《2013-aace糖尿病临床路径》
聚焦2013 AACE糖尿病管理路径,2,患病率 (%),中国糖尿病患病率呈急剧上升趋势,Diabetes Atlas, Fourth edition© International Diabetes Federation, 2009; 糖尿病学分会. 中华内分泌代谢杂志 2008; 24: 2a:1-22. Yang WY, et al. N Engl J Med 2010; 362:1090-1101.; 2010中国2型糖尿病治疗指南:p12, downloaded from http:/www.cdschina.org/x_uploadfiles/dm201otaolungao.pdf,Percentage of U.S. Adults Who Were Obese or Had Diagnosed Diabetes,Centers for Disease Control and Prevention: National Diabetes Surveillance System. Available online at: http:/apps.nccd.cdc.gov/DDTSTRS/default.aspx. Accessed 10/3/2011.,Obesity (BMI 30 kg/m2),Diabetes,No Data 4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% 9.0%,5,AACE引领全球内分泌领域发展,AACE是美国临床内分泌科医师学会（American Association of Clinical Endocrinologist） 始于1991年，由全球一流的临床内分泌学领导者创建，现已覆86个国家和地区，吸引全世界最好的临床内分泌医师成为会员 自建立之初制定并发布了内分泌领域众多疾病指南，指导全球内分泌疾病的规范化治疗，引领全球内分泌领域最新潮的治疗理念 学会取得飞速发展，某种程度上使得美国内科学成果在世界上占有领先地位,6,AACE制定众多内分泌疾病的临床专科指南-1,Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Patient - 2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery © 2013 Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. © 2012 American Association of Clinical Endocrinologists' Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis © 2012 AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Menopause © 2011 American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly - © 2011,https:/www.aace.com/publications/guidelines,7,AACE制定众多内分泌疾病的临床专科指南-2,Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists - © 2011 American Association of Clinical Endocrinologists Medical Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan - © 2011 American Association of Clinical Endocrinologists Guidelines for Clinical Practice for the Diagnosis and Treatment of Postmenopausal Osteoporosis © 2010 American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules © 2010 American Association of Clinical Endocrinologists Protocol for Standardized Production of Clinical Practice Guidelines - 2010 Update,AACE制定众多内分泌疾病的临床专科指南-3,11. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Growth Hormone Use in Growth Hormone-deficient Adults and Transition Patients 2009 Update American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas © 2009 American Association Of Clinical Endocrinologists, The Obesity Society, and American Society For Metabolic & Bariatric Surgery Medical Guidelines For Clinical Practice For The Perioperative Nutritional, Metabolic, And Non Surgical Support Of The Bariatric Surgery Patient © 2008 AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Hypertension © 2006 AACE Medical Guidelines for the Clinical Use of Dietary Supplements and Nutraceuticals © 2003,AACE制定众多内分泌疾病的临床专科指南-4,16. AACE Medical Guidelines for the Clinical Practice for Evaluation and Treatment of Male Sexual Dysfunction: A Couple's Problem- 2003 Update 17. AACE Medical Guidelines for Clinical Practice for Evaluation and Treatment of Hypogonadism in Adult Male Patients- 2002 Update 18. AACE Medical Guidelines for Clinical Practice for Evaluation and Treatment of Hyperthyroidism and Hypothyroidism © 2002 19. AACE/AAES Medical/Surgical Guidelines for Clinical Practice for Management of Thyroid Carcinoma © 2001 20. AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Hyperandrogenic Disorders © 2001,AACE糖尿病管理路径更被专科医师所推崇,美国第22届AACE年会于2013年5月1日5日在凤凰城召开 备受瞩目的糖尿病管理路径在会议期间隆重颁布,Garber AJ, et al. Endocr Pract. 2013 Mar-Apr;19(2):327-36.,11,2013AACE指南,血糖调节,生活方式改变（包括医学辅助减肥）,AG-I：-糖苷酶抑制剂 SGLT-2：葡萄糖转运体2 TZD: 噻唑烷二酮类 SU/GLN:磺脲类/格列奈类,糖尿病药物安全性整体评价一览表,Garber AJ, et al. Endocr Pract. 2013 Mar-Apr;19(2):327-36.,14,AACE2013指南有什么特点？（一）,AACE2013版指南强调并发症综合治疗及低血糖与体重的管理。 在药物选择方面，主要从安全性的角度考虑，而其中低血糖和体重增加被作为最重要的两个衡量指标，而降糖疗效则不是的关注点。,AACE2013指南有什么特点？（二）,磺脲类、格列奈类和胰岛素由于存在低血糖和体重增加的风险，因此在该指南中被标为慎用。 二甲双胍、GLP-1受体激动剂、DPP-4抑制剂和糖苷酶抑制剂由于在低血糖和体重增加方面更加安全，被该指南推荐为优先选择。,是不是我们中国的糖尿病的治疗，应该遵循AACE2013指南，慎用磺脲类药物？,众多权威指南在制定时的 出发点和考虑因素不尽相同,ADA-EASD（2012）磺脲类为二线联合治疗之一； NICE（2009）推荐磺脲类为一线治疗之一以及二线治疗首选； IDF（2012）以及中国指南（CDS 2010）均推荐磺脲类作为一线治疗备选和二线治疗首选。,磺脲类药物优势,磺脲类本身来说，其起效迅速，降糖疗效强，价格经济， 磺脲和双胍仍然是糖尿病医生和患者选择最多的药物。 在以降糖达标为首要目的的治疗中，磺脲依然是重要的选择。 而且在低血糖和体重增加方面，新一代的磺脲格列美脲相较于传统磺脲类已经有了显著改善。,AACE指南中提到基础胰岛素
