Evidence-based Paediatric and Adolescent Diabetes PDF
Preview Evidence-based Paediatric and Adolescent Diabetes
BLUK103-Allgrove August1,2007 16:47 Evidence-based Paediatric and Adolescent Diabetes Edited by Jeremy Allgrove BartsandtheLondonNHSTrust RoyalLondonHospital London,UK Peter G.F. Swift LeicesterRoyalInfirmary Children’sHospital Leicester,UK Stephen Greene UniversityofDundee DepartmentofMaternalandChildHealthSciences NinewellsHospital Dundee,UK BLUK103-Allgrove August1,2007 16:47 (cid:2)C 2007byBlackwellPublishing BMJBooksisanimprintoftheBMJPublishingGroupLimited,usedunderlicence BlackwellPublishing,Inc.,350MainStreet,Malden,Massachusetts02148-5020,USA BlackwellPublishingLtd,9600GarsingtonRoad,OxfordOX42DQ,UK BlackwellPublishingAsiaPtyLtd,550SwanstonStreet,Carlton,Victoria3053,Australia TherightoftheAuthortobeidentifiedastheAuthorofthisWorkhasbeenassertedin accordancewiththeCopyright,DesignsandPatentsAct1988. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrieval system,ortransmitted,inanyformorbyanymeans,electronic,mechanical, photocopying,recordingorotherwise,exceptaspermittedbytheUKCopyright,Designs andPatentsAct1988,withoutthepriorpermissionofthepublisher. Firstpublished 1 2007 LibraryofCongressCataloging-in-PublicationData Evidence-basedpaediatricandadolescentdiabetes/editedbyJeremyAllgrove,PeterG.F. Swift,StephenGreene. p.;cm. “BMJbooks.” Includesbibliographicalreferences. ISBN978-1-4051-5292-1(hardback) 1.Diabetesinchildren. 2.Diabetesinadolescence. 3.Evidence-basedmedicine. I.Allgrove,Jeremy. II.Swift,PeterG.F. III.Greene,StephenA. [DNLM:1.DiabetesMellitus. 2.Adolescent. 3.Child. 4.Evidence-BasedMedicine. WK810E932007] RJ420.D5.E952007 618.3(cid:3)646–dc22 2007013626 ISBN:978-1-4051-5292-1 AcataloguerecordforthistitleisavailablefromtheBritishLibrary Setin9.5/12MinionbyAptaraInc.,NewDelhi,India PrintedandboundinSingaporebyMarkonoPrintMediaPteLtd CommissioningEditor:MaryBanks EditorialAssistant:VictoriaPittman DevelopmentEditor:SimoneDudziak ProductionController:RachelEdwards ForfurtherinformationonBlackwellPublishing,visitourwebsite: http://www.blackwellpublishing.com Thepublisher’spolicyistousepermanentpaperfrommillsthatoperateasustainable forestrypolicy,andwhichhasbeenmanufacturedfrompulpprocessedusingacid-freeand elementarychlorine-freepractices.Furthermore,thepublisherensuresthatthetextpaper andcoverboardusedhavemetacceptableenvironmentalaccreditationstandards. 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BLUK103-Allgrove August2,2007 14:50 Contents Listofcontributors,v Foreword,ix Preface,xi 1 Methodologyofevidence-basedmedicine,1 JeremyAllgrove 2 Definition,epidemiologyandclassificationofdiabetesandstructure ofthediabetesteam,9 MariaCraig,SarahJ.Glastras&KimDonaghue 3 Aetiologyoftype1diabetesmellitus–genetics,autoimmunity andtriggerfactors,26 LoredanaMarcovecchio,DavidB.Dunger, MarkPeakman&KeithW.Taylor 4 Type1diabetesmellitus–management,42 JoanneJ.Spinks,JulieA.Edge,KrystynaMatyka&ShitalMalik 5 Type1diabetesmellitusintheveryyoungchild,63 StuartBrink 6 Adolescenceanddiabetes:clinicalandsocialscienceperspectives,76 AlexandraGreene&StephenGreene 7 Managementofspecialsituationsindiabetes,93 FergusJ.Cameron&JeremyAllgrove 8 Dietarymanagement:optimisingdiabetesoutcomes,104 SheridanWaldron 9 Educationinchildhooddiabetes,123 PeterG.F.Swift 10 Psychologicalinterventionsinchildhooddiabetes,141 JohnW.Gregory&SueChannon 11 Screeningforassociatedconditionsandpreventionofcomplications,157 CatherinePeters&JeremyAllgrove 12 Type2diabetesmellitus–genetics,diagnosisandmanagement. Polycysticovariansyndrome,175 JohnPorter&TimothyG.Barrett iii BLUK103-Allgrove August2,2007 14:50 Contents 