2022版ADA糖尿病診治標(biāo)準(zhǔn)于2021年年末發(fā)布，總體延續(xù)了2019-2021版本以來(lái)的架構(gòu)，而主要的結(jié)構(gòu)變更是慢性腎臟疾病從以往微血管疾病的章節(jié)獨(dú)立出來(lái)，在內(nèi)容上較2021版有較多更新，也體現(xiàn)出糖尿病領(lǐng)域的飛速進(jìn)展。CK經(jīng)典文獻(xiàn)翻譯組依然會(huì)在2019-2021版標(biāo)準(zhǔn)的中文譯文基礎(chǔ)上，將啟動(dòng)2022版ADA糖尿病醫(yī)學(xué)診治標(biāo)準(zhǔn)的翻譯。
CK注：以往ADA標(biāo)準(zhǔn)全文譯文：
指南共識(shí) l 2022
ADA糖尿病診療標(biāo)準(zhǔn)
修訂內(nèi)容摘要
編譯：陳康
The field of diabetes care is rapidlychanging as new research, technology, and treatments that can improve thehealth and well-being of people with diabetes continue to emerge. With annualupdates since 1989, the American Diabetes Association (ADA) has long been aleader in producing guidelines that capture the most current state of thefield.
隨著能夠改善糖尿病患者健康和福祉的新研究、技術(shù)和治療不斷涌現(xiàn)，糖尿病護(hù)理領(lǐng)域正在迅速變化。自1989年以來(lái)，美國(guó)糖尿病協(xié)會(huì)(ADA)每年都進(jìn)行更新，長(zhǎng)期以來(lái)一直作為制定反映該領(lǐng)域最新?tīng)顩r的指南的領(lǐng)導(dǎo)者。
Althoughlevels of evidence for several recommendations have been updated, these changesare not outlined below where the clinical recommendation has remained the same.That is, changes in evidence level from, for example,EtoCare notnoted below. The 2022 Standards of Care contains, in addition to many minorchanges that clarify recommendations or reflect new evidence, the followingmore substantive revisions.
盡管已更新了幾項(xiàng)推薦的證據(jù)水平，但在臨床推薦保持不變的情況下，正文未列出這些變化。也就是說(shuō)，以下未提及的來(lái)自例如EtoCare的證據(jù)水平變化?！?022年診治標(biāo)準(zhǔn)》除了包含許多澄清推薦或反映新證據(jù)的小改動(dòng)外，還包含以下更具實(shí)質(zhì)性的修訂。
(https://doi.org/10.2337/dc22-S001)
Additional information has been includedon online platforms to support behavior change and well-being. The renamed“Cost Considerations for Medication-Taking Behaviors” subsection has been expandedto include more discussion about costs of medications and treatment goals.
在線平臺(tái)還提供其他信息，以支持行為改變和福祉。更名后的“服藥行為的費(fèi)用考慮”小節(jié)已經(jīng)擴(kuò)展，納入了更多關(guān)于藥物費(fèi)用和治療目標(biāo)的討論。
The concept of health numeracy and itsrole in diabetes prevention and management was added to the newly named “HealthLiteracy and Numeracy” subsection.
健康算術(shù)的概念及其在糖尿病預(yù)防和管理中的作用已添加到新命名的“健康讀寫(xiě)算”小節(jié)中。
The community health workers content wasexpanded.
社區(qū)衛(wèi)生工作者的內(nèi)容得到拓展。
(https://doi.org/10.2337/dc22-S002)
A recommendation about adequatecarbohydrate intake prior to oral glucose tolerance testing as a screen fordiabetes was added, with supportive references added to the text (Recommendations2.4 and 2.12).
增加關(guān)于口服葡萄糖耐量試驗(yàn)前適當(dāng)攝入碳水化合物作為糖尿病篩查的推薦，并在文本中增加了支持性參考文獻(xiàn)(推薦2.4和2.12)。
The discussion regarding use ofpoint-of-care A1C assays for the diagnosis of diabetes has been revised.
關(guān)于使用護(hù)理點(diǎn)/快速A1C檢測(cè)診斷糖尿病的討論已經(jīng)過(guò)修訂。
More information has been added to the“Race/Ethnicity/Hemoglobinopathies” subsection.
更多信息已添加至“種族/民族/血紅蛋白病”小節(jié)。
The “Type 1 Diabetes” subsection and therecommendations within have been updated based on the publication of “TheManagement of Type 1 Diabetes in Adults. A Consensus Report by the AmericanDiabetes Association (ADA) and the European Association for the Study ofDiabetes (EASD)” (https://doi.org/10.2337/dci21-0043).
“1型糖尿病”小節(jié)和其中的推薦已根據(jù)文獻(xiàn)《成人1型糖尿病的管理-美國(guó)糖尿病協(xié)會(huì)(ADA)和歐洲糖尿病研究協(xié)會(huì)(EASD)的共識(shí)報(bào)告》進(jìn)行更新。
Under “Classification,” immunecheckpoint inhibitors have been added as a cause of medication-induceddiabetes. Additional evidence and discussion have been added to the subsection“Screening for Type 1 Diabetes Risk.”
