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2018 AACE/ACE 2型糖尿病综合管理策略更新要点(附幻灯)

2018-01-11 佚名 《国际糖尿病》

新指南认为,2型糖尿病患者通常需要进行联合治疗,联合治疗时应选择机制互补的药物。

近日,美国临床内分泌医师协会(AACE)联合美国内分泌学会(ACE)发布《2018AACE/ACE2型糖尿病综合管理策略共识声明》。作为AACE/ACE糖尿病综合管理计划临床实践指南的补充,2型糖尿病综合管理策略于2013年公布草案,2015年首次正式发布,此后每年更新。2018AACE/ACE2型糖尿病综合管理策略主要原则如下:

1、生活方式优化对所有糖尿病患者均至关重要,其内容应涉及多个方面且具有持续性,并需要整个糖尿病团队的参与。此外,药物治疗可与生活方式干预同时开始,并非只有在生活方式干预失败时才启动。

2、所有伴有超重或肥胖的糖尿病前期及2型糖尿病患者均应考虑减重,减重措施包括生活方式干预(低热量健康饮食、体力活动及行为干预)。糖尿病前期及2型糖尿病患者为达到减重目标,可考虑应用减肥药。

3、2型糖尿病患者HbA1c的控制目标应个体化,根据患者的年龄、预期寿命、合并症、糖尿病病程、低血糖风险或低血糖的不良后果、患者意愿及依从性等因素来决定。在保证安全性及患者可负担的情况下,将HbA1c水平控制在≤6.5%是比较理想的,当然某些患者可能适合选择相对较高的控制目标值,并随时间而调整。

4、血糖控制目标应涵盖空腹血糖及餐后血糖两方面。

5、糖尿病治疗药物的选择应个体化,需根据患者及药物本身的特性来决定,需考虑药物降糖疗效、作用机制、低血糖和体重增加风险、其他不良反应、耐受性、应用的方便性、可能的依从性、成本、对心脏/肾脏/肝脏的影响等因素。

6、将严重及非严重低血糖风险降至最低至关重要,因为这会影响到患者治疗的安全性、依从性及成本。

7、将体重增加风险降至最低也至关重要,对治疗的安全性、依从性、成本及患者的长期健康意义重大。

8、糖尿病管理成本不仅包括药物成本,还包括监测成本、低血糖及体重增加所导致的相关成本。糖尿病的管理应更关注治疗的有效性及安全性而非药物成本。

9、新指南基于HbA1c基线值对治疗选择进行了分层,为不同患者提供了不同的起始治疗选择,并强调应充分遵循个体化的原则。

10、新指南认为,2型糖尿病患者通常需要进行联合治疗,联合治疗时应选择机制互补的药物。

11、2型糖尿病的综合管理还应包括血脂及血压管理和相关并发症的治疗。

12、在患者血糖尚未稳定之时应定期(如每3个月)进行治疗评估,内容涉及HbA1c、SMBG记录(空腹及餐后)、动态血糖监测结果、确诊的或疑似低血糖事件、血脂及血压、不良事件(体重增加、体液潴留、肝肾损害或心血管疾病)、合并症情况、相关实验室数据、伴随用药、糖尿病并发症及影响患者管理的社会心理因素等。一旦患者血糖稳定达标,则可减少监测频率。

13、治疗方案应尽可能的简化以提高依从性。

14、新指南涉及了截止到2016年12月FDA批准的所有2型糖尿病治疗药物。



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    2018-10-29 gous
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    2018-01-19 zgwhgch
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    2018-03-05 shanyongle
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    2018-01-12 1ddf0692m34(暂无匿称)

    学习了.涨知识

    0

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由此可见,只要根据肾功能调整好治疗剂量,中度至重度CKD患者采用二甲双胍治疗是安全有效的。

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由此可见,使用基础胰岛素±速效/预混胰岛素并发生严重低血糖的2型糖尿病患者活动和工作效率受损程度更大,使用的医疗资源更多,并产生较高的成本,相比于那些非严重或无低血糖患者。研究还表明还对经济和健康相关生活质量结局产生影响。减少低血糖的发生率和严重程度在HRQoL上可获得临床上有意义的改善,并且降低医疗服务利用情况和费用。

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