留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

《中国老年2型糖尿病防治临床指南(2022年版)》解读

赵维纲

赵维纲. 《中国老年2型糖尿病防治临床指南(2022年版)》解读[J]. 协和医学杂志, 2022, 13(4): 574-580. doi: 10.12290/xhyxzz.2022-0199
引用本文: 赵维纲. 《中国老年2型糖尿病防治临床指南(2022年版)》解读[J]. 协和医学杂志, 2022, 13(4): 574-580. doi: 10.12290/xhyxzz.2022-0199
ZHAO Weigang. Interpretation on Clinical Guidelines for Prevention and Treatment of Type 2 Diabetes Mellitus in the Elderly in China (2022 Edition)[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(4): 574-580. doi: 10.12290/xhyxzz.2022-0199
Citation: ZHAO Weigang. Interpretation on Clinical Guidelines for Prevention and Treatment of Type 2 Diabetes Mellitus in the Elderly in China (2022 Edition)[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(4): 574-580. doi: 10.12290/xhyxzz.2022-0199

《中国老年2型糖尿病防治临床指南(2022年版)》解读

doi: 10.12290/xhyxzz.2022-0199
详细信息
    作者简介:

    赵维纲, E-mail: xiehezhaoweigang@163.com

  • 中图分类号: R587.1

Interpretation on Clinical Guidelines for Prevention and Treatment of Type 2 Diabetes Mellitus in the Elderly in China (2022 Edition)

More Information
  • 摘要: 根据我国第七次人口普查数据,2020年我国老年(≥60岁)人口占全国总人口的18.7%,其中约30%(7813万)的老年人患有糖尿病,且95%以上为2型糖尿病。目前我国老年2型糖尿病防治现状不佳,且存在弱化和消极趋势,其所带来的并发症成为危害老年人健康的主要原因。《中国老年2型糖尿病防治临床指南(2022年版)》汇总了国内外老年糖尿病相关研究信息,为优化我国老年糖尿病防治理念、促进临床诊疗规范化、提高老年糖尿病总体管理水平提供了循证医学证据。本文对其重要内容进行解读,以期更好地指导临床实践。
    利益冲突:作者声明不存在利益冲突
  • 图  1  老年2型糖尿病初诊患者综合评估内容[1]

    HbA1c: 糖化血红蛋白

    图  2  老年2型糖尿病降糖药物治疗路径[1]

    HbA1c: 同图 1;ASCVD: 动脉粥样硬化性心血管疾病;CKD: 慢性肾脏病;GLP-1R: 胰高血糖素样肽-1受体;DPP-4:二肽基肽酶4;SGLT-2I: 肾小管钠糖转运蛋白-2抑制剂;CSⅡ: 持续皮下胰岛素泵

    表  1  老年2型糖尿病血糖控制推荐标准及适宜人群[1]