在“分類(lèi)”下，添加免疫檢查點(diǎn)抑制劑作為藥物誘發(fā)糖尿病的病因（CK注，2020中國(guó)糖尿病指南歸類(lèi)于特殊類(lèi)型的藥物誘導(dǎo)類(lèi)，在此次ADA標(biāo)準(zhǔn)主要在1型糖尿病中討論）。在“1型糖尿病風(fēng)險(xiǎn)篩查”小節(jié)中增加了其他證據(jù)和討論。
Recommendation 2.9 has been revised torecommend that, for all people, screening for prediabetes and diabetes shouldbegin at age 35 years.
推薦2.9已經(jīng)過(guò)修訂，推薦對(duì)所有人而言，糖尿病前期和糖尿病的篩查應(yīng)從35歲開(kāi)始。
Recommendation 2.24 regarding genetictesting for those who do not have typical characteristics of type 1 or type 2diabetes has been revised based on the publication of “The Management of Type 1Diabetes in Adults. A Consensus Report by the American Diabetes Association(ADA) and the European Association for the Study of Diabetes (EASD)” (https://doi.org/10.2337/dci21-0043).
關(guān)于對(duì)不具有1型或2型糖尿病典型特征的患者進(jìn)行基因檢測(cè)的推薦2.24已根據(jù)文獻(xiàn)《成人1型糖尿病的管理-美國(guó)糖尿病協(xié)會(huì)(ADA)和歐洲糖尿病研究協(xié)會(huì)(EASD)的共識(shí)報(bào)告》進(jìn)行了修訂。
The gestational diabetes mellitusrecommendations have been revised with changes made regarding preconception andearly pregnancy screening for diabetes and abnormal glucose metabolism, withsupporting evidence added to the text.
已對(duì)妊娠糖尿病推薦進(jìn)行了修訂，對(duì)孕前和早孕篩查糖尿病和糖代謝異常進(jìn)行了更改，并在文本中添加支持證據(jù)。
(https://doi.org/10.2337/dc22-S003)
The title has been changed to“Prevention or Delay of Type 2 Diabetes and Associated Comorbidities.”
標(biāo)題已更改為“預(yù)防或延緩2型糖尿病及相關(guān)合并癥”。
Recommendation 3.1 has been modified tobetter individualize monitoring for the development of type 2 diabetes in thosewith prediabetes.
對(duì)推薦3.1進(jìn)行修改，以更好地對(duì)糖尿病前期患者的2型糖尿病發(fā)生情況進(jìn)行個(gè)體化監(jiān)測(cè)。
Adults with overweight/obesity arerecommended to be referred to an intensive lifestyle behavior change program(Recommendation 3.2).
推薦將超重/肥胖成人轉(zhuǎn)診至強(qiáng)化生活方式行為改變項(xiàng)目(推薦3.2)。
Additional considerations have beenadded to the recommendation regarding metformin therapy (Recommendation 3.6).
關(guān)于二甲雙胍治療的推薦(推薦3.6)中增加了其他考慮事項(xiàng)。
More discussion was added on vitamin Dsupplementation in the “Pharmacologic Interventions” subsection.
在“藥物干預(yù)”小節(jié)中增加了關(guān)于維生素D補(bǔ)充的更多討論。
There is a new subsection andrecommendation on patient-centered care aimed at weight loss or prevention ofweight gain, minimizing progression of hyperglycemia, and attention tocardiovascular risk and associated comorbidities.
有一個(gè)關(guān)于以患者為中心的護(hù)理的新小節(jié)和推薦，旨在減輕體重或預(yù)防體重增加，將高血糖癥的進(jìn)展降至最低，并關(guān)注心血管風(fēng)險(xiǎn)和相關(guān)合并癥。
(https://doi.org/10.2337/dc22-S004)
The “Immunizations” subsection has been revised, and moreinformation and evidence on the influenza vaccine for people with diabetes andcardiovascular disease has been added to the “Influenza” subsection. Withinthis subsection, coronavirus disease 2019 (COVID-19) vaccination informationhas been added based on evolving evidence.
對(duì)“免疫接種”小節(jié)進(jìn)行了修訂，并在“流感”小節(jié)中添加了更多關(guān)于糖尿病和心血管疾病患者流感疫苗的信息和證據(jù)。在本小節(jié)中，基于不斷發(fā)生的證據(jù)，添加了冠狀病毒疾病2019(新冠肺炎)疫苗接種信息。
Table 4.6,management of patients with nonalcoholic fatty liver disease (NAFLD) andnonalcoholic steatohepatitis (NASH), and Table 4.7,summary of published NAFLD guidelines, reproduced from “Preparing for the NASHEpidemic: A Call to Action” (https://doi.org/10.2337/dci21-0020), provide more information on how to manage these diseases.Developed following an American Gastroenterological Association conference onthe burden, screening, risk stratification, diagnosis, and management ofindividuals with NAFLD, the Call to Action informed other revisions to the“Nonalcoholic Fatty Liver Disease” subsection.
表4.6，非酒精性脂肪性肝病(NAFLD)和非酒精性脂肪性肝炎(NASH)患者的管理，表4.7，已發(fā)布的NAFLD指南摘要，摘自“為NASH流行病做好準(zhǔn)備:行動(dòng)呼吁”(https://doi.org/10.2337/dci21-0020；提供更多關(guān)于如何管理這些疾病的信息。在美國(guó)胃腸病學(xué)協(xié)會(huì)關(guān)于NAFLD患者的負(fù)擔(dān)、篩查、風(fēng)險(xiǎn)分層、診斷和管理的會(huì)議之后制定了《行動(dòng)呼吁》，據(jù)此，對(duì)“非酒精性脂肪肝”小節(jié)進(jìn)行了其他修訂
(https://doi.org/10.2337/dc22-S005)
Recommendation 5.5 has been added to the“Diabetes Self-Management Education and Support” subsection to address digitalcoaching and digital self-management interviews as effective methods ofeducation and support.
