medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-11-174-182medsovet-6305Research ArticleШКОЛА ПЕДИАТРАPEDIATRICIAN SCHOOLНарушения углеводного обмена у детей и подростков с ожирениемImpairment of carbohydrate metabolism in children and adolescents with obesityhttps://orcid.org/0000-0001-5689-0194ВитебскаяА. В.VitebskayaA. V.

Витебская Алиса Витальевна - кандидат медицинских наук, доцент, доцент кафедры детских болезней.

119435, Москва, ул. Б. Пироговская, д. 19

Alisa V. Vitebskaya, Cand. Sci. (Med.), Associate Professor of the Department of Childhood Diseases.

19, B. Pirogovskaya St., Moscow, 119435

dr.vitebskaya@gmail.comhttps://orcid.org/0000-0002-9660-8795ПоповичА. В.PopovichA. V.

Попович Анастасия Владимировна, врач – детский эндокринолог детского эндокринологического отделения Университетской детской клинической больницы.

119435, Москва, ул. Б. Пироговская, д. 19

Anastasia V. Popovich, Pediatric Endocrinologist of the Pediatric Endocrinology Department of the University Children’s Clinical Hospital.

19, B. Pirogovskaya St., Moscow, 119435

krutova_nastasya@mail.ruКлинический институт детского здоровья имени Н.Ф. Филатова, Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияFilatov Clinical Institute for Children’s Health, Sechenov First Moscow State Medical University (Sechenov University)Russian Federation202110082021011174182Copyright © Витебская А.В., Попович А.В., 20212021Витебская А.В., Попович А.В.Vitebskaya A.V., Popovich A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6305

Ожирение является одним из социально значимых заболеваний современности и общепризнанным фактором риска развития нарушений углеводного обмена, в т. ч. сахарного диабета (СД) 2-го типа, распространенность которого в детской популяции стремительно растет.

Цель работы

Цель работы. Продемонстрировать наиболее часто встречающиеся варианты нарушений углеводного обмена у детей и подростков с ожирением.

Материалы и методы

Материалы и методы. Обследовано 123 пациента до 18 лет с ожирением, проанализирована структура осложнений ожирения.

Результаты

Результаты. Нарушения углеводного обмена выявлены у 24 пациентов (19%): нарушенная гликемия натощак (НТГ) (8 девочек, 6 мальчиков (11%)), СД 2-го типа (6 девочек, 3 мальчика (7%)) и СД 1-го типа (1 мальчик (1%)). Приведены описания 4 клинических случаев: 1) пациент, 17 лет, с конституциональноэкзогенным ожирением 3-й степени, артериальной гипертензией (АГ), дислипидемией и неалкогольной жировой болезнью печени (НЖБП) и транзиторной НТГ в анамнезе; 2) пациентка, 16 лет, с морбидным ожирением, НЖБП, АГ, синдромом поликистозных яичников (СПКЯ), СД 2-го типа, компенсированным на фоне терапии метформином; 3) пациент, 17 лет, с конституциональноэкзогенным ожирением 3-й степени, АГ, дислипидемией, НЖБП, СД 2-го типа (на помповой инсулинотерапии), осложненным диабетической нефропатией и диабетической полинейропатией; 4) пациент, 12 лет, с СД 1-го типа, манифестировавшим на фоне ожирения.

Заключение

Заключение. При скрининге осложнений ожирения у детей и подростков нарушения углеводного обмена могут выявляться у каждого пятого пациента. Предиабет в детском возрасте может носить транзиторный характер. При выявлении СД у ребенка с ожирением необходимо проводить дифференциальную диагностику СД 1-го и 2-го типов. Необходимо обучать пациентов с СД 2-го типа навыкам самоконтроля наравне с пациентами с СД 1-го типа и мотивировать регулярно контролировать гликемию в домашних условиях.

Obesity is one of the socially significant diseases of our time and is a generally recognized risk factor for the development of carbohydrate metabolism disorders, including type 2 diabetes mellitus (DM), the prevalence of which in the pediatric population is rapidly increasing.

Aim of the study

Aim of the study. To demonstrate the most frequent types of carbohydrate metabolism disorders in children and adolescents with obesity.

Materials and methods

Materials and methods. 123 obese patients under 18 years old were examined and the structure of obesity complications was analyzed.

Results

Results. Carbohydrate metabolism disorders were identified in 24 patients (19%): impaired fasting glycemia (IFG) (8 girls, 6 boys (11%)), type 2 DM (6 girls, 3 boys (7%)), and type 1 DM (1 boy (1%)). Descriptions of 4 clinical cases are given: 1) patient, 17 years old, with constitutional-exogenous obesity of 3rd degree, arterial hypertension (AH), dyslipidemia and nonalcoholic fatty liver disease (NAFLD) and a history of transient IFG; 2) patient, 16 years old, with morbid obesity, NAFLD, AH, polycystic ovarian syndrome (PCOS), type 2 DM, compensated on metformin therapy; 3) patient, 17 years old, with constitutional-exogenous obesity of the 3rd degree, AH, dyslipidemia, NAFLD, type 2 DM (on insulin pump therapy), complicated by diabetic nephropathy and diabetic polyneuropathy; 4) patient, 12 years old, with type 1 DM, manifested against the background of obesity.

Conclusion

Conclusion. When screening for obesity complications in children and adolescents, carbohydrate metabolism disorders may be detected in one in five patients. Prediabetes in childhood can be transient. When a child with obesity is identified, differential diagnosis of type 1 and type 2 DM should be made. It is necessary to teach patients with type 2 DM the skills of self-monitoring on a par with patients with type 1 DM and motivate them to control glycemia regularly at home.

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The authors declare that there are no conflicts of interest present.