    指标 良好控制标准 中间过度阶段 可接受标准
    HbA1c (%) ≤7.0 >7.0~<8.0 8.0~8.5
    FPG (mmol/L) 4.4~7.0 5.0~7.5 5.0~8.5
    2 hPBG (mmol/L) <10.0 <11.1 <13.9
    治疗目标 预防并发症发生 减缓并发症进展 避免高血糖的急性损害
    适宜人群 适用于新诊断、病程短、低血糖风险低、以非胰岛素促泌剂类降糖药物治疗为主、自理能力好或有良好辅助生活条件的老年糖尿病患者 适用于预期生存期>5年、中等程度并发症及伴发疾病、有低血糖风险、应用胰岛素促泌剂类降糖药物或以多次胰岛素注射治疗为主、自我管理能力欠佳的老年糖尿病患者,希望在治疗调整中转向良好控制 适用于预期寿命<5年、伴有影响寿命的疾病、有严重低血糖发生史、反复合并感染、急性心脑血管病变、急性病入院治疗期间、完全丧失自我管理能力、缺少良好护理的患者,需避免高血糖造成的直接损害
    HbA1c:同图 1;FPG:空腹血糖;2 hPBG:餐后2 h血糖
    下载: 导出CSV
  • [1] 中国老年2型糖尿病防治临床指南编写组. 中国老年2型糖尿病防治临床指南(2022年版)[J]. 中国糖尿病杂志, 2022, 30: 2-51. doi:  10.3969/j.issn.1006-6187.2022.01.002
    [2] Li Y, Teng D, Shi XG, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J]. BMJ, 2020, 369: m997.
    [3] Pan XR, Yang WY, Li GW, et al. Prevalence of diabetes and its risk factors in China, 1994. National Diabetes Prevention and Control Cooperative Group[J]. Diabetes Care, 1997, 20: 1664-1669. doi:  10.2337/diacare.20.11.1664
    [4] Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China[J]. N Engl J Med, 2010, 362: 1090-1101. doi:  10.1056/NEJMoa0908292
    [5] Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults[J]. JAMA, 2013, 310: 948-959. doi:  10.1001/jama.2013.168118
    [6] Wang L, Gao P, Zhang M, et al. Prevalence and Ethnic Pattern of Diabete and Prediabetes in China in 2013[J]. JAMA, 2017, 317: 2515-2523. doi:  10.1001/jama.2017.7596
    [7] 国家统计局. 第七次全国人口普查公报(第五号)[EB/OL ]. (2021-05-11)[2022-04-11]. http://www.stats.gov.cn/tjsj/tjgb/rkpcgb/qgrkpcgb/202106/t20210628_1818824.html.
    [8] Yan ST, Li CX, Li CL, et al. Promotive effect of comprehensive management on achieving blood glucose control in senile type 2 diabetics[J]. Genet Mol Res, 2015, 14: 3062-3070.
    [9] Tinsley LJ, Kupelian V, D'Eon SA, et al. Association of Glycemic Control With Reduced Risk for Large-Vessel Disease After More Than 50 Years of Type 1 Diabetes[J]. J Clin Endocrinol Metab, 2017, 102: 3704-3711. doi:  10.1210/jc.2017-00589
    [10] Thompson TJ, Engelgau MM, Hegazy M, et al. The onset of NIDDM and its relationship to clinical diagnosis in Egyptian adults[J]. Diabet Med, 1996, 13: 337-340. doi:  10.1002/(SICI)1096-9136(199604)13:4<337::AID-DIA71>3.0.CO;2-A
    [11] Hou JN, Bi YF, Xu M, et al. The change points of HbA(1C) for detection of retinopathy in Chinese type 2 diabetic patients[J]. Diabetes Res Clin Pract, 2011, 91: 401-405. doi:  10.1016/j.diabres.2010.11.029
    [12] Lindström J, Peltonen M, Eriksson JG, et al. Improved lifestyle and decreased diabetes risk over 13years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS)[J]. Diabetologia, 2013, 56: 284-293. doi:  10.1007/s00125-012-2752-5
    [13] Kawamori R, Tajima N, Iwamoto Y, et al. Voglibose for prevention of type 2 diabetes mellitus: a randomised, double-blind trial in Japanese individuals with impaired glucose tolerance[J]. Lancet, 2009, 373: 1607-1614. doi:  10.1016/S0140-6736(09)60222-1
    [14] Gaede P, Lund-Andersen H, Parving HH, et al. Effect of a multifactorial intervention on mortality in type 2 diabetes[J]. N Engl J Med, 2008, 358: 580-591. doi:  10.1056/NEJMoa0706245
    [15] Gæde P, Oellgaard J, Carstensen B, et al. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21years follow-up on the Steno-2 randomised trial[J]. Diabetologia, 2016, 59: 2298-2307. doi:  10.1007/s00125-016-4065-6
    [16] ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes[J]. N Engl J Med, 2008, 358: 2560-2572. doi:  10.1056/NEJMoa0802987
    [17] Gerstein HC, Riddle MC, Kendall DM, et al. Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial[J]. Am J Cardiol, 2007, 99: 34i-43i.
    [18] van Hateren KJ, Landman GW, Kleefstra N, et al. Glycae-mic control and the risk of mortality in elderly type 2 diabetic patients (ZODIAC-20)[J]. Int J Clin Pract, 2011, 65: 415-419. doi:  10.1111/j.1742-1241.2010.02596.x
    [19] American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetesd 2018[J]. Diabetes Care, 2018, 41: S55-S64.
    [20] Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus Statement by The American Association of Clinical Endocrinologists and American College of Endocrinology on The Comprehensive Type 2 Diabetes Management ALGORITHM-2017 Executive Summary[J]. Endocr Pract, 2017, 23: 207-238.
    [21] Araki E, Haneda M, Kasuga M et al. New glycemic targets for patients with diabetes from the Japan Diabetes Society[J]. J Diabetes Investig, 2017, 8: 123-125. doi:  10.1111/jdi.12600
    [22] Lu JY, Ma XJ, Zhou J, et al. Association of Time in Range, as Assessed by Continuous Glucose Monitoring, With Diabetic Retinopathy in Type 2 Diabetes[J]. Diabetes Care, 2018, 41: 2370-2376. doi:  10.2337/dc18-1131
    [23] 戴冬君, 陆静毅, 张磊, 等. 应用葡萄糖在目标范围内时间评价2型糖尿病血糖控制情况的适宜切点分析[J]. 中华医学杂志, 2020, 100: 2990-2996. doi:  10.3760/cma.j.cn112137-20200619-01895

