目的 构建1型糖尿病儿童/青少年低血糖预防与管理策略,为降低低血糖发生率、优化血糖综合管理提供临床实践依据。方法 检索建库至2023年8月国内外关于儿童1型糖尿病低血糖预防管理的所有证据,包括临床实践指南、证据总结、最佳实践信息册、专家共识、系统评价及原始研究。结果 本研究共纳入9篇文献,包括3篇实践指南,4篇专家共识,1篇临床决策,1篇证据总结,从低血糖识别、危险因素、血糖监测目标、血糖监测、胰岛素治疗方案、健康教育、饮食、运动、心理支持9个方面,共34条证据进行介绍,综合了国内外对1型糖尿病儿童/青少年低血糖预防策略的最佳证据。结论 本研究基于国内外最新证据,系统阐述了1型糖尿病儿童/青少年低血糖的预防策略,证据内容全面,为提高临床护理人员低血糖防范意识、降低低血糖发生风险,构建系统的低血糖预防控制策略提供可靠的理论依据。
Abstract
Objective To establish strategies for preventing and managing hypoglycemia in children and adolescents with type 1 diabetes, in order to provide a clinical practice basis for reducing the incidence of hypoglycemia and optimizing comprehensive blood sugar management. Methods All domestic and foreign evidence on the prevention and management of hypoglycemia in children was retrieved until August 2023, including clinical practice guidelines, evidence summaries, best practice information books, expert consensus, systematic reviews, and original studies. Results This study included 9 articles, comprising 3 practical guidelines, 4 expert consensus articles, 1 clinical decision, and 1 evidence summary, covering 9 aspects ranging from hypoglycemia identification, risk factors, blood sugar monitoring, insulin treatment plans, health education, diet, exercise, and psychological support. It presents a total of 34 pieces of evidence, synthesizing the best evidence from both domestic and international sources on hypoglycemia prevention strategies for children and adolescents with type 1 diabetes. Conclusion Based on the latest evidence from domestic and global sources, this study systematically illustrates prevention strategies for hypoglycemia in children and adolescents with type 1 diabetes, providing comprehensive evidence and a reliable theoretical basis for raising clinical caregivers' awareness of hypoglycemia prevention, reducing the risk of hypoglycemia occurrence, and constructing a systematic hypoglycemia prevention and control strategy.
关键词
1型糖尿病 /
低血糖 /
预防 /
儿童
Key words
type 1 diabetes /
hypoglycemia /
prevention /
children
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参考文献
[1] Abraham MB, Jones TW, Naranjo D, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes[J]. Pediatric Diabetes, 2018, 19: 178-192.
[2] Jones TW, ISPAD Hypoglycemia Guidelines Writing Group. Defining relevant hypoglycemia measures in children and adolescents with type 1 diabetes[J]. Pediatric Diabetes, 2018, 19(3): 354-355.
[3] Pate T, Klemenčič S, Battelino T, et al. Fear of hypoglycemia, anxiety, and subjective well-being in parents of children and adolescents with type 1 diabetes[J]. J Health Psychol, 2019, 24(2): 209-218.
[4] 梁兰芳,钟艳清,黄程辉. 2型糖尿病患者住院期间低血糖监管及预防的循证证据总结[J]. 黑龙江医药,2021,34(4):985-987.
Liang LF,Zhong YQ,Huang CH.During hospitalized patients with type 2 diabetes low blood sugar regulation and prevention of evidence-based evidence[J].Heilongjiang Medicine,2021,34(4):985-987.(in Chinese)
[5] 周芬,郝玉芳,丛雪,等.指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J].护理学报,2018,25(18):56-58.
Zhou F,Hao YF,Cong X,et al.Guidelines research and evaluation tool somethingⅡ and each domain score of supplementary explanation and thinking[J].J Nur,2018,25(18):56-58. (in Chinese)
[6] 赵娟,孙迎红,李卫峰,等. 成人恶性肿瘤患者PICC血栓预防的最佳证据总结[J]. 护士进修杂志,2020,35(13):1197-1202.
Zhao J,Sun YH,Li WF,et al.PICC in adult patients with malignant tumor thrombus prevention the best evidence[J].The Nurse Education Magazine,2020,35(13):1197-1202.(in Chinese)
[7] 胡雁,郝玉芳.循证护理学[M].2版.北京:人民卫生出版社, 2018.
Hu Y,Hao YF.Evidence-based nursing[M].Version 2.Beijing: People's medical publishing house,2018.(in Chinese)
[8] National Collaborating Centre for Women's and Children's Health (UK).Diabetes (type 1 and type 2) in children and young people: Diagnosis and management[M]. London: National Institute for Health and Care Excellence (UK); 2015.
[9] American Diabetes Association. 13. Children and adolescents:Standards of medical care in diabetes-2020[J]. Diabetes Care, 2020, 43(Suppl 1):163-182.
[10] Craig ME, Twigg SM, Donaghue KC, et al. National evidence‐based clinical care guidelines for type 1 diabetes in children, adolescents and adults[S]. Australian Government Department of Health and Ageing, Canberra 2011.
