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【热门文献】儿童和青少年2型糖尿病筛查报告研究分析

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2022-09-21      

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在被诊断为2型糖尿病的年轻人中,许多人在刚成年时出现微血管并发症。该研究的目的是回顾儿童和青少年筛查前驱糖尿病和2型糖尿病的利弊证据,为美国预防服务工作小组(USPSTF)提供信息。


关于干预的危害,2个随机对照试验评估了不同的比较,招募了最近诊断出糖尿病的年轻人。只有不到1%的参与者报告了严重的低血糖事件。在TODAY中,与二甲双胍或二甲双胍加生活方式干预组相比,二甲双胍加罗格列酮治疗组的青少年发生轻微低血糖事件更为常见(8.2% vs 4.3% vs 3.4%, P = .05)。


没有合格的研究直接评估儿童和青少年筛查前驱糖尿病和2型糖尿病的益处或危害。对于患有前驱糖尿病或最近诊断出(非筛查检测)糖尿病的年轻人,唯一合格的试验报告了很少的健康结果,组间没有发现差异,尽管证据受到严重的不精确性和随访时间可能不足以评估健康结果的限制


Abstract

Importance: Of youths diagnosed with type 2 diabetes, many develop microvascular complications by young adulthood.

Objective: To review the evidence on benefits and harms of screening children and adolescents for prediabetes and type 2 diabetes to inform the US Preventive Services Task Force (USPSTF).

Data sources: PubMed/MEDLINE, Cochrane Library, and trial registries through May 3, 2021; references; experts; literature surveillance through July 22, 2022.

Study selection: English-language controlled studies evaluating screening or interventions for prediabetes or type 2 diabetes that was screen detected or recently diagnosed.

Data extraction and synthesis: Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings.

Main outcomes and measures: Mortality, cardiovascular morbidity, diabetes-related morbidity, development of diabetes, quality of life, and harms.

Results: This review included 8 publications (856 participants; mean age, 14 years [range, 10-17 years]). Of those, 6 were from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. No eligible studies directly evaluated the benefits or harms of screening. One randomized clinical trial (RCT) (TODAY; n = 699 adolescents with obesity; mean age, 14 years) comparing metformin, metformin plus rosiglitazone, and metformin plus lifestyle intervention reported that 2 youths with recently diagnosed diabetes developed kidney impairment (0 vs 1 vs 1, respectively; P > .99) and 11 developed diabetic ketoacidosis (5 vs 3 vs 3, respectively; P = .70). One RCT of 75 adolescents (mean age, 13 years) with obesity with prediabetes compared an intensive lifestyle intervention with standard care and reported that no participants in either group developed diabetes, although follow-up was only 6 months. Regarding harms of interventions, 2 RCTs assessing different comparisons enrolled youths with recently diagnosed diabetes. Major hypoglycemic events were reported by less than 1% of participants. Minor hypoglycemic events were more common among youths treated with metformin plus rosiglitazone than among those treated with metformin or metformin plus lifestyle intervention in TODAY (8.2% vs 4.3% vs 3.4%, P = .05). In 1 study, gastrointestinal adverse events were more commonly reported by those taking metformin than by those taking placebo (abdominal pain: 25% vs 12%; nausea/vomiting: 17% vs 10%; P not reported).

Conclusions and relevance: No eligible studies directly evaluated the benefits or harms of screening for prediabetes and type 2 diabetes in children and adolescents. For youths with prediabetes or recently diagnosed (not screen-detected) diabetes, the only eligible trials reported few health outcomes and found no difference between groups, although evidence was limited by substantial imprecision and a duration of follow-up likely insufficient to assess health outcomes.


文章连接:

https://jamanetwork.com/journals/jama/fullarticle/2796245?resultClick=1



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