    Dai DJ, Lu JY, Zhang L, et al. The appropriate cut-off point of time in range (TIR) for evaluating glucose control in type 2 diabetes mellitus[J]. Zhognhua Yixue Zazhi, 2020, 100: 2990-2996. doi:  10.3760/cma.j.cn112137-20200619-01895
    [24] Lu J, Wang C, Shen Y, et al. Time in Range in Relation to All-Cause and Cardiovascular Mortality in Patients With Type 2 Diabetes: A Prospective Cohort Study[J]. Diabetes Care, 2021, 44: 549-555. doi:  10.2337/dc20-1862
    [25] Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range[J]. Diabetes Care, 2019, 42: 1593-1603.
    [26] 中国老年保健医学研究会老年内分泌与代谢病分会, 中国毒理学会临床毒理专业委员会. 老年人多重用药安全管理专家共识[J]. 中国全科医学, 2018, 21: 3533-3544. doi:  10.12114/j.issn.1007-9572.2018.00.225
    [27] Norwood P, Liutkus JF, Haber H, et al. Safety of exenatide once weekly in patients with type 2 diabetes mellitus treated with a thiazolidinedione alone or in combination with metformin for 2 years[J]. Clin Ther, 2012, 34: 2082-2090.
    [28] Kadowaki T, Nangaku M, Hantel S, et al. Empagliflozin and kidney outcomes in Asian patients with type 2 diabetes and established cardiovascular disease: Results from the EMPA-REG OUTCOME trial[J]. J Diabetes Investig, 2019, 10: 760-770.
    [29] Mosenzon O, Wiviott SD, Cahn A, et al. Effects of dapagliflozin on development and progression of kidney disease in patients with type 2 diabetes: an analysis from the DECLARE-TIMI 58 randomised trial[J]. Lancet Diabetes Endocrinol, 2019, 7: 606-617.
    [30] Gomes MB, Rathmann W, Charbonnel B, et al. Treatment of type 2 diabetes mellitus worldwide: Baseline patient characteristics in the global DISCOVER study[J]. Diabetes Res Clin Pract, 2019, 151: 20-32.
    [31] Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis[J]. Lancet, 2016, 387: 435-443.
    [32] 高尿酸血症相关疾病诊疗多学科共识专家组. 中国高尿酸血症相关疾病诊疗多学科专家共识[J]. 中华内科杂志, 2017, 56: 235-248.
    [33] 中华医学会内分泌学分会. 中国高尿酸血症与痛风诊疗指南(2019)[J]. 中华内分泌代谢杂志, 2020, 36: 1-13. https://www.cnki.com.cn/Article/CJFDTOTAL-LCLZ202007023.htm
    [34] Ferrari SL, Abrahamsen B, Napoli N, et al. Diagnosis and management of bone fragility in diabetes: an emerging challenge[J]. Osteoporos Int, 2018, 29: 2585-2596.
    [35] 吴芸杨, 陈晓宏, 季晶俊, 等. 肌肉衰减综合征的诊断和治疗进展[J]. 医学综述, 2020, 26: 4499-4503. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS202022025.htm

    Wu YY, Chen XH, Ji JJ, et al. Research Progress of Diagnosis and Treatment of Sarcopenia[J]. Yixue Zongshu, 2020, 26: 4499-4503. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS202022025.htm
    [36] Boccardi V, Murasecco I, Mecocci P. Diabetes drugs in the fight against Alzheimer's disease[J]. Ageing Res Rev, 2019, 54: 100936.
    [37] Lee AA, Piette JD, Heisler M, et al. Diabetes self-management and glycemic control: The role of autonomy support from informal health supporters[J]. Health Psychol, 2019, 38: 122-132.
    [38] Lee AA, Heisler M, Trivedi R, et al. Autonomy support from informal health supporters: links with self-care activi-ties, healthcare engagement, metabolic outcomes, and cardiac risk among Veterans with type 2 diabetes[J]. J Behav Med, 2021, 44: 241-252.
    [39] Koetsenruijter J, Eikelenboom Nv, Lieshout Jv, et al. Social support and self-management capabilities in diabetes patients: An international observational study[J]. Patient Educ Couns, 2016, 99: 638-643.
  • 加载中
图(2) / 表(1)
计量
  • 文章访问数:  66
  • HTML全文浏览量:  10
  • PDF下载量:  30
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-05-09
  • 录用日期:  2022-06-06
  • 网络出版日期:  2022-06-10
  • 刊出日期:  2022-07-30

目录

    /

    返回文章
    返回