13 Rareformsofdiabetes,197 JulianShield,MaciejT.Malecki,NicolaA.Bridges&JeremyAllgrove 14 Diabetesandinformationtechnology,221 KennethJ.Robertson Abbreviations,228 Index,232 iv BLUK103-Allgrove August2,2007 14:50 Contributors JeremyAllgroveMBBChir,MA, Children’sCentre MD,FRCP,FRCPCH StDavid’sHospitalCanton ConsultantinPaediatricEndocrinologyand Cardiff,UK Diabetes BartsandtheLondonNHSTrust MariaCraig,MBBS,PhD,FRACP, RoyalLondonHospital MMed(ClinEpid) London,UK PaediatricEndocrinologist InstituteofEndocrinologyandDiabetes TimothyG.BarrettPhD,MBBS, Children’sHospitalWestmead MRCP,MRCPCH,DCH Westmead,Australia ProfessorofPaediatrics InstituteofChildHealth KimDonaghue,MBBS,PhD, Birmingham,UK FRACP AssociateProfessor NicolaA.Bridges,DM,MRCP, HeadofDiabetesServices FRCPCH TheChildren’sHospitalatWestmead ConsultantPaediatricEndocrinologist UniversityofSydney ChelseaandWestminsterHospital Westmead,Australia London,UK DavidB.Dunger,MD,FRCPCH StuartBrink,MD ProfessorofPaediatrics SeniorEndocrinologist DepartmentofPaediatrics New England Diabetes and Endocrinology Addenbrooke’sNHSTrust Center(NEDEC) Cambridge,UK AssociateClinicalProfessorofPediatrics TuftsUniversitySchoolofMedicine Waltham,USA JulieA.Edge,MD,FRCPCH ConsultantinPaediatricDiabetes FergusJ.Cameron andEndocrinology AssociateProfessor DepartmentofPaediatrics HeadDiabetesServices JohnRadcliffeHospital DeputyDirector Oxford,UK DepartmentofEndocrinologyandDiabetes RoyalChildren’sHospital SarahJ.Glastras,MBBS(Hons), Parkville,Australia BScPsychol(Hons) JuniorMedicalOfficer SueChannon,BScDClinPsych InstituteofEndocrinologyandDiabetes ConsultantClinicalPsychologist TheChildren’sHospitalatWestmead ChildPsychologyDepartment Westmead,Australia v BLUK103-Allgrove August2,2007 14:50 Contributors AlexandraGreene MarkPeakman,BSc,MSc,PhD, SeniorResearchFellow MBBS,FRCPath HealthServicesResearchCentre ProfessorofClinicalImmunology UniversityofAberdeen DepartmentofImmunology Scotland,UK King’sCollegeLondon SchoolofMedicineatGuy’s StephenGreene,MBBS,FRCP, King’sCollegeandStThomas’Hospital FRCPCH Guy’sHospital London,UK ReaderinChildandAdolescentHealth MaternalandChildHealthSciences UniversityofDundee CatherinePeters,MD,MRCPCH NinewellsHospital SpRPaediatricEndocrinology Dundee,UK RoyalLondonHospital London,UK JohnW.Gregory,MBChB,DCH, MD,FRCP,FRCPCH JohnPorter,BA(Hons),MBBS ProfessorofPaediatricEndocrinology SpecialistRegistrar DepartmentofChildHealth DepartmentofEndocrinology WalesCollegeofMedicine BirminghamChildren’sHospital CardiffUniversity Birmingham,UK Cardiff,UK MaciejT.Malecki,MD,PhD KennethJ.Robertson,MBChB, FRCP,FRCPCH SeniorLecturer DepartmentofMetabolicDiseases ConsultantPaediatrician JagiellonianUniversity RoyalHospitalforSickChildren MedicalCollege Glasgow,UK Krakow,Poland J.P.H.Shield,MD,MRCP,FRCPCH ShitalMalik,MRCPCH,MD,DCH, ReaderinDiabetesandMetabolic DNB Endocrinology PaediatricSpecialistRegistrar UniversityofBristol UniversityHospitalCoventryand BristolRoyalHospitalforChildren WarwickshireNHSTrust Bristol,UK Coventry,UK JoanneJ.Spinks,BSc(Hons),BM, LoredanaMarcovecchio MRCPCH ResearchFellow SpecialistRegistrarPaediatricDiabetesand UniversityofCambridge Endocrinology DepartmentofPaediatrics JohnRadcliffeHospital Addenbrooke’sHospital Oxford,UK Cambridge,UK PeterG.F.Swift,MA,FRCPCH, KrystynaMatyka,MRCP,MD DCH SeniorLecturerinPaediatrics ConsultantPaediatrician ClinicalSciencesResearchInstitute LeicesterRoyalInfirmary UniversityofWarwick Children’sHospital Coventry,UK Leicester,UK vi BLUK103-Allgrove August2,2007 14:50 Contributors KeithW.Taylor,MB,PhD,FRCP SheridanWaldron,PhD EmeritusProfessor DieteticManager BartsandtheLondon LeicestershireNutritionandDietetic