ACP发表关于2型糖尿病糖化血红蛋白(HbA1c)控制目标的最新指南

发布组织:美国医师协会

目标受众:所有临床医生

目标人群:非妊娠成人2型糖尿病患者

指南目的:以指导临床医生选择2型糖尿病药物治疗目标。

指南背景:糖尿病是目前美国疾病死亡的主要原因,其与微血管和大血管并发症有关。约2,910万人(占美国人口的9.3%)患有2型糖尿病。 

2012年,美国与糖尿病有关的直接和间接费用总额为2450亿美元,给美国经济带来了沉重负担。


同时,糖尿病伴随的显着升高的葡萄糖水平可导致亚急性症状,如多尿,多饮,体重减轻和脱水。随着时间的推移,与糖尿病有关的代谢紊乱可能导致视力丧失,疼痛性神经病变或感觉丧失,足部溃疡,截肢,心肌梗塞,中风和终末期肾病。降低血糖可降低并发症的风险,但目前的降低策略会带来一些危害,患者负担的成本也较高。

血糖的测量可以通过多种方式,包括血红蛋白A1c(HbA1c;也称为糖基化或糖化血红蛋白)水平,其接近约3个月的平均血糖控制。与所有实验室检查一样,HbA1c测量与变异性相关,并且可以随着种族进一步变化。历史上,指南建议启动或强化药物治疗以达到特定的HbA1c目标,而具体情况取决于所讨论的人群。最佳平衡利益和危害的理想目标仍然不确定。


 

方法

国家指南信息交换中心和指南国际网络图书馆(2017年5月)搜索汇总了涉及治疗非妊娠门诊成人2型糖尿病的血红蛋白A1c(HbA1c)目标的以英文出版的国家准则。此外,还评估了包括美国临床内分泌学家协会和美国内分泌学会,美国糖尿病协会,苏格兰校际指南网络和美国退伍军人事务部和国防部审查等常用指南。 使用AGREE II(评估研究和评估准则II)文件来评估准则。


 

指南意见

• 在评估药物疗法的益处和危害,患者的偏好,患者的一般健康和预期寿命,治疗负担和护理费用的基础上,临床医生应为2型糖尿病患者的血糖控制设定个人化目标。

 对于大多数2型糖尿病患者,HbA1c应控制在7%至8%水平。

• HbA1c水平低于6.5%的患者应降低药物治疗强度

• 对于年龄在80岁或以上,住在养老院或慢性病患者而预期寿命低于10岁的患者(如痴呆,癌症,晚期肾脏疾病或严重的慢性阻塞性肺病或充血性心力衰竭)治疗应尽量减少与高血糖相关的症状,避免将定的HbA1c水平作为目标治疗值。


原文如下


Description

The American College of Physicians developed this guidance statement to guide clinicians in selecting targets for pharmacologic treatment of type 2 diabetes.


Methods

The National Guideline Clearinghouse and the Guidelines International Network library were searched (May 2017) for national guidelines, published in English, that addressed hemoglobin A1c (HbA1c) targets for treating type 2 diabetes in nonpregnant outpatient adults. The authors identified guidelines from the National Institute for Health and Care Excellence and the Institute for Clinical Systems Improvement. In addition, 4 commonly used guidelines were reviewed, from the American Association of Clinical Endocrinologists and American College of Endocrinology, the American Diabetes Association, the Scottish Intercollegiate Guidelines Network, and the U.S. Department of Veterans Affairs and Department of Defense. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the guidelines.


Guidance Statement 1

Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care.


Guidance Statement 2

Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.


Guidance Statement 3

Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1clevels less than 6.5%.


Guidance Statement 4

Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA1clevel in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population.



Powered by 上海翼石信息科技有限公司 © 2001-2016 dayibian Inc.
沪ICP备12046386号-1