001/jama.297.24.2716