在“糖尿病自我管理教育和支持”小節(jié)中增加了推薦5.5，以將數(shù)字輔導(dǎo)和數(shù)字自我管理訪談作為有效的教育和支持方法。
In the “Carbohydrates” subsection, moreemphasis has been placed on the quality of carbohydrates selected. InRecommendation 5.15, a fiber goal has been added for additional clarity.Evidence on consumption of mixed meals, insulin dosing, and impact on glycemiahas also been added to this subsection.
在“碳水化合物”小節(jié)中，更加強(qiáng)調(diào)了所選碳水化合物的質(zhì)量。在推薦5.15中，增加了一個(gè)（有關(guān)）纖維目標(biāo)以進(jìn)一步澄清。本小節(jié)中還增加關(guān)于混合餐消耗量、胰島素劑量以及對(duì)血糖影響的證據(jù)。
A new subsection on cognitivecapacity/impairment has been added, with recommendations for monitoring(Recommendation 5.51) and referral (Recommendation 5.52) for formal assessment,and a discussion of the evidence regarding cognitive impairment and diabetes.
增加關(guān)于認(rèn)知能力/障礙的新章節(jié)，包括正式評(píng)估的監(jiān)測(cè)推薦(推薦5.51)和轉(zhuǎn)診推薦(推薦5.52)，以及關(guān)于認(rèn)知障礙和糖尿病證據(jù)的討論。
(https://doi.org/10.2337/dc22-S006)
Time in range has been more fullyincorporated into the “Glycemic Assessment” subsection.
范圍內(nèi)時(shí)間（TIR）已更全面地納入“血糖評(píng)估”小節(jié)。
Time in range thresholds were removedfrom Recommendation 6.4, and the reader is directed to Table 6.2 forthose values.
從推薦6.4中刪除了范圍內(nèi)時(shí)間閾值，這些值請(qǐng)讀者參考表6.2。
Glucose variability and the associationof hypoglycemia was added to the “Hypoglycemia” subsection, as well asinformation on hypoglycemia prevention, including the Blood Glucose AwarenessTraining, Dose Adjusted for Normal Eating (DAFNE), and DAFNEplus programs.
“低血糖”小節(jié)中增加葡萄糖變異性和低血糖相關(guān)性，以及低血糖預(yù)防信息，包括血糖意識(shí)培訓(xùn)、針對(duì)正常飲食調(diào)整的劑量(DAFNE)和DAFNEplus計(jì)劃。
https://doi.org/10.2337/dc22-S007
General recommendations on the selectionof technology based on individual and caregiver preferences (Recommendation7.1), ongoing education on use of devices (Recommendation 7.2), continuedaccess to devices across payers (Recommendation 7.3), support of students usingdevices in school settings (Recommendation 7.4), and early initiation oftechnology (Recommendation 7.5) now introduce the technology section, whenpreviously these concepts were distributed throughout the section.
關(guān)于根據(jù)個(gè)人和照護(hù)人的喜好選擇技術(shù)的一般性推薦(推薦7.1)、關(guān)于設(shè)備使用的持續(xù)教育(推薦7.2)、支付與繼續(xù)使用設(shè)備(推薦7.3)、支持學(xué)生在學(xué)校環(huán)境中使用設(shè)備(推薦7.4)以及技術(shù)的早期啟動(dòng)(推薦7.5)現(xiàn)在引入到技術(shù)部分，而以前這些概念在整個(gè)部分中都有介紹。
“Self-monitoring of blood glucose(SMBG)” was replaced with the more commonly used “blood glucose monitoring(BGM)” throughout, and more information based on the U.S. Food and DrugAdministration recommendation regarding when an individual might need access toBGM was added to the “Blood Glucose Monitoring” subsection.
“血糖自我監(jiān)測(cè)(SMBG)”在全文中被替換為更常用的“血糖監(jiān)測(cè)(BGM)”，并且在“血糖監(jiān)測(cè)”小節(jié)中添加了更多基于美國(guó)美國(guó)食品藥品監(jiān)督管理局關(guān)于個(gè)人可能需要何時(shí)訪問(wèn)BGM的推薦的信息。
The recommendations regarding use ofcontinuous glucose monitoring (CGM) were divided between adults(Recommendations 7.11 and 7.12) and youth (Recommendations 7.13 and 7.14), andthe recommendation regarding periodic use of CGM or the use of professional CGMhas been simplified (Recommendation 7.17). Frequency of sensor use has alsobeen added to the text of the “Continuous Glucose Monitoring Devices”subsection, as well as a restructuring of the text in this section based onstudy design.
關(guān)于使用連續(xù)血糖監(jiān)測(cè)(CGM)的推薦分為成人(推薦7.11和7.12)和青年(推薦7.13和7.14)，關(guān)于定期使用CGM或使用專(zhuān)業(yè)CGM的推薦已被簡(jiǎn)化(推薦7.17)?！斑B續(xù)血糖監(jiān)測(cè)設(shè)備”小節(jié)的文本中還增加了傳感器使用頻率，以及本節(jié)中基于研究設(shè)計(jì)的文本重構(gòu)。
“Smart pens” are now referred to as“connected insulin pens,” and more discussion and evidence has been added tothe insulin pens content.
