李成,周健

• 1:上海交通大学附属第六人民医院内分泌代谢科上海市糖尿病临床医学中心上海市糖尿病重点实验室上海市糖尿病研究所

摘要(Abstract)：

美国糖尿病学会(American Diabetes Association,ADA)制定的"糖尿病医学诊疗标准"自1989年起发布至今,已成为指导临床医师、护理人员等进行糖尿病管理临床实践的权威指南之一。近日,ADA依据最新循证证据对指南进行了更新,并于Diabetes Care增刊上发布了《2019年ADA糖尿病医学诊疗标准》,该诊疗标准继续强调以患者为中心的理念,对于糖尿病的管理、治疗等方案进行了完善,同时对日新月异的糖尿病诊治新技术给予了更多关注。本文就其中热点问题及重要更新内容进行解读。

关键词(KeyWords)： 糖尿病;技术;治疗;评估

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李成,周健

参考文献(References)：

• [1]American Diabetes Association.Standards of Medical Care in Diabetes-2019[J].Diabetes Care,2019,42(Suppl 1):S1-S193.
• [2]Selvin E,Wang D,Matsushita K,et al.Prognostic implications of single sample confirmatory testing for undiagnosed diabetes:a prospective cohort study[J].Ann Intern Med,2018,169(3):156-164.
• [3]Picón MJ,Murri M,Mu?oz A,et al.HemoglobinA1c versus oral glucose tolerance test in postpartum diabetes screening[J].Diabetes Care,2012,35(8):1648-1653.
• [4]G?bl CS,Bozkurt L,Yarragudi R,et al.Is early postpartum Hb A1c an appropriate risk predictor after pregnancy with gestational diabetes mellitus?[J].Acta Diabetol,2014,51(5):715-722.
• [5]Megia A,N?f S,Herranz L,et al.The usefulness of HbA1c in postpartum reclassification of gestational diabetes[J].BJOG,2012,119(7):891-894.
• [6]Welsh KJ,Kirkman MS,Sacks DB.Role of Glycated Proteins in the Diagnosis and Management of Diabetes:Research Gaps and Future Directions[J].Diabetes Care,2016,39(8):1299-1306.
• [7]Eckhardt BJ,Holzman RS,Kwan CK,et al.Glycated hemoglobin A(1c)as screening for diabetes mellitus in HIV-infected individuals[J].AIDS Patient Care STDS,2012,26(4):197-201.
• [8]Kim C,Bullard KM,Herman WH,et al.Association between iron deficiency and A1C levels among adults without diabetes in the National Health and Nutrition Examination Survey,1999-2006[J].Diabetes Care,2010,33(4):780-785.
• [9]Salas-SalvadóJ,BullóM,Babio N,et al.Reduction in the incidence of type 2 diabetes with the Mediterranean diet:results of the PREDIMED-Reus nutrition intervention randomized trial[J].Diabetes Care,2011,34(1):14-19.
• [10]Salas-SalvadóJ,Guasch-FerréM,Lee CH,et al.Protective Effects of the Mediterranean Diet on Type 2 Diabetes and Metabolic Syndrome[J].J Nutr,2016,146:920S-927S.
• [11]Bloomfield HE,Koeller E,Greer N,et al.Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake:A Systematic Review and Meta-analysis[J].Ann Intern Med,2016,165(7):491-500.
• [12]Estruch R,Ros E,Salas-SalvadóJ,et al.PREDIMED Study Investigators.Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts[J].N Engl J Med,2018,378(25):e34.
• [13]Diabetes Prevention Program Research Group.Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year followup:the Diabetes Prevention Program Outcomes Study[J].Lancet Diabetes Endocrinol,2015,3(11):866-875.
• [14]Noto H,Goto A,Tsujimoto T,Noda M.Long-term lowcarbohydrate diets and type 2 diabetes risk:a systematic review and meta-analysis of observational studies[J].J Gen Fam Med,2016,17:60-70.
• [15]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(12):2669-2701.
• [16]Lipska KJ,Ross JS,Wang Y,et al.National trends in UShospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries,1999 to 2011[J].JAMA Intern Med,2014,174(7):1116-1124.
• [17]Shorr RI,Ray WA,Daugherty JR,et al.Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas[J].Arch Intern Med,1997,157(15):1681-1686.
• [18]Abdelhafiz AH,Rodríguez-Ma?as L,Morley JE,et al.Hypoglycemia in older people-a less well recognized risk factor for frailty[J].Aging Dis,2015,6(2):156-167.
