Diabetes Care：ADA与ENDO低血糖共识

　　低血糖对糖尿病患者产生的影响一直以来广受关注，美国糖尿病学会（ADA）和美国内分泌学会（ENDO）对既往与新进证据进行回顾，并于近日公布一份共识文件Hypoglycemia and Diabetes: A Report of aWorkgroup of the American Diabetes Association and The Endocrine Society。

　　ADA和ENDO专家组成的工作组再次确认了既往对糖尿病患者低血糖的定义，回顾了低血糖对患者短期与长期转归的影响，新共识考虑了低血糖对治疗结局的影响，给出了预防低血糖的策略，并提出将来的临床研究应注意解决的问题。新共识还提供了糖尿病患者每次随访时报告低血糖的工具，以及医生用于记录的工具。

与糖尿病相关的拓展阅读：

• NEJM：糖尿病治疗有进展但仍存不足
• PLoS Med：先兆子痫是糖尿病发病危险因素
• Diabetes Care：ADA和ENDO发布低血糖和糖尿病共识报告
• FDA拟重新审议GSK糖尿病药物文迪雅的安全性
• Diabetes Res Clin Pract：台北双和医院林俊佃等发现第一时相胰岛素分泌是2型糖尿病的触发因素
• Diabetes Care：低碳饮食对妊娠期糖尿病无效
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原始出处：

Hypoglycemia and Diabetes: A Report of aWorkgroup of the American Diabetes Association and The Endocrine Society
OBJECTIVE
To review the evidence about the impact of hypoglycemia on patients with diabetes that has become available since the past reviews of this subject by the American Diabetes Association and The Endocrine Society and to provide guidance about how this new information should be incorporated into clinical practice.
PARTICIPANTS
Five members of the American Diabetes Association and five members of The Endocrine Society with expertise in different aspects of hypoglycemia were invited by the Chair, who is a member of both, to participate in a planning conference call and a 2-day meeting that was also attended by staff from both organizations. Subsequent communications took place via e-mail and phone calls. The writing group consisted of those invitees who participated in the writing of the manuscript. The workgroup meeting was supported by educational grants to the American Diabetes Association from Lilly USA, LLC and Novo Nordisk and sponsorship to the American Diabetes Association from Sanofi. The sponsors had no input into the development of or content of the report.
EVIDENCE
The writing group considered data from recent clinical trials and other studies to update the prior workgroup report. Unpublished data were not used. Expert opinion was used to develop some conclusions.
CONSENSUS PROCESS
Consensus was achieved by group discussion during conference calls and face-to-face meetings, as well as by iterative revisions of the written document. The document was reviewed and approved by the American Diabetes Association’s Professional Practice Committee in October 2012 and approved by the Executive Committee of the Board of Directors in November 2012 and was reviewed and approved by The Endocrine Society’s Clinical Affairs Core Committee in October 2012 and by Council in November 2012.
CONCLUSIONS
The workgroup reconfirmed the previous definitions of hypoglycemia in diabetes, reviewed the implications of hypoglycemia on both short- and long-term outcomes, considered the implications of hypoglycemia on treatment outcomes, presented strategies to prevent hypoglycemia, and identified knowledge gaps that should be addressed by future research. In addition, tools for patients to report hypoglycemia at each visit and for clinicians to document counseling are provided.