“智能筆”現(xiàn)在被稱(chēng)為“連接型胰島素筆”，有關(guān)胰島素筆內(nèi)容的討論和證據(jù)越來(lái)越多。
The discussion of automated insulindelivery (AID) systems has been combined with the insulin pumps subsection andis separate from the “Do-It-Yourself Closed-Loop Systems” subsection.
關(guān)于自動(dòng)胰島素輸送(AID)系統(tǒng)的討論已與胰島素泵小節(jié)結(jié)合在一起，并與“自己動(dòng)手閉環(huán)系統(tǒng)”小節(jié)分開(kāi)。
Recommendation 7.29 has been modified toinclude outpatient procedures and the consideration that people should beallowed continued use of diabetes devices during inpatient or outpatientprocedures when they can safely use them and supervision is available.
對(duì)推薦7.29進(jìn)行修改，以納入門(mén)診程序，并考慮到應(yīng)允許人們?cè)谧≡夯蜷T(mén)診程序中繼續(xù)使用糖尿病設(shè)備，只要他們能夠安全使用這些設(shè)備并且有監(jiān)管。
(https://doi.org/10.2337/dc22-S008)
The title has been changed to “Obesityand Weight Management for the Prevention and Treatment of Type 2 Diabetes.”
標(biāo)題已更改為“為預(yù)防和治療2型糖尿病而進(jìn)行的肥胖和體重管理”。
Evidence has been added regarding theimportance of addressing obesity, as both obesity and diabetes increase riskfor more severe COVID-19 infections.
已有證據(jù)表明解決肥胖問(wèn)題的重要性，因?yàn)榉逝趾吞悄虿《紩?huì)增加更嚴(yán)重的新冠肺炎感染的風(fēng)險(xiǎn)。
The concept of weight distribution andweight gain pattern and trajectory, in addition to weight and BMI, has beenadded to the “Assessment” subsection.
“評(píng)估”小節(jié)中除體重和BMI外，還增加了體重分布和體重增加模式及軌跡的概念。
Recommendation 8.12 and its associatedtext discussion added to the “Diet, Physical Activity, and Behavioral Therapy”subsection address the lack of clear evidence that dietary supplements areeffective for weight loss.
添加到“飲食、體育活動(dòng)和行為治療”小節(jié)的推薦8.12及其相關(guān)文本討論解決了缺乏明確證據(jù)表明膳食補(bǔ)充劑對(duì)減肥有效的問(wèn)題。
The “Medical Devices for Weight Loss”subsection has been revised to include more information on a newly approvedoral hydrogel.
對(duì)“減肥醫(yī)療器械”小節(jié)進(jìn)行了修訂，增加了關(guān)于新批準(zhǔn)的口服水凝膠的更多信息。
Recommendation 8.21 has been revised to include behavioralsupport and routine monitoring of metabolic status.
推薦8.21已經(jīng)過(guò)修訂，納入了行為支持和代謝狀態(tài)的常規(guī)監(jiān)測(cè)。
A new recommendation (Recommendation8.22) and discussion on postbariatric hypoglycemia, its causes, diagnosis, andmanagement have been added.
增加了關(guān)于減重手術(shù)后低血糖癥、其原因、診斷和管理的新推薦(推薦8.22)和討論。
Table 8.2,medications approved by the FDA for the treatment of obesity, has been updatedto include semaglutide.
表8.2(FDA批準(zhǔn)的治療肥胖的藥物)已更新，增加了司美格魯肽。
(https://doi.org/10.2337/dc22-S009)
Recommendation 9.3 has been revised toinclude fat and protein content, in addition to carbohydrates, as part ofeducation on matching mealtime insulin dosing.
推薦9.3已經(jīng)過(guò)修訂，除碳水化合物外，還包括脂肪和蛋白質(zhì)含量，作為匹配進(jìn)餐時(shí)間胰島素劑量教育的一部分。
Fig. 9.1,“Choices of insulin regimens in people with type 1 diabetes,” Fig. 9.2,“Simplified overview of indications for β-cell replacement therapy in peoplewith type 1 diabetes,” and Table 9.1, “Examples of subcutaneous insulinregimens,” from “The Management of Type 1 Diabetes in Adults. A ConsensusReport by the American Diabetes Association (ADA) and the European Associationfor the Study of Diabetes (EASD)” (https://doi.org/10.2337/dci21-0043), have been added to the “Pharmacologic Therapy for Adults withType 1 Diabetes” subsection.
圖9.1，“1型糖尿病患者胰島素治療方案的選擇”，圖9.2，“1型糖尿病患者β細(xì)胞替代治療適應(yīng)癥的簡(jiǎn)化概述”，以及表9.1，“皮下胰島素治療方案的示例”，內(nèi)容來(lái)自“成人1型糖尿病的管理-美國(guó)糖尿病協(xié)會(huì)(ADA)和歐洲糖尿病研究協(xié)會(huì)(EASD)的共識(shí)報(bào)告”，已添加到“成人1型糖尿病藥物治療”小節(jié)。
Table 9.2 hasbeen updated.
表9.2已更新。
Recommendation 9.4 has been revised andis now two recommendations (Recommendations 9.4a and 9.4b) on first-linetherapies and initial therapies, all based on comorbidities, patient-centeredtreatment factors, and management needs.
