这不仅是一份指导原则，更是一本指南索引，你想知道的，里面都能找到！
作者｜鲸鱼
来源｜医学界内分泌频道
本文提要
简介：指南的集大成者！
重点：十大原则都是啥？
资源：一大波指南袭来！
简介：
指南的集大成者！
01
美国国家糖尿病教育项目（The National Diabetes Education Program, NDEP）日前修订了其《糖尿病及糖尿病高危人群管理的指导原则》，并于2018年8月发布在了美国国家糖尿病、消化和肾病研究所（National Institute of Diabetes and Digestive and Kidney Diseases, NIDKK）的官网上[1]。
Fig 1.1 《指导原则》在线发布于NIDDK并提供免费下载
本次发布的《指导原则》更新了2014年的老版本，更新过程中受到美国20家相关组织协会的支持，包括美国糖尿病学会（ADA）、美国临床内分泌医师协会（AACE）等。这一更新后版本反应了过去几年中不断发生变化的新证据，内容上强调了糖尿病患者自我管理教育和以患者为中心的管理共同决策的重要性，并增加了一条新原则：管理糖尿病患者的超重或肥胖问题。
Fig 1.2 支持《指导原则》发布的20家组织协会
这一文件侧重于成人2型糖尿病的预防和管理，但也提供了部分有关1型糖尿病、妊娠糖尿病、儿童及青少年2型糖尿病和其他类型糖尿病的信息。这一版本的《指导原则》简介中指出，这份文件并不是官方指南，也不是系统的证据梳理、立场或共识声明，而是综合了各家指南中共同的意见，精炼地总结为10条原则并辅以相应阐述，展现出现今人们在糖尿病管理中的普遍认识，以指导糖尿病及糖尿病前期患者的诊疗。
接下来，就让我们看看这十大原则是什么！
重点：
十大原则都是啥？
02
Fig 2.1 糖尿病管理十大原则及中译
除了这10条指导原则之外，文件中还有许多有价值的表格及总结值得我们关注，包括糖尿病的危险因素、糖尿病的筛查和诊断标准、糖化血红蛋白（HbA1c）与血糖的换算等——简直是一文在手，高招我有！
Fig 2.2 2型糖尿病的危险因素
Fig 2.3 糖尿病前期和2型糖尿病的筛查诊断标准
Fig 2.4 妊娠糖尿病的筛查诊断标准
Fig 2.5 根据BMI的超重/肥胖分类
Fig 2.6 糖尿病药物对体重的影响
Fig 2.7 HbA1c水平或范围对应的平均血糖水平
看完了这些表格和总结是不是还有些意犹未尽？不怕！这只不过是“开胃小菜”，“主菜”还在后面呢！这份文件的每条指导原则之后均附有相应的指南供读者参考，并贴心地附上了下载链接。文件中总计有39份指南，可以说是集糖尿病指南之大成了！
资源：
一大波指南袭来！
03
虽然这份指南在Medscape上被一些临床医师诟病：“没有什么用处”[2]。的确，这十大原则都是些非常正确的“废话”。但是，这并不妨碍我们将这份文件当作一份指南的索引来使用——接下来就让我们看看这份文件里究竟列举了哪些指南！
序号 | 指南、立场声明与共识报告 | 链接 |
1 | 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines | https://www.ahajournals.org/doi/abs/10.1161/01.cir.0000437740.48606.d1 |
2 | 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society | https://www.ahajournals.org/doi/abs/10.1161/01.cir.0000437739.71477.ee |
3 | American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association. Joint Principles of the Patient-Centered Medical Home. Patient Centered Primary Care Collaborative 2007. | https://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf |
4 | American Association of Clinical Endocrinologists and American College of Endocrinology – Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan – 2015 | https://www.aace.com/files/dm-guidelines-ccp.pdf |
5 | American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. 2016. | https://www.aace.com/files/final-appendix.pdf |
6 | American College of Obstetricians and Gynecologists. Women’s Prevention Services Initiative: Screening for Gestational Diabetes Mellitus | https://www.womenspreventivehealth.org/recommendations/screening-for-gestational-diabetes-mellitus/ |
7 | American College of Physicians. Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update. 2018. | http://annals.org/aim/fullarticle/2674121/hemoglobin-1c-targets-glycemic-control-pharmacologic-therapy-nonpregnant-adults-type |
8 | American College of Physicians. Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline | http://annals.org/aim/fullarticle/1033354/oral-pharmacologic-treatment-type-2-diabetes-mellitus-clinical-practice-guideline |
9 | American Diabetes Association Standards of Care in Diabetes—2018: Cardiovascular Disease and Risk Management | http://care.diabetesjournals.org/content/41/Supplement_1/S86 |
10 | American Diabetes Association Standards of Medical Care in Diabetes—2018: Obesity Management for the Treatment of Type 2 Diabetes | http://care.diabetesjournals.org/content/41/Supplement_1/S65 |
11 | American Diabetes Association, American Cancer Society. Diabetes and Cancer: A consensus report. 2010. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890380/ |
12 | American Diabetes Association, European Association for the Study of Diabetes. Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). 2012. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357214/ |
13 | American Diabetes Association. Psychosocial Care for People with Diabetes: A Position Statement of the American Diabetes Association. 2016. | http://care.diabetesjournals.org/content/39/12/2126 |
14 | American Diabetes Association. Standards of Care in Diabetes—2018: Lifestyle Management | http://care.diabetesjournals.org/content/41/Supplement_1/S38 |
15 | American Diabetes Association. Standards of Medical Care in Diabetes—2018: Classification and Diagnosis of Diabetes | http://care.diabetesjournals.org/content/41/Supplement_1/S13 |
16 | American Diabetes Association. Standards of Medical Care in Diabetes—2018: Comprehensive Medical Evaluation and Assessment of Comorbidities | http://care.diabetesjournals.org/content/41/Supplement_1/S28 |
17 | American Diabetes Association. Standards of Medical Care in Diabetes—2018: Glycemic Targets | http://care.diabetesjournals.org/content/41/Supplement_1/S55 |
18 | American Diabetes Association. Standards of Medical Care in Diabetes—2018: Improving Care a d Promoting Health in Populations | http://care.diabetesjournals.org/content/41/Supplement_1/S7 |