[11] 中华医学会儿科学分会内分泌遗传代谢学组,中华儿科杂志编辑委员会.中国儿童1型糖尿病标准化诊断与治疗专家共识(2020版)[J]. 中华儿科杂志,2020,58(6):447-454.
[12] American Diabetes Association Professional Practice Committee. American Diabetes Association Professional Practice Committee, Draznin B, et al. 12. retinopathy, neuropathy, and foot care:Standards of medical care in Diabetes-2022[J]. Diabetes Care, 2022, 45: 185-194.
[13] Abraham MB, Jones TW,Naranjo D,et al.ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes[J].Pediatr Diabetes, 2018,19(27):178-192.
[14] Couper JJ, Haller MJ, Greenbaum CJ, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Stages of type 1 diabetes in children and adolescents[J]. Pediatric Diabetes, 2018, 19(27): 20-27.
[15] Handelsman Y, Mechanick JI, Blonde L, et al. American association of clinical endocrinologists medical guidelines for clinical practice for developing a diabetes mellitus comprehensive care plan[J]. Endocr Pract, 2011, 17 (2):1-53.
[16] 王锐,李智,杨芹,等. 1型糖尿病患儿居家低血糖识别及处理最佳证据总结[J]. 护理学报,2022,29(7):50-56.
Wang R,Li Z,Yang Q,et al.Children with type 1 diabetes hypoglycemia recognize and deal with the best evidence that occupy the home[J].J Nurs,2022,29(7):50-56.(in Chinese)
[17] 王春青,胡雁.JBI 证据预分级及证据推荐级别系统(2014 版)[J].护士进修杂志,2015,30(11):964-967.
Wang CQ,Hu Y. JBI evidence classification and the level of evidence to recommend system(2014)[J].J Nurs Train,2015,30(11):964-967.(in Chinese)
[18] Blasetti A, Chiuri RM, Tocco AM, et al. The effect of recurrent severe hypoglycemia on cognitive performance in children with type 1 diabetes:A meta-analysis[J]. J Child Neurol, 2011, 26(11): 1383-1391.
[19] Chiang JL, Kirkman MS, Laffel LMB, et al. Type 1 diabetes through the life span:A position statement of the American Diabetes Association[J]. Diabetes care, 2014, 37(7): 2034-2054.
[20] Blair J, McKay A, Ridyard C, et al. Continuous subcutaneous insulin infusion versus multiple daily injections in children and young people at diagnosis of type 1 diabetes: The SCIPI RCT[J]. Health Technol Assess, 2018, 22(42): 1-112.
[21] Berhe T, Postellon D, Wilson B, et al. Feasibility and safety of insulin pump therapy in children aged 2 to 7 years with type 1 diabetes:A retrospective study[J]. Pediatrics, 2006, 117(6): 2132-2137.
[22] Miculis CP, De Campos W, da Silva BoguszewskiMC. Correlation between glycemic control and physical activity level in adolescents and children with type 1 diabetes[J]. J Phys Act Health, 2015, 12(2): 232-237.
[23] Beraki , Magnuson A, Srnblad S, et al. Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes:Results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS)[J]. Diabetes Res Clin Pract, 2014, 105(1): 119-125.
[24] Quirk H, Blake H, Tennyson R, et al. Physical activity interventions in children and young people with type 1 diabetes mellitus: A systematic review with meta‐analysis[J]. Diabet Med, 2014, 31(10): 1163-1173.
[25] Ostman C, Jewiss D, King N, et al. Clinical outcomes to exercise training in type 1 diabetes:A systematic review and meta-analysis[J]. Diabetes Res Clin Pract, 2018, 139: 380-391.
[26] Galler A, Lindau M, Ernert A, et al. Associations between media consumption habits, physical activity, socioeconomic status, and glycemic control in children, adolescents, and young adults with type 1 diabetes[J]. Diabetes care, 2011, 34(11): 2356-2359.
[27] Svoren BM, Butler D, Levine BS, et al. Reducing acute adverse outcomes in youths with type 1 diabetes:A randomized, controlled trial[J]. Pediatrics, 2003, 112(4): 914-922.
[28] Ellis DA, Frey MA, Naar-King S, et al. Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control: A randomized controlled trial[J]. Diabetes Care, 2005, 28(7): 1604-1610.
[29] American Diabetes Association. 13. Children and adolescents: Standards of medical care in diabetes-2020[J]. Diabetes Care, 2020, 43(Suppl 1): 163-182.
[30] Sundberg F, Barnard K, Cato A, et al. Managing diabetes in preschool children[J]. Pediatric Diabetes, 2017, 18(7): 499-517.
[31] McGill DE, Levitsky LL. Management of hypoglycemia in children and adolescents with type 1 diabetes mellitus[J].Curr Diab Rep,2016,16(9):88.
[32] Riddell MC, Gallen IW, Smart CE, et al. Exercise management in type 1 diabetes:A consensus statement[J]. Lancet Diabetes Endocrinol, 2017,5(5):377-390.
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