推薦9.4已經(jīng)過(guò)修訂，目前是關(guān)于一線治療和初始治療的兩項(xiàng)推薦(推薦9.4a和9.4b)，均基于合并癥、以患者為中心的治療因素和管理需求。
Recommendation 9.5 has been updated withother considerations for the continuation of metformin therapy after patientshave been initiated on insulin.
已對(duì)推薦9.5進(jìn)行更新，納入了患者開(kāi)始使用胰島素后繼續(xù)二甲雙胍治療的其他考慮因素。
A new recommendation has been addedregarding the use of insulin and combination therapy with a glucagon-likepeptide 1 (GLP-1) receptor agonist for greater efficacy and durability(Recommendation 9.11).
增加關(guān)于使用胰島素和胰高血糖素樣肽1(GLP-1)受體激動(dòng)劑聯(lián)合治療以提高療效和持久性的新推薦(推薦9.11)。
The section now concludes with anoverview of changes made to Fig. 9.3, “Pharmacologic treatment of hyperglycemiain adults with type 2 diabetes,” to reconcile emerging evidence and supportharmonization of guidelines recognizing alternative initial treatmentapproaches to metformin as acceptable, depending on comorbidities,patient-centered treatment factors, and glycemic and comorbidity managementneeds. The principle of medication incorporation is emphasized throughout Fig. 9.3—notall treatment intensification results in sequential add-on therapy, and insteadmay involve switching therapy or weaning current therapy to accommodatetherapeutic changes.
本節(jié)最后概述對(duì)圖9.3“2型糖尿病成人高血糖癥的藥物治療”所做的更改，以協(xié)調(diào)新出現(xiàn)的證據(jù)，并支持統(tǒng)一指南，根據(jù)合并癥、以患者為中心的治療因素以及血糖和合并癥管理需求，確認(rèn)二甲雙胍的替代初始治療方法是可接受的。在整個(gè)圖9.3中強(qiáng)調(diào)了藥物并入的原則-并非所有治療強(qiáng)化都會(huì)導(dǎo)致順序附加治療，而是可能涉及切換治療或停用當(dāng)前治療以適應(yīng)治療變化。（CK注：終于……）
（https://doi.org/10.2337/dc22-S010）
This section is endorsed for the fourthconsecutive year by the American College of Cardiology.
本部分已連續(xù)第四年獲得美國(guó)心臟病學(xué)會(huì)的認(rèn)可。
A new figure (Fig. 10.1) hasbeen added to depict the recommended comprehensive approach to the reduction inrisk of diabetes-related complications.
增加了一個(gè)新圖表(圖10.1)，以描述降低糖尿病相關(guān)并發(fā)癥風(fēng)險(xiǎn)的推薦綜合方法。
Recommendation 10.1 on screening anddiagnosis of blood pressure has been revised to include diagnosis ofhypertension at a single health care visit for individuals with blood pressuremeasuring ≥180/110 mmHg and cardiovascular disease.
修訂了關(guān)于血壓篩查和診斷的推薦10.1，將在單次醫(yī)療訪視時(shí)血壓測(cè)量值≥180/110 mmHg伴心血管疾病的個(gè)體診斷為高血壓。
More information on low diastolic bloodpressure and blood pressure management has been added to the “Individualizationof Treatment Targets” subsection under “Hypertension/Blood Pressure Control.”
關(guān)于低舒張壓和血壓管理的更多信息已添加到“高血壓/血壓控制”下的“治療目標(biāo)的個(gè)體化”小節(jié)。
In the “Treatment Strategies: LifestyleInterventions” subsection under “Hypertension/Blood Pressure Control,”discussion has been added on the use of internet or mobile-based digitalplatforms to reinforce healthy behaviors and their ability to enhance theefficacy of medical therapy for hypertension.
在“高血壓/血壓控制”下的“治療策略:生活方式干預(yù)”小節(jié)中，增加了關(guān)于使用互聯(lián)網(wǎng)或基于移動(dòng)的數(shù)字平臺(tái)來(lái)加強(qiáng)健康行為及其提高高血壓藥物治療效果的能力的討論。
More information on use of ACEinhibitors and angiotensin receptor blocker (ARB) therapy for those with kidneyfunction decline has been added to the “Pharmacologic Interventions” subsectionunder “Hypertension/Blood Pressure Control.”
關(guān)于使用ACE抑制劑和血管緊張素受體阻滯劑(ARB)治療腎功能減退患者的更多信息，已添加到“高血壓/血壓控制”下的“藥物干預(yù)”小節(jié)。
Ezetimibe being preferential due to itslower cost has been removed from Recommendation 10.24.
依折麥布因成本較低而具有優(yōu)勢(shì)的內(nèi)容已從推薦10.24中刪除。
More discussion was added on use ofevolocumab therapy and reduction in all strokes and ischemic stroke.
增加了更多關(guān)于evolocumab治療的使用和減少所有卒中和缺血性卒中的討論。
A new subsection on statins andbempedoic acid has been added.
增加了關(guān)于他汀類(lèi)藥物和bempedoicacid的新章節(jié)。
A discussion of the ADAPTABLE (AspirinDosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness)trial has been added to the “Aspirin Dosing” subsection.
在“阿司匹林給藥”小節(jié)中增加了對(duì)ADAPTABLE (阿司匹林給藥:以患者為中心評(píng)估獲益和長(zhǎng)期有效性的試驗(yàn))試驗(yàn)的討論。
A discussion of the TWILIGHT (TicagrelorWith Aspirin or Alone in High-Risk Patients After Coronary Intervention) trialhas been added to the “Indications for P2Y12 Receptor Antagonist Use”subsection.
