《美国糖尿病学会2019年版糖尿病医学诊疗标准》更新与解读Interpretation on the Update of American Diabetes Association Standards of Medical Care in Diabetes—2019
杨娜;张化冰;李玉秀;
YANG Na;ZHANG Hua-bing;LI Yu-xiu;Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;
摘要(Abstract):
糖尿病是目前最常见的慢性非传染性疾病之一,美国糖尿病学会(American Diabetes Association,ADA)每年都会发布一版糖尿病医学诊疗标准,2019年版已于2018年12月发布,该诊疗标准为广大临床工作者在糖尿病的预防、诊断、治疗等方面提供了指导意见。本文主要对该版指南中更新的部分内容,包括糖尿病用药方面尤其是合并动脉粥样硬化性心血管疾病、慢性肾脏病及心力衰竭的糖尿病患者的二联用药选择,注射性降糖药物的选择,糖尿病血压控制目标及阿司匹林使用等方面的内容进行解读,以供临床医师参考。
Diabetes mellitus is one of the most common chronic non-infectious diseases. The American Diabetes Association publishes a new version of Diabetes Medical Standards every year that provides guidance for clinicians in the prevention,diagnosis,and treatment of diabetes. The latest version was released in December 2018. This article interprets some of the updated contents in this edition of the Standards for reference,including Diabetic medications especially for patients with arteriosclerosis cardiovascular disease,chronic kidney disease,or heart failure,choices of injectable hypoglycemic agents,goals of blood pressure control,and the use of aspirin.
关键词(KeyWords):
糖尿病;动脉硬化性心血管疾病;慢性肾脏病;心力衰竭
diabetes mellitus;arteriosclerosis cardiovascular disease;chronic kidney disease;heart failure
基金项目(Foundation): 国家自然科学基金(NSFC91846106、NSFC71432004);; 中国医学科学院医学与健康科技创新工程经费资助(CIFMS2016-I2M-4-001),中国医学科学院中央级公益性科研院所基本业务费(2017PT32020、2018PT32001);; 东城区优秀人才培养资助项目
作者(Author):
杨娜;张化冰;李玉秀;
YANG Na;ZHANG Hua-bing;LI Yu-xiu;Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;
Email:
DOI:
参考文献(References):
- [1] American Diabetes Association. American Diabetes Association Standards of Medical Care in Diabetes—2019[J]. Diabetes Care,2019,42:S1-S186.
- [2]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10:4-67.
- [3] Davies MJ,D'Alessio DA,Fradkin J,et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association(ADA)and the European Association for the Study of Diabetes(EASD)[J]. Diabetes Care,2018,41:2669-2701.
- [4] Jorsal A,Kistorp C,Holmager P,et al. Effect of lirag-lutide,a glucagon-like peptide-1 analogue,on left ventricular function in stable chronic heart failure patients with and without diabetes(LIVE)-a multicentre,double-blind,randomised,placebo-controlled trial[J]. Eur J Heart Fail,2017,19:69-77.
- [5] Margulies KB,Hernandez AF,Redfield MM,et al. Effects of Liraglutide on Clinical Stability Among Patients With Advanced Heart Failure and Reduced Ejection Fraction:A Randomized Clinical Trial[J]. JAMA, 2016, 316:500-508.
- [6] Marso SP,Bain SC,Consoli A,et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes[J].N Engl J Med,2016,375:1834-1844.
- [7] Marso SP, Daniels GH, Brown-Frandsen K, et al.Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes[J]. N Engl J Med,2016,375:311-322.
- [8] Neal B,Perkovic V,Mahaffey KW,et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes[J]. N Engl J Med,2017,377:644-657.
- [9] Zinman B,Inzucchi SE,Lachin JM,et al. Rationale,design,and baseline characteristics of a randomized,placebocontrolled cardiovascular outcome trial of empagliflozin(EMPA-REG OUTCOME)[J]. Cardiovasc Diabetol,2014,13:102.
- [10] Abd El Aziz MS,Kahle M,Meier JJ,et al. A metaanalysis comparing clinical effects of short-or long-acting GLP-1 receptor agonists versus insulin treatment from headto-head studies in type 2 diabetic patients[J]. Diabetes Obes Metab,2017,19:216-227.
- [11] Bowman L,Mafham M,Wallendszus K,et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus[J]. N Engl J Med,2018,379:1529-1539.
- [12] Gaziano JM,Brotons C,Coppolecchia R,et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease(ARRIVE):a randomised,double-blind,placebo-controlled trial[J]. Lancet,2018,392:1036-1046.
- [13] Group ASC, Bowman L, Mafham M, et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus[J]. N Engl J Med,2018,379:1529-1539.
- [14]朱铁楠.抗血小板治疗实验室监测之我见[J].协和医学杂志,2018,9:123-126.
- [15] Rothwell PM,Cook NR,Gaziano JM,et al. Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose:analysis of individual patient data from randomised trials[J]. Lancet,2018,392:387-399.
- 糖尿病
- 动脉硬化性心血管疾病
- 慢性肾脏病
- 心力衰竭
diabetes mellitus - arteriosclerosis cardiovascular disease
- chronic kidney disease
- heart failure
- 杨娜
- 张化冰
- 李玉秀
YANG Na- ZHANG Hua-bing
- LI Yu-xiu
- Department of Endocrinology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences &Peking Union Medical College
- 杨娜
- 张化冰
- 李玉秀
YANG Na- ZHANG Hua-bing
- LI Yu-xiu
- Department of Endocrinology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences &Peking Union Medical College