QueenMary’sSchoolofMedicineand Service Dentistry LeicesterRoyalInfirmary London,UK Leicester,UK vii BLUK103-Allgrove August2,2007 14:50 Foreword There appear to be a number of irrefutable facts about diabetes in childhood: some to dowithaetiologyandothersrelatedtothemanagementofthisgroupofdisorders[1]. First, type 1 diabetes mellitus (T1DM) accounts for the vast majority of children and youths with diabetes. T1DM is increasing in incidence worldwide at the rate of 2–5% peryear,withimmigrantpopulationsrelativelyquicklyassumingthehigherincidencein their new countries. Second, there has been a staggering increase in childhood obesity worldwide,bringingwithitasignificantincreaseinearlieronsetofT2DM,probablynot yetoftheepidemicproportionsintheyouththatmanyhavethreatened.Third,molec- ulargenetictechnologieshavehelpedunravelthemysteriesofanincreasingnumberof monogenictypesofdiabetes,bothneonatalandchildhood/youngadultonset.Finally,the dataderivedfromtwosentinelrandomisedcontroltrials,namelytheDiabetesControl and Complications Trial (DCCT) andits extension observation study Epidemiology of DiabetesInterventionsandComplications(EDIC)inT1DM,andtheUnitedKingdom ProspectiveDiabetesStudy(UKPDS)inT2DMinformthecurrentapproachtothecontrol ofhyperglycaemiainordertopreventtheonsetorslowtheprogressionofdiabetes-related complications. Whilecertain‘facts’mayseemirrefutable,whatislessrobustarethedataneededtofill inthedetailsaboutthewhy’s,when’s,what’sandhow-to’saboutthecause,courseand complicationsofalltypesofdiabetes.Thisiswhereacarefuldistillationoftheavailable informationisrequiredanddecisionsaremadebasedonthemostconvincingevidence. Thedisciplineofevidence-basedmedicinehasarisenandrapidlyevolvedasameansof accomplishingthisasaccuratelyandreproduciblyaspossibleinordertoprovidethestate- of-the-artrecommendationsfordiagnosis,treatmentandprognosisoftheconditionunder review.Thereareseveralcaveatsthatwarrantattentionhere.First,therecommendations can only be as strong as the data that underpin them. Second, there is in the field of diabetesinchildrenandtheyouthapaucityofdataonwhichtomakethehighestgrade recommendations.Thisisafactoflifeinmostareasofpaediatricmedicine.Finally,the evidencechanges,anditmaydosoquiterapidlywiththeemergenceofnewtherapeutic agents(e.g.insulinanaloguesandoralhypoglycaemicagents).Hopefully,thismeansthat assteadilyastheevidenceaccumulatesandimproves,sodoesthetreatmentandoutcome ofthecondition. A couple of sobering thoughts are in order here. First, a study from the Centers for DiseaseControlinAtlanta,USA[2],in2003reportedalossofalmost20lifeyearsfor10- year-oldchildrendiagnosedwithdiabetesintheyear2000.AndGalefromBristol[3]has pointedoutthatthemajorityofchildrenwithdiabetesworldwidewillnotachievelevels ofcontrolcommensuratewithreasonableprotectionfrommicrovascularcomplications. Furthermore,‘theindividualandcommunallegacyofpoorglucosecontrolwillremainwith usforthenextthirtyyears,evenifaneffectivemeansofpreventingnewcasesofthedisease ix BLUK103-Allgrove August2,2007 14:50 Foreword weretobeintroducedtomorrow.’Galeconcludedthat‘thegreatestneedisformoreeffective implementationofwhatisalreadyknown’[3]. In this book, editor Jeremy Allgrove has marshalled the energies and expertise of a highlyqualifiedandaccomplishedinternationalgroupofchildhooddiabetesspecialists tosiftcarefullythroughtheevidence(‘whatisalreadyknown’)andmakethebestpossible recommendationsforthecareofchildrenandtheyouthwithdiabetes.Theresultisan outstandingadditiontotheliteratureinthisfield.Thishasbeenagargantuan,buthighly worthwhile,taskatanumberoflevels.First,ithelpsthereaderunderstandjusthowstrong (ornot)theevidenceisforrecommendingoneapproachoveranother.Then,ithighlights