在“使用P2Y12受體拮抗劑的適應(yīng)癥”小節(jié)中增加了對(duì)TWILIGHT (替卡格雷聯(lián)合阿司匹林或單獨(dú)用于冠狀動(dòng)脈介入術(shù)后高?；颊?試驗(yàn)的討論。
Recommendation 10.42c has been added tothe “Cardiovascular Disease: Treatment” subsection, providing guidance forpatients with type 2 diabetes and established atherosclerotic cardiovasculardisease (ASCVD) or multiple risk factors for ASCVD on the use of combinedtherapy with a sodium–glucose cotransporter 2 (SGLT2) inhibitor withdemonstrated cardiovascular benefit and a GLP-1 receptor agonist withdemonstrated cardiovascular benefit.
在“心血管疾病:治療”小節(jié)中增加了推薦10.42c，為患有2型糖尿病伴已確定的動(dòng)脈粥樣硬化性心血管疾病(ASCVD)或ASCVD的多種風(fēng)險(xiǎn)因素的患者使用聯(lián)合治療提供指導(dǎo)，聯(lián)合治療包括已證明對(duì)心血管有益的鈉-葡萄糖共轉(zhuǎn)運(yùn)體2 (SGLT2)抑制劑和已證明對(duì)心血管有益的GLP-1受體激動(dòng)劑。
A discussion of the Dapagliflozin andPrevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial, theEffect of Sotagliflozin on Cardiovascular Events in Patients With Type 2Diabetes Post Worsening Heart Failure (SOLOIST-WHF) trial, and the Effect ofEfpeglenatide on Cardiovascular Outcomes (AMPLITUDE-O) have been added, inaddition to the results of the Dapagliflozin and Prevention of Adverse Outcomesin Heart Failure (DAPA-HF) trial, the Evaluation of Ertugliflozin Efficacy andSafety Cardiovascular Outcomes Trial (VERTIS CV), and the Effect ofSotagliflozin on Cardiovascular and Renal Events in Patients With Type 2Diabetes and Moderate Renal Impairment Who Are at Cardiovascular Risk (SCORED)trial, which were added as a Living Standards update in June 2021.
除了作為2021年6月的動(dòng)態(tài)標(biāo)準(zhǔn)更新而增加達(dá)格列凈和預(yù)防心力衰竭不良結(jié)局(DAPA-HF)試驗(yàn)、Ertugliflozin療效和安全性心血管結(jié)局評(píng)價(jià)(VERTIS CV) 以及Sotagliflozin對(duì)有心血管風(fēng)險(xiǎn)的2型糖尿病和中度腎功能損害患者的心血管和腎臟事件的影響(SCORED)試驗(yàn)的結(jié)果之外，還增加了對(duì)達(dá)格列凈和預(yù)防慢性腎病不良結(jié)局(DAPA-CKD)試驗(yàn)、Sotagliflozin對(duì)2型糖尿病惡化后心力衰竭患者心血管事件的影響(SOLOIST-WHF)試驗(yàn)以及Efpeglenatide對(duì)心血管結(jié)局(AMPLITUDE-O)的影響的討論。
Table 10.3C has been updated.
表10.3C已更新。
A new subsection, “Clinical Approach,”now concludes this section on risk reduction with SGLT2 inhibitors or GLP-1receptor agonist therapy. Fig. 10.3 has been reproduced from the ADA-endorsedAmerican College of Cardiology “2020 Expert Consensus Decision Pathway on NovelTherapies for Cardiovascular Risk Reduction in Patients with Type 2 Diabetes” (https://doi.org/10.1016/j.jacc.2020.05.037) and outlines the approach to risk reduction with SGLT2inhibitor or GLP-1 receptor agonist therapy in conjunction with othertraditional, guideline-based preventive medical therapies for blood pressure aswell as lipid, glycemic, and antiplatelet therapy.
本節(jié)關(guān)于SGLT2抑制劑或GLP-1受體激動(dòng)劑治療降低風(fēng)險(xiǎn)的內(nèi)容進(jìn)行總結(jié)，新增加一小節(jié)“臨床方法”。圖10.3摘自ADA認(rèn)可的美國(guó)心臟病學(xué)會(huì)“2020年2型糖尿病患者心血管風(fēng)險(xiǎn)降低新療法專(zhuān)家共識(shí)決策路徑”，并概述了使用SGLT2抑制劑或GLP-1受體激動(dòng)劑治療以及其他傳統(tǒng)的、基于指南的預(yù)防性藥物治療降低血壓、血脂、血糖和抗血小板治療風(fēng)險(xiǎn)的方法。
(https://doi.org/10.2337/dc22-S011)
Formerly, Section 11, “MicrovascularComplications and Foot Care,” contained content on chronic kidney disease,retinopathy, neuropathy, and foot care. This section has now been divided intotwo sections: Section 11, “Chronic Kidney Disease and Risk Management” (https://doi.org/10.2337/dc22-S011), and Section 12, “Retinopathy, Neuropathy, and Foot Care” (https://doi.org/10.2337/dc22-S012).
