PUDF2020丨张俊清教授:从ADA新指南看Ⅱ型糖尿病综合优化管理

2020-09-26 医学论坛网 医学论坛网

糖尿病是一种慢性疾病,糖尿病的治疗和管理需要以疾病结局为导向调整治疗策略并需要长期坚持,如果不能长期有效的来进行管理,可能会对患者带来不利的影响。

糖尿病是一种慢性疾病,糖尿病的治疗和管理需要以疾病结局为导向调整治疗策略并需要长期坚持,如果不能长期有效的来进行管理,可能会对患者带来不利的影响。

2020ADA指南中特别关注了治疗惰性,强调今早调整治疗方案的重要性。

目前,临床上患者的糖化血红蛋白控制效果并不理想,而糖化血红蛋白不达标的患者中有26.2%的患者未及时启动强化治疗, 在糖化血红蛋白>7%的患者中,启动强化治疗的时间平均大约会滞后两年。

ADA主编Stephen Brunton教授、国内的宁光院士都指出治疗惰性是Ⅱ型糖尿病患者综合管理现状不佳的主要原因。

治疗惰性会源自医生端、患者端以及医疗保健系统等,所以克服治疗惰性需要多方协作共同干预。

因此,2020ADA指南强调应定期评估并及时调整治疗方案,根据患者情况及时采取强化或联合治疗,以满足患者个性化治疗需求。

合并血管疾病的Ⅱ型糖尿病患者

有研究显示,利拉鲁肽降低Ⅱ型糖尿病患者MACE(心血管死亡、非致死性心梗、非致死性卒中)以及单独心血管死亡风险。因此指南推荐这些患者二甲双胍治疗后无论糖化血红蛋白是否达标,应优先推荐联合具有心血管疾病获益的GLP-1RA。

合并心衰和慢性肾脏病的Ⅱ型糖尿病患者

有研究显示,利拉鲁肽不会增加患者因心衰引起的住院风险,同时,利拉鲁肽可降低患者22%的肾脏时间风险。所以确诊心力衰竭或糖尿病肾病的Ⅱ型糖尿病患者在经二甲双胍治疗后无论糖化血红蛋白是否达标均可推荐联合GLP-1RA。

没有相关合并症的Ⅱ型糖尿病患者

不伴有高风险因素或确诊的动脉硬化性心血管疾病、糖尿病肾病以及心力衰竭的患者应根据患者不同需求即使联合药物治疗。目前,低血糖仍是患者治疗过程最常见的不良反应,因此治疗时,推荐优先考虑低血糖风险低的药物。一些迫切需要减重的患者,在二甲双胍治疗不达标的情况下优先推荐减重疗效较好的GLP-1RA。

治疗惰性至现今Ⅱ型糖尿病患者管理状况较差的主要原因,医生需严格遵守糖尿病指南推荐,对疾病进行规范管理。

 

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    2021-05-03 AspirantSuo
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    2020-09-28 般若傻瓜
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    2020-09-26 misszhang

    谢谢MedSci提供最新的资讯

    0

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    2020-09-26 466906000_35880212

    二甲双胍

    0

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