소아 청소년기에 발생한 2형 당뇨병의 임상적 경과
Clinical Course of Childhood and Adolescence Onset Type 2 Diabetes Mellitus
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목적:소아청소년기 2형 당뇨병의 유병율은 1980년대 이후 증가하고 있다. 저자들은 서울대학교병원에서 치료받은 2형 당뇨병 환자들의 진단 당시의 임상적 양상과 만성 합병증을 조사하였다. 방법:18세가 되기 전에 2형 당뇨병으로 진단받은 69명의 의무기록을 후향적으로 검토하였다. 결과:진단 당시의 평균연령은 13.1±2.0세였고, 69.1%가 당뇨병의 가족력이 있었고 66.6%가 진단 당시 과체중이거나 비만이었다. 22.4% (13/58)가 부당경량아였고 이들의 체질량지수는 정상체중으로 태어난 환자군과 차이가 없었다. 7명에서 미세혈관 합병증이 발생하였고 진단부터 합병증 발생까지의 기간은 9.1±3.3년이었으며 당화혈색소 값은 합병증이 없는 군과 차이가 없었다. 결론:본원의 소아청소년 2형 당뇨병 환자의 수는 증가하고 있으며 부당경량아의 분율이 높고 청소년기나 성인기 초기에 미세혈관 합병증이 발생한 환자들이 있었다. 2형 당뇨병 환자들에서 적극적인 위험인자의 제거와 정기적인 합병증검사가 필요하며 부당경량아에 대한 체계적인 관찰이 필요할 것이다.
Abstract
Purpose:Worldwide incidence of type 2 diabetes mellitus in youth is increased for last 3 decades. We reviewed the clinical characteristics of the patients and their long term complications. Methods:We reviewed the medical data of 69 patients who were diagnosed type 2 diabetes mellitus at Seoul National University Children's Hospital before the age of 18 years between January 1991 and December 2007. Results:Forty seven patients (68.1%) developed after 2000. The mean age of onset was 13.1±2.0 years. Forty seven (69.1%) patients had family history of diabetes mellitus and forty six (66.6%) patients had overweight or obesity. Thirteen (22.4%) patients were small for gestational age but their body mass index wasn't increased compared to that of appropriate for gestational age at the onset of disease. There were 7 patients who had microvascular complication and the mean disease duration was 9.1±3.3 years. Hemoglobin A1c was not increased in the complication group compared to the complication-free group. Conclusion:The number of childhood and adolescence onset type 2 diabetes mellitus was increased. The proportion of small for gestation age was high and the long term complication developed in adolescence or early adult life. Early intervention of the risk factors and regular evaluation of the complications are needed and systematized follow-up of small for gestational age is also necessary.
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