以前，第11部分“微血管并發(fā)癥和足部護(hù)理”包含關(guān)于慢性腎病、視網(wǎng)膜病、神經(jīng)病和足部護(hù)理的內(nèi)容。本節(jié)現(xiàn)分為兩節(jié):第十一部分“慢性腎臟疾病及風(fēng)險(xiǎn)管理”和第十二部分“視網(wǎng)膜病變，神經(jīng)病變和足病”
Recommendation 11.3a has been revised toinclude lower glomular filtration rates and lower urinary albumin as indicatorsfor use of SGLT2 inhibitors to reduce chronic kidney disease (CKD) progressionand cardiovascular events.
已修訂推薦11.3a，將較低的腎小球?yàn)V過(guò)率和較低的尿白蛋白作為使用SGLT2抑制劑以減少慢性腎病(CKD)進(jìn)展和心血管事件的指標(biāo)。
Recommendation 11.3c has also beenrevised to include therapy options (nonsteroidal mineralocorticoid receptorantagonist [finerenone]), and a new recommendation has been added(Recommendation 11.3d) regarding reduction of urinary albumin to slow CKDprogression.
修訂了推薦11.3c，以納入治療方案(非甾體鹽皮質(zhì)激素受體拮抗劑[finerenone，非奈利酮])，并增加了一項(xiàng)新推薦(推薦11.3d)，即減少尿白蛋白以減緩CKD進(jìn)展。
The concept of blood pressurevariability has been added to Recommendation 11.4.
推薦11.4中增加了血壓變異性的概念。
More discussion has been added to the“Acute Kidney Injury” subsection regarding use of ACE inhibitors or ARBs.
關(guān)于ACE抑制劑或ARB的使用，在“急性腎損傷”小節(jié)中增加了更多討論。
(https://doi.org/10.2337/dc22-S012)
Formerly, Section 11, “MicrovascularComplications and Foot Care,” contained content on chronic kidney disease,retinopathy, neuropathy, and foot care. This section has now been divided intotwo sections: Section 11, “Chronic Kidney Disease and Risk Management” (https://doi.org/10.2337/dc22-S011), and Section 12, “Retinopathy, Neuropathy, and Foot Care” (https://doi.org/10.2337/dc22-S012).
以前，第11節(jié)“微血管并發(fā)癥和足部護(hù)理”包含關(guān)于慢性腎病、視網(wǎng)膜病、神經(jīng)病和足部護(hù)理的內(nèi)容。本節(jié)現(xiàn)分為兩部分:第十一部分“慢性腎臟疾病及風(fēng)險(xiǎn)管理” 和第十二部分“視網(wǎng)膜病變，神經(jīng)病變和足病”
More discussion was added to the“Diabetic Retinopathy” subsection regarding use of GLP-1 receptor agonists andretinopathy.
在“糖尿病視網(wǎng)膜病變”小節(jié)中增加了更多關(guān)于使用GLP-1受體激動(dòng)劑和視網(wǎng)膜病變的討論。
Recommendation 12.11 was updated toindicate that intravitreous injections of anti–vascular endothelial growthfactor are a reasonable alternative to traditional panretinal laserphotocoagulation for some patients with proliferative diabetic retinopathy andalso reduce the risk of vision loss in these patients.
更新了推薦12.11，以表明玻璃體內(nèi)注射抗血管內(nèi)皮生長(zhǎng)因子是治療某些增生性糖尿病視網(wǎng)膜病變患者的傳統(tǒng)全視網(wǎng)膜激光光凝術(shù)的合理替代方法，并可降低這些患者的視力喪失風(fēng)險(xiǎn)。
Recommendation 12.12 was also updated torecommend intravitreous injections of anti–vascular endothelial growth factoras first-line treatment for most eyes with diabetic macular edema that involvesthe foveal center and impairs visions acuity.
還更新了推薦12.12，推薦玻璃體內(nèi)注射抗血管內(nèi)皮生長(zhǎng)因子作為大多數(shù)糖尿病黃斑水腫眼(累及視網(wǎng)膜中央凹中心并損害視力)的一線治療。
A new recommendation (Recommendation12.13) was added on macular focal/grid photocoagulation and intravitrealinjections of corticosteroid.
增加了關(guān)于黃斑局灶性/格柵光凝和玻璃體內(nèi)注射皮質(zhì)類(lèi)固醇的新推薦(推薦12.13)。
(https://doi.org/10.2337/dc22-S013)
In the “Hypoglycemia” subsection,glycemic variability and older adults with physical or cognitive limitationswas added to the discussion of use of CGM.
在“低血糖”小節(jié)中，將血糖變異性和有身體或認(rèn)知障礙的老年人添加到CGM使用的討論中。
The upper threshold of 8.5% (69mmol/mol) was removed from the example of less stringent goals for those withmultiple coexisting chronic illnesses, cognitive impairment, or functionaldependence in Recommendation 13.6.
在推薦13.6中，從針對(duì)患有多種共存慢性疾病、認(rèn)知障礙或功能依賴(lài)性的患者的較寬松目標(biāo)示例中移除了8.5% (69 mmol/mol)的上限閾值。
More discussion was added onclassification of older adults in the “Patients With Complications and ReducedFunctionality” subsection.
在“并發(fā)癥和功能減退患者”小節(jié)中增加了關(guān)于老年人分類(lèi)的更多討論。
The benefits of a structured exerciseprogram (as in the Lifestyle Interventions and Independence for Elders [LIFE]Study) was incorporated into the “Lifestyle Management” subsection.