theareaswheretheevidenceisnotbasedonthetypeofstudiesneededtoprovidehigh- grade recommendations, but in which there is general consensus as to a most sensible approach.Inmanyoftheseinstances,thegold-standardstudy,arandomisedcontrolled trial,isunlikelytobeperformed.Finally,itlaysbaretheissuesthatremaininadequately addressedsuchthatnodefinitiverecommendationscanbemade. Undoubtedly,boththeeditorandthechapterauthorsaswellasthereadershopethat therecommendationswillsoonbeoutofdatewiththeemergenceof‘newerandbetter’ approachestodiabetespredictionandpreventioninbothT1DMandT2DM,management thatfacilitatesachievementandmaintenanceofnormoglycaemiawithouttheever-present threatofhypoglycaemiaandpreventionorreversalofcomplications.Untilsuchtimeas theseadvancesbecomereality,thisvolumewillstandasawonderfulnavigatorforhealth- careprofessionalsinvolvedinthecareofchildrenwithalltypesofdiabetes.Myheartiest congratulationstoDrAllgroveandhiscontributorsfortheirsuperbefforts. DenisDaneman PastPresident,ISPAD References 1 DanemanD.Type1diabetes.Lancet2006;367:847–58. 2 NarayanKM,BoyleJP,ThompsonTJetal.LifetimeriskfordiabetesmellitusintheUnitedStates.JAMA 2003;290:1884–90. 3 GaleEA.Type1diabetesintheyoung:theharvestofsorrowgoeson.Diabetologia2005;48:1435–8. x BLUK103-Allgrove August2,2007 14:50 Preface Thisbookisintendedtobepartofaseriesofevidencebasedpublicationsonavariety oftopics.Itisparticularlyintendedasacompanionvolumeto‘Evidence-BasedDiabetes’ whichwilldealinasimilarmannerwiththefieldofadultdiabetes.Itisnotintendedto beyetanotherguidelinetothetreatmentofdiabetesasseveralofthesehavealreadybeen published,butrathertoconcentrateontheevidencethatisavailableinthepaediatricfield tosupportthedevelopmentofthoseguidelines.Whilstwehavetriedtobeascompre- hensiveaspossible,therearecertaintopicsthathavenotyethadasignificantimpacton paediatricpracticeandarethereforenotcovered.Theseincludeinhaledinsulins,thearti- ficialpancreasandpancreaticcelltransplantation.Nevertheless,therearetopicscovered, notleastthechapteronType2Diabetes,whichareunlikelytohavebeenincludedina similarpublicationevenfiveyearsagobutwhichareofincreasingimportancetoday. Ithasbeenanenormousprivilegetohavebeenaskedtoeditthiseditionof‘Evidence- BasedPaediatricandAdolescentDiabetes’andagreatpleasuretobeabletoworkwith myco-authors,PeterSwiftandStephenGreene,bothofthemlong-standingcolleagues andgoodfriends.Iwishtothankthemandallofourco-authorsfortheirhardworkand effortinseeingthisbookthroughtoitsfinalstages.Ialsowishtothankthepublishers, Blackwell’s,fortheirunstintingsupportandencouragementinmakingitpossible. Manythanksalsotoalloftheauthorswhohavecontributedtothebookandfortheir efforts in getting manuscripts in on time so that publication can go ahead within the timeframeoriginallyenvisaged.FinallyIwishtothankmywife,Natalie,forherpatience andunderstandingintoleratingmyslavingoverahotcomputerwhenotherattractions beckoned. Whenoneisresponsibleforeditingabookthatisdependentuponevidence,itis,of course, necessary to ensure that the evidence presented is as was originally published, eveniftheconclusionsreachedinthosepapersweredubious.MartinRouth(1755–1854), BritishacademicandPresidentofMagdalenCollege,Oxfordfrom1791untilhisdeath in1854,wasonceaskedbyanadmiringstudent,towardstheendofhislife,tosupplya precept which mightserveasa guidingprinciplein ayoungman’slife. ‘I think, sir,’ he replied,afteramoment’sthought,‘sinceyoucomefortheadviceofanoldman,youwill finditaverygoodpracticealwaystoverifyyourreferences!’Ihopethatallofthereferences quotedherehavebeenverified. JeremyAllgrove, Editor-in-Chief xi
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