• [19]Yun JS,Ko SH,Ko SH,et al.Presence of macroalbuminuria predicts severe hypoglycemia in patients with type 2 diabetes:a10-year follow-up study[J].Diabetes Care,2013,36(5):1283-1289.
• [20]Chelliah A,Burge MR.Hypoglycaemia in elderly patients with diabetes mellitus:causes and strategies for prevention[J].Drugs Aging,2004,21(8):511-530.
• [21]Agiostratidou G,Anhalt H,Ball D,et al.Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes:A Consensus Report of the American Association of Clinical Endocrinologists,the American Association of Diabetes Educators,the American Diabetes Association,the Endocrine Society,JDRF International,The Leona M.and Harry B.Helmsley Charitable Trust,the Pediatric Endocrine Society,and the T1D Exchange[J].Diabetes Care,2017,40(12):1622-1630.
• [22]Diabetes Control and Complications Trial Research Group,Nathan DM,Genuth S,et al.The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus[J].N Engl J Med,1993,329(14):977-986.
• [23]Sherr JL,Cengiz E,Palerm CC,et al.Reduced hypoglycemia and increased time in target using closed-loop insulin delivery during nights with or without antecedent afternoon exercise in type 1 diabetes[J].Diabetes Care,2013,36(10):2909-2914.
• [24]Troncone A,Bonfanti R,Iafusco D,et al.Evaluating the Experience of Children With Type 1 Diabetes and Their Parents Taking Part in an Artificial Pancreas Clinical Trial Over Multiple Days in a Diabetes Camp Setting[J].Diabetes Care,2016,39(12):2158-2164.
• [25]Barnard KD,Wysocki T,Allen JM,et al.Closing the loop overnight at home setting:psychosocial impact for adolescents with type 1 diabetes and their parents[J].BMJ Open Diabetes Res Care,2014,2(1):e000025.
• [26]Barnard KD,Wysocki T,Thabit H,et al.Psychosocial aspects of closed-and open-loop insulin delivery:closing the loop in adults with type 1 diabetes in the home setting[J].Diabet Med,2015,32(5):601-608.
• [27]Weissberg-Benchell J,Hessler D,Polonsky WH,et al.Psychosocial Impact of the Bionic Pancreas During Summer Camp[J].J Diabetes Sci Technol,2016,10(4):840-844.
• [28]Schauer PR,Bhatt DL,Kirwan JP,et al.Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes[J].N Engl J Med,2014,370(21):2002-2013.
• [29]Yu H,Di J,Bao Y,et al.Visceral fat area as a new predictor of short-term diabetes remission after Roux-en-Y gastric bypass surgery in Chinese patients with a body mass index less than 35kg/m2[J].Surg Obes Relat Dis,2015,11(1):6-11.
• [30]Mayer-Davis EJ,Lawrence JM,Dabelea D,et al.SEARCH for Diabetes in Youth Study.Incidence Trends of Type 1 and Type2 Diabetes among Youths,2002-2012[J].N Engl J Med,2017,376(15):1419-1429.
• [31]Markowitz JT,Butler DA,Volkening LK,et al.Brief screening tool for disordered eating in diabetes:internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes[J].Diabetes Care,2010,33(3):495-500.
• [32]Goebel-Fabbri AE.Disturbed eating behaviors and eating disorders in type 1 diabetes:clinical significance and treatment recommendations[J].Curr Diab Rep,2009,9(2):133-139.
• [33]Atik Alt?nok Y,?zgür S,Meseri R,et al.Reliability and Validity of the Diabetes Eating Problem Survey in Turkish Children and Adolescents with Type 1 Diabetes Mellitus[J].JClin Res Pediatr Endocrinol,2017,9(4):323-328.
• [34]Sa?mann H,Albrecht C,Busse-Widmann P,et al.Psychometric properties of the German version of the Diabetes Eating Problem Survey-Revised:additional benefit of disease-specific screening in adolescents with Type 1 diabetes[J].Diabet Med,2015,32(12):1641-1647.