AACE积极调整剂量安全达标-科室会ppt课件

1、AACE启示：积极调整剂量 平安达标AACE引领全球内分泌领域开展 始于1991年年，由全球一流的临床内分泌学指导者创立，现已覆86个个国家和地区，吸引全世界最好的临床内分泌最好的临床内分泌医师医师成为会员 自建立之初制定并发布了内分泌领域众多疾病众多疾病指南指南，指导全球内分泌疾病的标准化治疗，引领全球内分泌领域最新潮的治疗最新潮的治疗理念理念 协会获得了飞速开展，某种程度上使得美国内科学成果在世界上占占有领先有领先地位地位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,

2、 Metabolic, and Nonsurgical Support of the Bariatric Patient - 2021 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery 2021 2.Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored

3、by the American Association of Clinical Endocrinologists and the American Thyroid Association. 2021 3.American Association of Clinical Endocrinologists Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis 2021 4.AACE Medical Guidelines for Clinical Practice for Diagnosis and T

4、reatment of Menopause 2020 5.American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly - 2020 6.Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American As

5、sociation of Clinical Endocrinologists - 2020 7.American Association of Clinical Endocrinologists Medical Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan - 2020 8.American Association of Clinical Endocrinologists Guidelines for Clinical Practice for the Diagnosis and Treatment

6、of Postmenopausal Osteoporosis 2020 9.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 2020 10. American Association of Clinical Endocrin

7、ologists Protocol for Standardized Production of Clinical Practice Guidelines - 2020 Update 11. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Growth Hormone Use in Growth Hormone-deficient Adults and Transition Patients 2020 Update 12. American Associ

8、ation of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas 2020 13. American Association Of Clinical Endocrinologists, The Obesity Society, and American Society For Metabolic & Bariatric Surgery Medical Guidel

9、ines For Clinical Practice For The Perioperative Nutritional, Metabolic, And Non Surgical Support Of The Bariatric Surgery Patient 2020 14. AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Hypertension 2006 15. AACE Medical Guidelines for the Clinical Use of Dietary Suppl

10、ements and Nutraceuticals 2003 16. AACE Medical Guidelines for the Clinical Practice for Evaluation and Treatment of Male Sexual Dysfunction: A Couples Problem- 2003 Update 17. AACE Medical Guidelines for Clinical Practice for Evaluation and Treatment of Hypogonadism in Adult Male Patients- 2002 Upd

11、ate 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 T

12、reatment of Hyperandrogenic Disorders 2001 s aace /publications/guidelines?AACE糖尿病管理途径?更被专科医师所推崇美国第22届AACE年会于2021年5月1日5日在凤凰城召开备受瞩目的?糖尿病管理途径?在会议期间隆重公布Garber AJ, et al. Endocr Pract. 2021 Mar-Apr;192:327-36.考来维仑考来维仑糖苷酶抑制剂糖苷酶抑制剂胰岛素胰岛素其他药物其他药物= 较少的不良事件较少的不良事件 或可能获益或可能获益单药治疗单药治疗*就诊时就诊时 A1c 9.0%无病症无病症有病症有

13、病症疾病的进展疾病的进展* 所列药物顺序为用药推荐等级次序* * 基于临床3期试验的数据图例图例二甲双胍二甲双胍GLP-1 受体冲动剂受体冲动剂DPP4-抑制剂抑制剂糖苷酶抑制剂糖苷酶抑制剂SGLT-2 *TZDSU/GLN假设治疗假设治疗3个月后个月后A1c6.5%，加用第二种药物加用第二种药物两药结合治疗两药结合治疗两药结合治疗两药结合治疗*GLP-1 受体冲动剂受体冲动剂假设假设3个月未能达标，个月未能达标，那么胰岛素强化治疗那么胰岛素强化治疗三药结合治疗三药结合治疗*血糖控制流程图血糖控制流程图生活方式生活方式干预干预包括医疗干预减轻体重包括医疗干预减轻体重DPP4-抑制剂抑制剂TZD

