改善1型糖尿病的发现和管理。

Practitioner Pub Date : 2016-01-01
Peter Hammond
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引用次数: 0

摘要

在英国,约有37万成年人患有1型糖尿病,约占所有确诊糖尿病患者的10%。在1型糖尿病中,由于自身免疫对β细胞的破坏,β细胞胰岛素分泌不足。然而,患者不受胰岛素抵抗的影响,因此不会经常出现2型糖尿病的代谢综合征特征。NICE建议,当怀疑1型糖尿病,但表现不典型(如年龄≥50岁、BMI≥25 kg/m2、高血糖进展缓慢或前驱症状较长)时,考虑进一步进行自身抗体检测或c肽检测;1型糖尿病已确诊并开始治疗,但临床怀疑患者可能患有单基因型糖尿病,c肽和/或自身抗体检测可指导基因检测的使用;分类不确定,确认1型糖尿病将对治疗产生影响。有组织的教育是提供有效自我管理工具的基础。在新诊断为1型糖尿病后,应在12个月内提供结构化教育。新诊断的患者应提供一种方案,包括基础(长效)胰岛素和在用餐时给药(速效)胰岛素。最佳的治疗方案,应该从诊断开始提供,是每日两次地特米胰岛素和在用餐时间给予的速效类似物的组合。然而,如果血糖控制已经在替代胰岛素方案中得到优化,则不应停止使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Improving the detection and management of type 1 diabetes.

Type 1 diabetes affects around 370,000 adults in the UK, about 10% of all those diagnosed with diabetes. In type 1 diabetes there is a lack of beta cell insulin secretion as a result of autoimmune destruction of the beta cells. However, patients are not affected by insulin resistance, and so do not routinely experience the features of metabolic syndrome that occur in type 2 diabetes. NICE recommends considering further investigation with autoantibody testing or measurement of C-peptide when: type 1 diabetes is suspected but the presentation includes atypical features (e.g. age ≥50, BMI ≥ 25 kg/m2, slow evolution of hyperglycaemia or long prodrome); type 1 diabetes has been diagnosed and treatment started but there is a clinical suspicion that the patient may have a monogenic form of diabetes, and C-peptide and/or autoantibody testing may guide the use of genetic testing; classification is uncertain, and confirming type 1 diabetes would have implications for therapy. Structured education is the cornerstone of care providing tools to allow effective self-management. Following a new diagnosis of type 1 diabetes structured education should be offered within 12 months. Newly diagnosed patients should be offered a regimen including a basal (long-acting) insulin with bolus (rapid-acting) insulin given at mealtimes. The optimal regimen, which should be offered from diagnosis, is a combination of twice daily insulin detemir and a rapid-acting analogue given at mealtimes. However, where glycaemic control is already optimised on an alternative insulin regimen this should not be discontinued.

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来源期刊
Practitioner
Practitioner Medicine-Family Practice
自引率
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1
期刊介绍: The term "practitioner" of course has general application. It is used in a wide variety of professional contexts and industry and service sectors. The Practioner.Com portal is intended to support professionals in a growing number of these. Across a range of sub-sites, we offer a raft of useful information and data on the core topic(s) covered. These range from Legal Practioner (legal profession) through ITIL Practitioner (IT Infrastructure Library), Information Security Practitioner, Insolvency Practitioner (IP), General Practitioner and beyond.
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