2012ADA/EASD立场声明-2型糖尿病患者的高血糖管理:以患者为中心的治疗

2012-04-27 美国糖尿病协会；欧洲糖尿病协会 Diabetes Care

2012ADA+EASD立场声明-2型糖尿病患者的高血糖管理-以患者为中心的治疗.pdf 美国糖尿病学会(ADA)和欧洲糖尿病研究协会(EASD)联合发布立场声明，强调对2型糖尿病患者的高血糖进行个体化的治疗。这一最新指南于4月19日在线发表于Diabetes Care和Diabetologia。新指南建议如下：　　? 必须根据患者具体特点制定个体化的血糖目标和降血糖治疗方案;

2012ADA+EASD立场声明-2型糖尿病患者的高血糖管理-以患者为中心的治疗.pdf

美国糖尿病学会(ADA)和欧洲糖尿病研究协会(EASD)联合发布立场声明，强调对2型糖尿病患者的高血糖进行个体化的治疗。这一最新指南于4月19日在线发表于Diabetes Care和Diabetologia。

新指南建议如下：

　　♦ 必须根据患者具体特点制定个体化的血糖目标和降血糖治疗方案;

　　♦ 所有2型糖尿病治疗方案的主体仍然是饮食、运动和患者教育;

　　♦ 在无禁忌证的情况下，二甲双胍是首选的一线降糖治疗药物;

　　♦ 关于二甲双胍外的降糖药物应用，目前数据有限。合理的做法是在二甲双胍基础上额外增加1到2种口服药物或注射药物进行联合治疗，以尽可能减少副反应;

　　♦ 为了控制血糖，很多患者最终需要接受胰岛素单一治疗或联合其他降糖药治疗;

　　♦ 患者应尽可能参与到所有的治疗决策中来，制定决策时以自己的喜好、需求和利益为重点。

　　♦ 降糖的主要目标之一应是全面降低心血管风险。

　　该声明的编写小组组长——耶鲁大学糖尿病中心主任Silvio E. Inzucchi博士指出，对于2型糖尿病患者，除了应重视血糖控制之外，还应重视对其他心血管危险因素的管理，如降压和调脂治疗、抗血小板治疗和戒烟治疗等。

　　Inzucchi博士指出，以患者为中心的治疗是对患者喜好、需求和价值的尊重和回应，这种方法尤其适用于2型糖尿病患者，因为在2型糖尿病的治疗中，采取何种生活方式最终仍由患者自己决定。另外，让患者参与治疗决策也有助于提高其对治疗的依从性。

　　新指南的其他建议包括：

　　♦ 血糖控制——血红蛋白A1c的控制目标仍为低于7%，与既往无异。然而，根据个体患者考虑因素可适当调整目标，包括：患者态度和预期治疗力度、低血糖相关风险、其他不良事件、病程、预期寿命、重要合并症、血管并发症、资源和支持系统。

　　♦ 生活方式干预——旨在增加活动量及优化食物摄入的生活方式干预是任何2型糖尿病治疗方案的基础。建议对所有患者提供标准化的一对一或集体式普通糖尿病教育。

　　♦ 药物选择——与既往指南一样，该声明也认为二甲双胍是最佳的一线药物，除非存在禁忌证。另外，加用1~2种口服或注射药物也较为合理，不过需尽可能减少副作用。为了维持血糖控制，许多患者需要接受单纯胰岛素治疗或在胰岛素治疗基础上加用其他药物。

　　该声明建议考虑在二甲双胍基础上加用其他主要类别的降糖药物(磺脲类、噻唑烷二酮类、DPP-4抑制剂、GLP-1受体拮抗剂和胰岛素)，以及过渡至单独使用胰岛素和各种基于胰岛素的方案。

　　♦ 患者考量——需考虑的患者因素包括年龄、体重、性别/种族/遗传差异、合并症和低血糖。近期研究发现低血糖的危害比既往认为的要大得多，因此对2型糖尿病患者的低血糖应给予更为密切的关注。

　　该声明最后呼吁进行更高质量的降糖药疗效对比研究，并加强对生活质量议题、避免并发症和血糖控制的重视。另外，还需获取有关药物基因组学的临床数据，以明确表型和患者/疾病特异性特征是如何影响药物选择的。由于对所有药物组合进行头对头比较需要非常大的样本量，不太可行，因此在治疗上有赖于临床医生的经验判断。

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2012-12-12 okhuali

#ASD#

46 0
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2012-04-29 智慧医人

#高血糖#

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2012-04-29 般若傻瓜

#ADA#

41 0
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2012-04-29 aids213

#2型糖尿病患者#

30 0
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2012-04-29 xue8604

#糖尿病患者#

34 0
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2012-04-29 zhangying8792

#血糖管理#

40 0
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2012-04-29 qilu_qi

#EASD#

32 0

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2012ADA/EASD立场声明-2型糖尿病患者的高血糖管理:以患者为中心的治疗

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