microjuh 2008-10-26 10:39 PM
美国糖尿病学会、欧洲糖尿病研究学会发表第2型糖尿病治疗策略
[font=新宋体][size=4][color=Red][b]美国糖尿病学会、欧洲糖尿病研究学会发表第2型糖尿病治疗策略[/b][/color][/size][/font]
Microjuh译
2008.10.22美国维吉尼亚州亚力山卓及德国杜塞道夫－由美国糖尿病学会和欧洲糖尿病研究学会所共同召集的专家小组会议已经发布一份第2型糖尿病新的治疗建议，这项一致性声明已经刊载于今天Diabetes Care和Diabetolgia杂志的网络上。
这次对2006年发布的糖尿病治疗策略的修正，主要是提供健康照护人员在治疗第2型糖尿病人时的指南，同时将新上市的新药以及先前所建议药物的最新科学研究资料列入考虑。
治疗策略说明一种阶段式照护法来治疗升高的血糖和糖化血色素－前二到三个月血糖的平均。一致性声明的作者们再次建议以生活型态的改变和Metformin做为初始治疗，以协助新诊断为第2型糖尿病人能够达到糖化血色素的控制目标，生活型态的介入和Metformin通常会持续整个治疗过程。然而，如果血糖没有达到控制目标，或是无法维持一段时间，那治疗策略便会进入第2阶段，而且提供2种选择；第一种选择，较为人偏好且效果良好，也就是在生活型态改变和Metformin之外，加入基础胰岛素或是磺酰尿素类(Sulfonylureas)的口服降血糖药；第2种选择，是在生活型态改变和Metformin之外，再包括Pioglitazone或GLP-1促进剂。假如第2阶段的选择无法维持糖化血色素的目标，而且没有使用基础胰岛素的方式的话，专家建议开始以基础胰岛素介入，然后，如果需要的话，将治疗方式转变为胰岛素强化治疗（第3阶段）。在原初的治疗策略上，所有治疗策略的改变通常是以3个月为间隔，冀望能快速达成和持续维持接近正常的血糖值和糖化血色素。
〝优良的血糖控制是重要的，以避免与糖尿病相关的长期并发症，这些并发症会导致失明、肾衰竭以及截肢〞，专门小组会议主席David M. Nathan表示，〝在慎重考虑下，我们高度推荐安全、有效以及有许多证据支持的疗法，如果低血糖是个主要的关切点的话，第二线用药是有价值的，但这些药物的使用较少经过确认〞。
[font=Tahoma][size=5][color=Red]American Diabetes Association, European Association for the Study of Diabetes Publish Consensus Algorithm for Type 2 Diabetes Treatment[/color][/size][/font]
ALEXANDRIA, VA and DUeSSELDORF, GERMANY, Oct 22, 2008 (MARKET WIRE via COMTEX) -- A panel of experts convened by the American Diabetes Association and the European Association for the Study of Diabetes has issued updated treatment recommendations for type 2 diabetes, in a consensus statement being published online today in the journals Diabetes Care and Diabetologia.
The revisions to the diabetes treatment algorithm, first published in 2006, provide guidance to health care providers for treating type 2 diabetes, taking into account new medications that have come on the market and the most current scientific data regarding previously recommended drugs.
The algorithm describes a stepped-care approach to treat the elevated levels of blood glucose and A1C, a measure of average glucose levels during the previous two to three months that characterize diabetes. The consensus statement authors again suggest lifestyle changes and metformin as the initial treatment to help people newly diagnosed with type 2 diabetes achieve A1C goals. The lifestyle intervention and metformin are usually continued throughout the treatment course. However, if glucose/glycemic goals are not met, or not maintained over time, the algorithm progresses to Step 2 and provides two choices. The first choice, which is preferred and well validated, calls for the addition of basal insulin or a sulfonylurea to lifestyle changes and metformin. The second choice includes the addition of pioglitazone or a GLP-1 agonist to lifestyle changes and metformin. If the Step 2 choices do not maintain A1C goals, the panel suggests initiation of basal insulin, if not already started, and then transition to intensive insulin (Step 3), if needed. As in the original algorithm, all of the transitions in therapy usually occur at 3-month intervals, aiming for rapid achievement and continuous maintenance of near-normal glucose and A1C levels.
"Excellent glycemic control is critical to prevent the long-term complications associated with diabetes, which can lead to loss of vision, kidney failure, and amputations," said Dr. David M. Nathan, Chair of the Panel. "After much deliberation, we intentionally chose therapies we highly recommend as safe, effective, and that have much evidence supporting their use. The second tier drugs are valuable if hypoglycemia is a major concern, but the use of these drugs is less validated."
资料来源：[url=http://www.diabetes.org/diabetesnewsarticle.jsp?storyId=18710504&filename=20081022/comtex20081022iw00001272KEYWORDMissingEDIT.xml]American Diabetes Association, European Association for the Study of Diabetes Publish Consensus Algorithm for Type 2 Diabetes Treatment[/url]
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