結(jié)構(gòu)化鍛煉計(jì)劃的益處(如“老年人生活方式干預(yù)和獨(dú)立性[LIFE]研究”中所述)已納入“生活方式管理”小節(jié)。
More discussion of overtreatment wasadded to the “Pharmacologic Therapy” subsection, as was the consideration thatfor those taking metformin long term, monitoring vitamin B12 deficiency shouldbe considered. The insulin therapy discussion was also updated with moreinformation on avoidance of hypoglycemia.
在“藥物治療”小節(jié)中增加了更多關(guān)于過(guò)度治療的討論，同時(shí)考慮到長(zhǎng)期服用二甲雙胍的患者應(yīng)考慮監(jiān)測(cè)維生素B12缺乏。胰島素治療討論也更新了更多關(guān)于避免低血糖的信息。
(https://doi.org/10.2337/dc22-S014)
Table 14.1A and Table 14.1B havebeen newly created and provide an overview of the recommendations for screeningand treatment of complications and related conditions in pediatric type 1diabetes (Table 14.1A) and type 2 diabetes (Table 14.1B).
新創(chuàng)建的表14.1A和表14.1B概述了兒科1型糖尿病(表14.1A)和2型糖尿病(表14.1B)并發(fā)癥和相關(guān)疾病的篩查和治療推薦。
The “Diabetes Self-Management Educationand Support” subsection now discusses adult caregivers as critical to diabetesself-management in youth, and how they should be engaged to ensure there is nota premature transfer of responsibility for self-management to the youth.
“糖尿病自我管理教育和支持”小節(jié)討論了成人護(hù)理人員對(duì)青少年糖尿病自我管理的重要性，以及應(yīng)如何讓他們參與進(jìn)來(lái)，以確保不會(huì)將自我管理的責(zé)任過(guò)早移交給青少年。
Recommendation 14.7 has been simplified.
推薦14.7已經(jīng)簡(jiǎn)化。
Recommendations in the renamed “GlycemicMonitoring, Insulin Delivery, and Targets” subsection (Recommendations14.18–14.27) have been reorganized and revised to better align withrecommendations in Section 7, “Diabetes Technology” (https://doi.org/10.2337/dc22-S007).
更名后的“血糖監(jiān)測(cè)、胰島素輸送和目標(biāo)”小節(jié)中的推薦(推薦14.18–14.27)已進(jìn)行重組和修訂，以更好地與第7節(jié)“糖尿病技術(shù)”中的推薦保持一致
The recommendations in the type 1diabetes “Management of Cardiovascular Risk Factors” subsection(Recommendations 14.34–14.42) have been revised to include more information ontiming of screening and treatment and updates to indicators for screening andtreatment.
1型糖尿病“心血管風(fēng)險(xiǎn)因素的管理”小節(jié)中的推薦(推薦14.34-14.42)已經(jīng)過(guò)修訂，納入了更多關(guān)于篩選和治療時(shí)間的信息以及篩選和治療指標(biāo)的更新。
Throughout the section, more has beenadded regarding reproductive counseling in female youth considering ACEinhibitors and ARBs.
在整個(gè)章節(jié)中，增加了更多關(guān)于考慮ACE抑制劑和ARB的女性青年生殖咨詢(xún)的內(nèi)容。
A new recommendation (Recommendation14.49) was added to the “Retinopathy” subsection for type 1 diabetes regardingretinal photography.
在1型糖尿病的“視網(wǎng)膜病變”小節(jié)中增加了關(guān)于視網(wǎng)膜攝影的新推薦(推薦14.49)。
A new recommendation (Recommendation14.61) has been added on the use of CGM for youth with type 2 diabetes onmultiple daily injections or continuous subcutaneous insulin infusion.
增加了一項(xiàng)新推薦(推薦14.61)，即2型糖尿病青年每日多次注射或持續(xù)皮下胰島素輸注時(shí)應(yīng)使用CGM。
The recommendations for hypertensionscreening and management (Recommendations 14.77–14.80) for type 2 diabetes havebeen revised.
針對(duì)2型糖尿病的高血壓篩查和管理推薦(推薦14.77-14.80)已經(jīng)過(guò)修訂。
Fig. 14.1 hasbeen updated.
圖14.1已更新。
(https://doi.org/10.2337/dc22-S015)
A new recommendation (Recommendation15.16) and discussion of the evidence on telehealth visits for pregnant womenwith gestational diabetes mellitus has been added to the “Management ofGestational Diabetes Mellitus” subsection.
“妊娠糖尿病的管理”小節(jié)中增加了一項(xiàng)新推薦(推薦15.16)以及對(duì)妊娠糖尿病孕婦遠(yuǎn)程健康訪視證據(jù)的討論。
A new subsection on “Physical Activity”has been added.
增加了一個(gè)關(guān)于“身體活動(dòng)”的新小節(jié)。
Additional discussion was addedregarding insulin as the preferred treatment for type 2 diabetes in pregnancy.
增加了關(guān)于胰島素作為妊娠2型糖尿病首選治療的其他討論。
(https://doi.org/10.2337/dc22-S016)
Additional information has been added onthe use of CGM during the COVID-19 pandemic to minimize contact between healthcare providers and patients, especially those in the intensive care unit.
增加了關(guān)于在新冠肺炎疫情期間使用CGM的其他信息，以盡量減少醫(yī)療服務(wù)提供者和患者之間的接觸，尤其是重癥監(jiān)護(hù)室中的患者。
(https://doi.org/10.2337/dc22-S017)
No changes have been made to thissection.
對(duì)該部分未做任何更改。
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