Δημοσιεύτηκαν οι νέες – μερικά αναθεωρημένες – κατευθυντήριες οδηγίες 2024-2025 για τη διαχείριση του διαβήτη στα παιδιά και στους εφήβους από την International Society for Pediatric and Adolescent Diabetes (ISPAD 
).
Citation: Farid H. MahmudISPAD Clinical Practice Guidelines 2024: Editorial Horm Res Paediatr (2024) https://doi.org/10.1159/000543154 | PubMed:39681103
Editorial: (…)This 2024 CPCG Update marks the 7th iteration, with succeeding editions from 1995, 2000, 2009, 2014, 2018, and 2022. Over the years, the CPCG have evolved to embrace innovations in glycemic monitoring, medications, and their delivery, foster cultural awareness, and emphasize optimal care across a broad range of healthcare systems and models. Recent editions have also incorporated more diverse authorship perspectives, increasing geographic and multidisciplinary representation, as well as adding individuals with firsthand diabetes experience. The 2024 CPCG Update features six high-impact chapters in rapidly evolving areas, including advancements in technology (insulin delivery and glucose monitoring), innovations in screening, early-stage monitoring and prevention of type 1 diabetes, insulin and adjunct-to-insulin treatments, management of type 2 diabetes, and glycemic targets(…) περισσότερα »» | κατεβάστε το αρχείο pdf
Οι νέες συστάσεις περιλαμβάνουν σημαντικές ενημερώσεις των κατευθυντήριων οδηγιών του 2022 (σχετικό αρχείο ) από τον ίδιο οργανισμό, στα πεδία – κεφάλαια:
- Chapter 02: Screening, Staging, and Strategies to Preserve Beta-Cell Function in Children and Adolescents with Type 1 Diabetes | κατεβάστε το αρχείο pdf
Abstract: The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This guideline serves as an update to the 2022 ISPAD consensus guideline on staging for type 1 diabetes (T1D). Key additions include an evidence-based summary of recommendations for screening for risk of T1D and monitoring those with early-stage T1D. In addition, a review of clinical trials designed to delay progression to Stage 3 T1D and efforts seeking to preserve beta-cell function in those with Stage 3 T1D are included. Lastly, opportunities and challenges associated with the recent US Food and Drug Administration (FDA) approval of teplizumab as an immunotherapy to delay progression are discussed. - Chapter 03: Type 2 Diabetes in Children and Adolescents | κατεβάστε το αρχείο pdf
Abstact: The ISPAD guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. Youth-onset type 2 diabetes (T2D) results from genetic, environmental, and metabolic causes that differ among individuals and populations. This chapter builds on the 2022 ISPAD guidelines, and summarizes recent advances in the management of T2D in children and adolescents. Updates include diagnostic algorithm for youth with new onset T2D, algorithms and tables for treatment, management, and assessment of co-morbidities and complications and recommendations on recently approved pharmacologic therapies for the treatment of youth-onset T2D and management strategies. - Chapter 08: Glycemic Targets | κατεβάστε το αρχείο pdf
Abstract: The ISPAD guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and updates recommendations on the glycemic targets for children and adolescents living with diabetes. A new target of HbA1c of ≤6.5% (48mmol/mol) for those who have access to advanced diabetes technologies like continuous glucose monitoring (CGM) and automated insulin delivery (AID). This target should be encouraged for all children and adolescents living with diabetes when safely achievable. In other settings, the HbA1c target is ≤7.0% (53mmol/mol). - Chapter 16: Diabetes Technologies: Insulin Delivery | κατεβάστε το αρχείο pdf
Abstract: The ISPAD guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and summarizes recent advances in the technology behind insulin administration, with special emphasis on insulin pump therapy, especially on glucose-responsive integrated technology that is feasible with the use of automated insulin delivery (AID) systems in children and adolescents. - Chapter 17: Diabetes Technologies: Glucose Monitoring | κατεβάστε το αρχείο pdf
Abstract: The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and summarizes recent advances in the technology behind glucose monitoring, and its role in glucose-responsive integrated technology that is feasible with the use of automated insulin delivery (AID) systems in children and adolescents.
◊ Κατεβάστε όλες τις παραπάνω αναθεωρήσεις – ενημερώσεις σε μορφή ενιαίου συγκεντρωτικού αρχείου pdf | Σελίδες:108, Μέγεθος αρχείου: 13.8 MB
(δεν περιλαμβάνεται το Kεφάλαιο 17, το οποίο δημοσιεύτηκε μεταγενέστερα).
◊ Eπίσημη ιστοσελίδα των επικαιροποιημένων συστάσεων από την ISPAD
Θεματικές ενότητες (ISPAD)
* The diagnosis of T1D should be considered in youth with diabetes with the following clinical features: [B]
• BMI <85th percentile
• Age of diabetes onset of <10 years of age
• Pre-pubertal at diabetes onset
• Absence of risk factors and clinical features of T2D
• DKA or cerebral edema at presentation
Pancreatic autoantibodies: glutamic acid decarboxylase-65 (GAD-65), islet antigen-2 (IA-2), zinc transporter 8 (ZnT8) and insulin antibody (IAA)
* Recommended criteria for the diagnosis of T2D: Symptoms of hyperglycemia and ONE of the following laboratory values. [B]
• Hemoglobin A1c (HbA1c) ≥ 6.5% (48 mmol/mol)
• FPG ≥ 126 mg/dL (7.0 mmoL/L)
• Random plasma glucose ≥ 200 mg/dL (11.1 mmol/L)
• 2-hour plasma glucose on an OGTT ≥ 200 mg/dL (11.1 mmoL/L). OGTT: 1.75 g/kg (max 75
g) anhydrous glucose dissolved in water.
• When measuring HbA1c utilize a laboratory based, Diabetes Control and Complications Trial (DCCT) aligned, National Glycohemoglobin Standardization Program (NGSP) certified method. [B]
• In the absence of unequivocal hyperglycemia symptoms (including polyuria, polydipsia, nocturia, unexplained weight loss and general fatigue), utilize TWO of the criteria above or confirmatory testing on a different day.
The following support the diagnosis of T2D [B]
• BMI ≥85th percentile
• Signs of insulin resistance
• Associated metabolic co-morbidities (dyslipidemia, MASLD, hypertension, PCOS)
• Family history of T2D
• Negative (absent) pancreatic autoantibodies
* Monogenic diabetes – The diagnosis of Maturity Onset Diabetes of the Young (MODY) should be considered in youth with the following clinical features: [B]
• BMI < 85th percentile
• Family history of diabetes in one parent and first-degree relatives of that affected parent
• Absence of other risk factors and clinical features of T2D
• Absence of pancreatic autoantibodies
• Features such as genitourinary tract abnormalities, renal cysts, pancreatic atrophy, hyperuricemia or gout (HNF1B MODY)
• Stable isolated fasting hyperglycemia in the range of 100-150mg/dL (5.5-8.5 mmol/L) (GCK MODY)
• History of neonatal diabetes
Citation: ISPAD Clinical Practice Consensus Guidelines 2024: Type 2 Diabetes in Children and Adolescents, Horm Res Paediatr (2024), https://doi.org/10.1159/000543033, PubMed: 39675348