14、* SGLT-2根底胰岛素根底胰岛素二甲双胍二甲双胍或其他或其他一线药物一线药物SU/GLN快速释放型溴隐亭快速释放型溴隐亭假设假设3个月后个月后仍未能达标，仍未能达标，那么三药结合治疗那么三药结合治疗二甲双胍二甲双胍或其他或其他一线药物一线药物考来维仑考来维仑糖苷酶抑制糖苷酶抑制GLP-1 受体冲动剂受体冲动剂TZD* SGLT-2根底胰岛素根底胰岛素快速释放型溴隐亭快速释放型溴隐亭二线药物二线药物DPP4-抑制剂抑制剂SU/GLN两药结合治疗两药结合治疗三药结合治疗三药结合治疗 或或加药或胰岛素强化治疗加药或胰岛素强化治疗= 慎重使用糖尿病药物平安性整体评价一览表Garber AJ, et

15、 al. Endocr Pract. 2021 Mar-Apr;192:327-36.考来维仑考来维仑糖苷酶抑制剂糖苷酶抑制剂胰岛素胰岛素其他药物其他药物= 较少的不良事件较少的不良事件 或可能获益或可能获益单药治疗单药治疗*就诊时就诊时 A1c 9.0%无病症无病症有病症有病症疾病的进展疾病的进展* 所列药物顺序为用药推荐等级次序* * 基于临床3期试验的数据图例图例二甲双胍二甲双胍GLP-1 受体冲动剂受体冲动剂DPP4-抑制剂抑制剂糖苷酶抑制剂糖苷酶抑制剂SGLT-2 *TZDSU/GLN假设治疗假设治疗3个月后个月后A1c6.5%，加用第二种药物加用第二种药物两药结合治疗两药结合治疗两

16、药结合治疗两药结合治疗*GLP-1 受体冲动剂受体冲动剂假设假设3个月未能达标，个月未能达标，那么胰岛素强化治疗那么胰岛素强化治疗三药结合治疗三药结合治疗*生活方式生活方式干预干预包括医疗干预减轻体重包括医疗干预减轻体重DPP4-抑制剂抑制剂TZD* SGLT-2根底胰岛素根底胰岛素二甲双胍二甲双胍或其他或其他一线药物一线药物SU/GLN快速释放型溴隐亭快速释放型溴隐亭假设假设3个月后个月后仍未能达标，仍未能达标，那么三药结合治疗那么三药结合治疗二甲双胍二甲双胍或其他或其他一线药物一线药物考来维仑考来维仑糖苷酶抑制糖苷酶抑制GLP-1 受体冲动剂受体冲动剂TZD* SGLT-2根底胰岛素根底胰

17、岛素快速释放型溴隐亭快速释放型溴隐亭二线药物二线药物DPP4-抑制剂抑制剂SU/GLN两药结合治疗两药结合治疗三药结合治疗三药结合治疗 或或加药或胰岛素强化治疗加药或胰岛素强化治疗= 慎重使用根底胰岛素：具备较好的平安性根底胰岛素：具备较好的平安性 备受专业指南推崇备受专业指南推崇“根底胰岛素根底胰岛素两联及三联治疗方案中作为两联及三联治疗方案中作为 唯一唯一推荐推荐 假设假设A1c9%明确推荐作为起始胰岛素方案明确推荐作为起始胰岛素方案启示：启示： 积极积极调整剂量调整剂量 安全安全达标达标目的兼顾疗效及目的兼顾疗效及平安性平安性剂量调整是达标的剂量调整是达标的“关键一步关键一步方法简单、实

18、用性强方法简单、实用性强分层设定血糖管理目的目的问题目的问题*对于对于无无合并症及合并症及低血糖风险小的低血糖风险小的患者患者*伴伴合并症及有低血糖合并症及有低血糖风险的患者风险的患者指南指南HbA1c程度程度空腹及餐前空腹及餐前BG程度程度平安性目的平安性目的?中国2型糖尿病防治指南?2020年版7%3.9-7.2 mmol/L无明显低血糖?ADA/EASD 糖尿病诊疗指南?2021年版7%7.2 mmol/L且无明显低血糖?AACE 糖尿病临床途径?2021年版6.5%*6.5%*6.1 mmol/L且无低血糖发生?中国2型糖尿病防治指南?Inzucchi SE, et al. Diabetes Care. 2021 Jun;356:1364-79.Garber AJ, et al. Endocr Pract. 2021 Mar-Apr;192:327-36.中国糖尿病控制现状不容乐观亚洲糖尿病管理中国协作组在2001至2002年调查了中国华北、华南、华东、华西和东北5大地区的49家市级中心医院的2248例糖尿病患者，