19 | American Diabetes Association. Standards of Medical Care in Diabetes—2018: Prevention or Delay of Type 2 Diabetes | http://care.diabetesjournals.org/content/41/Supplement_1/S51 |
20 | American Geriatrics Society. Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 Update and Supplemental Information. 2013. | https://geriatricscareonline.org/ProductAbstract/guidelines-for-improving-the-care-of-the-older-adult-with-diabetes-mellitus-2013-update-and-supplemental-information/CL008/ |
21 | Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient – 2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery | https://www.aace.com/files/publish-ahead-of-print-final-version.pdf |
22 | Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2018 Executive Summary | https://www.aace.com/sites/all/files/diabetes-algorithm-executive-summary.pdf |
23 | Diabetes Self-management Education and Support in Type 2 Diabetes. A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. 2015. | https://www.diabeteseducator.org/docs/default-source/practice/practice-resources/position-statements/dsme_joint_position_statement_2015.pdf?sfvrsn=0 |
24 | Endocrine Society. Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults. 2016. | https://academic.oup.com/jcem/article/101/11/3922/2764917 |
25 | International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy | http://care.diabetesjournals.org/content/33/3/676.long |
26 | Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. 2016. | http://care.diabetesjournals.org/content/39/6/861 |
27 | Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. 2015. Cosponsored by the European Society of Endocrinology and The Obesity Society. | https://academic.oup.com/jcem/article/100/2/342/2813109 |
28 | Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. 2016. | http://care.diabetesjournals.org/content/39/11/2065 |
29 | Position of the Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults. 2016. | https://secure.jbs.elsevierhealth.com/action/getSharedSiteSession?redirect=https%3A%2F%2Fwww.andjrnl.org%2Farticle%2FS2212-2672%2815%2901636-6%2Fpdf&rc=0 |
30 | Primary Prevention of Cardiovascular Disease and Type 2 Diabetes in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline | https://academic.oup.com/jcem/article/93/10/3671/2627256 |
31 | The Obesity Society with the ACC/AHA Task Force on Practice Guidelines. Guidelines (2013) for Managing Overweight and Obesity in Adults | https://onlinelibrary.wiley.com/toc/1930739x/22/S2 |
32 | U.S. Preventive Services Task Force. Final Recommendation Statement: Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Behavioral Counseling. 2014. | https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/healthy-diet-and-physical-activity-counseling-adults-with-high-risk-of-cvd |
33 | Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association. 2015. | https://www.ahajournals.org/doi/abs/10.1161/cir.0000000000000230 |
34 | USPSTF Final Recommendation Statement. Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening | https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes |
35 | USPSTF Final Recommendation Statement. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication | https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-to-prevent-cardiovascular-disease-and-cancer |
36 | USPSTF Final Recommendation Statement. Gestational Diabetes Mellitus, Screening | https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/gestational-diabetes-mellitus-screening |
37 | USPSTF Final Recommendation Statement. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication | https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/statin-use-in-adults-preventive-medication1 |
38 | USPSTF Final Recommendation Statement. Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions | https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions1 |
39 | VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care – 2017 | https://www.healthquality.va.gov/guidelines/CD/diabetes/ |
一共39份，赶紧收好咯！
最后，附上这份文件的下载链接：
https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication-Programs/NDEP/health-care-professionals/Guiding_Principles_Final.pdf?la=en
—————
Reference
[1] National Diabetes Education Program (NDEP), The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2018). Guiding Principles for the Care of People With or at Risk for Diabetes.
Available at:
https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication-Programs/NDEP/health-care-professionals/Guiding_Principles_Final.pdf?la=en
Last assessed on 2018-08-26.
[2] Miriam E. Tucker. NIDDK Updates 'Guiding Principles' for Diabetes, Prediabetes. Medscape. August 23, 2018.
Available at:
https://www.medscape.com/viewarticle/901127
Last assessed on 2018-08-26.
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