Assuntos
Diabetes Mellitus Tipo 1 , Adolescente , Criança , Consenso , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/terapia , Endocrinologia/organização & administração , Endocrinologia/normas , Humanos , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Estados UnidosRESUMO
Type 2 diabetes is a significant and increasing burden in adolescents and young adults. Clear strategies for research, prevention, and treatment of the disease in these vulnerable patients are needed. Evidence suggests that type 2 diabetes in children is different not only from type 1 but also from type 2 diabetes in adults. Understanding the unique pathophysiology of type 2 diabetes in youth, as well as the risk of complications and the psychosocial impact, will enable industry, academia, funding agencies, advocacy groups, and regulators to collectively evaluate both current and future research, treatment, and prevention approaches. This Consensus Report characterizes type 2 diabetes in children, evaluates the fundamental differences between childhood and adult disease, describes the current therapeutic options, and discusses challenges to and approaches for developing new treatments.
Assuntos
Atenção à Saúde , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Adolescente , Idade de Início , Alostase , Criança , Consenso , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Dietoterapia , Gerenciamento Clínico , Etnicidade/estatística & dados numéricos , Terapia por Exercício , Humanos , Hipoglicemiantes/uso terapêutico , Grupos Minoritários/estatística & dados numéricos , Risco , Comportamento de Redução do Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto JovemAssuntos
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Serviços de Saúde Escolar/normas , Adolescente , Criança , Pré-Escolar , Competência Clínica/normas , Atenção à Saúde , Exercício Físico/fisiologia , Docentes/normas , Educação em Saúde , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/terapia , Hipoglicemia/diagnóstico , Hipoglicemia/terapia , Defesa do Paciente , Segurança do Paciente , Guias de Prática Clínica como Assunto , Preconceito , Serviços de Saúde Escolar/legislação & jurisprudência , Serviços de Enfermagem Escolar/educação , Serviços de Enfermagem Escolar/normas , Autocuidado , Viagem , Estados UnidosRESUMO
Insights from prospective, longitudinal studies of individuals at risk for developing type 1 diabetes have demonstrated that the disease is a continuum that progresses sequentially at variable but predictable rates through distinct identifiable stages prior to the onset of symptoms. Stage 1 is defined as the presence of ß-cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of ß-cell autoimmunity with dysglycemia and is presymptomatic, and stage 3 as onset of symptomatic disease. Adoption of this staging classification provides a standardized taxonomy for type 1 diabetes and will aid the development of therapies and the design of clinical trials to prevent symptomatic disease, promote precision medicine, and provide a framework for an optimized benefit/risk ratio that will impact regulatory approval, reimbursement, and adoption of interventions in the early stages of type 1 diabetes to prevent symptomatic disease.
Assuntos
Diabetes Mellitus Tipo 1/diagnóstico , Autoanticorpos/imunologia , Autoimunidade/imunologia , Diabetes Mellitus Tipo 1/classificação , Diabetes Mellitus Tipo 1/imunologia , Progressão da Doença , Diagnóstico Precoce , Predisposição Genética para Doença , Humanos , Células Secretoras de Insulina/imunologia , Estado Pré-Diabético/classificação , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/imunologia , Estudos Prospectivos , Sociedades Médicas , Estados UnidosRESUMO
Emerging data suggest that type 1 diabetes is a more aggressive disease in children than in adults, with important differences in pathophysiology and clinical course. Therefore, the efficacy of disease-modifying therapies may be different in the two populations. Understanding the developmental and regulatory pathways for type 1 diabetes-modifying therapies in children will enable industry, academia, funders, advocacy groups, and regulators to translate new science to clinical care. This consensus report characterizes the fundamental differences in type 1 diabetes between children and adults and proposes a thoughtful approach to better understand the development and regulatory pathways for type 1 diabetes therapies.
Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Adulto , Fatores Etários , Criança , Ensaios Clínicos como Assunto/legislação & jurisprudência , Ensaios Clínicos como Assunto/métodos , Transtornos Cognitivos/etiologia , Consenso , Efeitos Psicossociais da Doença , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Progressão da Doença , Ética Médica , Hemoglobinas Glicadas/metabolismo , Humanos , Insulina/metabolismo , Secreção de Insulina , Produção de Droga sem Interesse Comercial , Qualidade de Vida , Resultado do TratamentoAssuntos
Asiático , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Fatores de Risco , Circunferência da CinturaRESUMO
The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world. Although incidence rates for ESRD attributable to DKD have recently stabilized, these rates continue to rise in high-risk groups such as middle-aged African Americans, Native Americans, and Hispanics. The costs of care for people with DKD are extraordinarily high. In the Medicare population alone, DKD-related expenditures among this mostly older group were nearly $25 billion in 2011. Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions. Major topic areas in DKD included (1) identification and monitoring, (2) cardiovascular disease and management of dyslipidemia, (3) hypertension and use of renin-angiotensin-aldosterone system blockade and mineralocorticoid receptor blockade, (4) glycemia measurement, hypoglycemia, and drug therapies, (5) nutrition and general care in advanced-stage chronic kidney disease, (6) children and adolescents, and (7) multidisciplinary approaches and medical home models for health care delivery. This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.
Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Gerenciamento Clínico , Adolescente , Adulto , Ensaios Clínicos como Assunto , Comorbidade , Atenção à Saúde , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Etnicidade , Humanos , Hipoglicemiantes/classificação , Hipoglicemiantes/uso terapêutico , Testes de Função Renal/métodos , Monitorização Fisiológica/métodos , Guias de Prática Clínica como Assunto , Prevalência , Fatores de RiscoAssuntos
Cuidado da Criança/normas , Creches/normas , Diabetes Mellitus Tipo 1/terapia , Adolescente , Idade de Início , Glicemia/análise , Glicemia/metabolismo , Criança , Cuidado da Criança/métodos , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Atividade Motora , Estados Unidos , Adulto JovemRESUMO
The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world. Although incidence rates for ESRD attributable to DKD have recently stabilized, these rates continue to rise in high-risk groups such as middle-aged African Americans, Native Americans, and Hispanics. The costs of care for people with DKD are extraordinarily high. In the Medicare population alone, DKD-related expenditures among this mostly older group were nearly $25 billion in 2011. Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions. Major topic areas in DKD included 1) identification and monitoring, 2) cardiovascular disease and management of dyslipidemia, 3) hypertension and use of renin-angiotensin-aldosterone system blockade and mineralocorticoid receptor blockade, 4) glycemia measurement, hypoglycemia, and drug therapies, 5) nutrition and general care in advanced-stage chronic kidney disease, 6) children and adolescents, and 7) multidisciplinary approaches and medical home models for health care delivery. This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.
Assuntos
Nefropatias Diabéticas , Adolescente , Idoso , Anti-Hipertensivos/uso terapêutico , Glicemia/análise , Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Criança , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Humanos , Incidência , Testes de Função Renal , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapiaRESUMO
Remarkable progress has been made in strategies to arrest pancreatic ß-cell destruction in type 1 diabetes. Although knowledge of the disease has increased, a safe therapeutic intervention to reverse or prevent it remains elusive. The interaction of genes, immune system, and environment result in a complex disease process that has delayed hopes for a cure. Several well-designed prevention and intervention studies have aspired to test potentially efficacious and safe therapies. This article updates the principles used to design prevention and intervention trials, reviews clinical trials, addresses controversial issues, and provides a framework for future efforts to interdict this condition.