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中国老年2型糖尿病诊疗措施专家共识(2018年版)
According to the national survey data over the past five years,there are about 50.16 million elderly diabetic patients (≥60 years old) in China.With the increase in the total number of the elderly,this number will be expected to increase.Among the elderly patients,most of them are newly diagnosed,and are associated with a number of risk factors for cardiovascular diseases at the time of initial diagnosis.Those who were with young-onset have a long-term clinical course,and often complicated with diabetic chronic complications and potential organ dysfunctions.Most of the elderly diabetic patients in China are with poor glycemic control.The diabetes-related complications have become one of the major reasons for the senile death.It is well accepted that early diagnosis and reasonable treatment could reduce the occurrence of diabetic complications,and the disability and fatal cardiovascular and cerebrovascular events.Thus,it is recommended,in the consensus,to conduct a comprehensive assessment of the glycemic control,metabolic cardiovascular risk factors,diabetes complications,multiple organ functions of the elderly patients,as well as their intelligence and physical fitness.Personalized control targets on blood glucose,pressure,lipids,uric acid and body weight would be established based on the assessment of each patient and consideration of the balance between benefits and risks in order to achieve the goal of early detection,early diagnosis,early treatment and early target reaching.Moreover,it is also recommended,in the consensus,to focus on the basic treatments (diets,exercises,self-monitoring and management),initiate suitable hypoglycemic drugs with complementary mechanisms when needed,and take into consideration of management of multiple cardiovascular risk factors and drug usage together with the caution of mutual interactions of multiple drugs.
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国家基层糖尿病防治管理指南(2018)
The prevalence of diabetes in China was 10.4%, and the rates of awareness, treatment and glycemic control of diabetes in China were 38.6%, 35.6% and 33.0%, respectively. There are rigorous challenges existing in terms of diabetes prevention and glycemic control, especially in primary medical care. Under the guidance of National Health Commission of the People's Republic of China and Chinese Medical Association, National Office for Primary Diabetes Care has developed this guideline to improve the ability of primary health facilities and provide standardized basic public health and medical services thoughout the country. The guideline is applicable to healthcare providers in primary care for type 2 diabetic patients over 18 years of age. The main contents include basic requirements for management, workflow of health management, diagnosis, treatment, identification and management of diabetic acute complications and chronic complications, referral, and long-term follow-up.
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Basal insulin and GLP-1 receptor agonists:A complementary approach to achievement of glycemic control
Today,we are fortunate to have multiple therapeutic agents that address the pathophysiologic defects resulting in hyperglycemia in type 2 diabetes. Evidence from clinical trials,as well as experience in practice, support recent treatment guidelines which call for the early combination of agents with complementary mechanisms of action to help patients achieve and maintain individualized glycemic targets. In patients with type 2 diabetes not achieving adequate glycemic control despite the addition of basal insulin,one such combination that has been shown to be safe and effective in multiple clinical trials, is the combination of basal insulin and a glucagon-like peptide 1 receptor agonist(GLP-1 RA). Through complimentary mechanisms of action,this regimen improves glycemic control and does so with significantly less hypoglycemia and with favorable effects on body weight compared with the addition of rapid-acting insulin(e.g.,basal-bolus insulin regimen). The addition of a GLP-1 RA should therefore be considered in patients with type 2 diabetes suboptimally controlled with basal insulin.
