《2013 AACE糖尿病临床路径》

聚焦《2013AACE糖尿病管理路径》

患病率(%)中国糖尿病患病率呈急剧上升趋势DiabetesAtlas,Fourthedition©InternationalDiabetesFederation,2009;中华医学会糖尿病学分会.中华内分泌代谢杂志2008;24:2a:1-22.YangWY,etal.NEnglJMed2010;362:1090-1101.;2010中国2型糖尿病治疗指南:p12,downloadedfrom/x_uploadfiles/dm201otaolungao.pdf2PercentageofU.S.AdultsWhoWereObeseorHadDiagnosedDiabetesCentersforDiseaseControlandPrevention:NationalDiabetesSurveillanceSystem.

Availableonlineat:/DDTSTRS/default.aspx.Accessed10/3/2011.Obesity(BMI≥30kg/m2)Diabetes1994199420002000NoData<14.0%14.0-17.9%18.0-21.9%22.0-25.9%26.0%NoData<4.5%4.5-5.9%6.0-7.4%7.5-8.9%≥9.0%20082008AACE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（AmericanAssociationofClinicalEndocrinologist）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5AACE制定众多内分泌疾病的临床专科指南-1ClinicalPracticeGuidelinesforthePerioperativeNutritional,Metabolic,andNonsurgicalSupportoftheBariatricPatient-2013Update:CosponsoredbyAmericanAssociationofClinicalEndocrinologists,TheObesitySociety,andAmericanSocietyforMetabolic&BariatricSurgery©2013

ClinicalPracticeGuidelinesforHypothyroidisminAdults:CosponsoredbytheAmericanAssociationofClinicalEndocrinologistsandtheAmericanThyroidAssociation.©2012

AmericanAssociationofClinicalEndocrinologists'GuidelinesforManagementofDyslipidemiaandPreventionofAtherosclerosis©2012

AACEMedicalGuidelinesforClinicalPracticeforDiagnosisandTreatmentofMenopause©2011

AmericanAssociationofClinicalEndocrinologistsMedicalGuidelinesforClinicalPracticefortheDiagnosisandTreatmentofAcromegaly-©2011

/publications/guidelines6AACE制定众多内分泌疾病的临床专科指南-2HyperthyroidismandOtherCausesofThyrotoxicosis:ManagementGuidelinesoftheAmericanThyroidAssociationandAmericanAssociationofClinicalEndocrinologists-©2011

AmericanAssociationofClinicalEndocrinologistsMedicalGuidelinesforDevelopingaDiabetesMellitusComprehensiveCarePlan-©2011

AmericanAssociationofClinicalEndocrinologistsGuidelinesforClinicalPracticefortheDiagnosisandTreatmentofPostmenopausalOsteoporosis©2010

AmericanAssociationofClinicalEndocrinologists,AssociazioneMediciEndocrinologi,andEuropeanThyroidAssociationMedicalGuidelinesforClinicalPracticefortheDiagnosisandManagementofThyroidNodules©2010

AmericanAssociationofClinicalEndocrinologistsProtocolforStandardizedProductionofClinicalPracticeGuidelines-2010Update

7AACE制定众多内分泌疾病的临床专科指南-311.AmericanAssociationofClinicalEndocrinologistsMedicalGuidelinesforClinicalPracticeforGrowthHormoneUseinGrowthHormone-deficientAdultsandTransitionPatients–2009UpdateAmericanAssociationofClinicalEndocrinologistsandAmericanAssociationofEndocrineSurgeonsMedicalGuidelinesfortheManagementofAdrenalIncidentalomas©2009

AmericanAssociationOfClinicalEndocrinologists,TheObesitySociety,andAmericanSocietyForMetabolic&BariatricSurgeryMedicalGuidelinesForClinicalPracticeForThePerioperativeNutritional,Metabolic,AndNonSurgicalSupportOfTheBariatricSurgeryPatient©2008

AACEMedicalGuidelinesforClinicalPracticeforDiagnosisandTreatmentofHypertension©2006

AACEMedicalGuidelinesfortheClinicalUseofDietarySupplementsandNutraceuticals©2003

AACE制定众多内分泌疾病的临床专科指南-416.AACEMedicalGuidelinesfortheClinicalPracticeforEvaluationandTreatmentofMaleSexualDysfunction:ACouple'sProblem-2003Update17.AACEMedicalGuidelinesforClinicalPracticeforEvaluationandTreatmentofHypogonadisminAdultMalePatients-2002Update

18.AACEMedicalGuidelinesforClinicalPracticeforEvaluationandTreatmentofHyperthyroidismandHypothyroidism©2002

19.AACE/AAESMedical/SurgicalGuidelinesforClinicalPracticeforManagementofThyroidCarcinoma©2001

20.AACEMedicalGuidelinesforClinicalPracticeforDiagnosisandTreatmentofHyperandrogenicDisorders©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实践性来源于临床治疗经验，可操作性强前沿性凝结了最前沿的内分泌专业性的治疗理念专业性临床内分泌专科学术组织，强调专业性GarberAJ,etal.EndocrPract.2013Mar-Apr;19(2):327-36.2013AACE指南11血糖调节生活方式改变（包括医学辅助减肥）增加或强化胰岛素治疗三个月后若HbA1c>6.5%

加用第二种药

三个月后若血糖未达标加用第三种药三个月后若血糖未达标胰岛素强化治疗HbA1c<7.5%单一疗法AG-ISGLT-2!二甲双胍

GLP-1受体激动剂DPP-1抑制剂TZD!SU/GLN!HbA1c≥7.5%两联疗法

DPP-1抑制剂考来维仑溴隐亭

AG-ITZD!SGLT-2!基础胰岛素!SU/GLN!GLP-1受体激动剂

二甲双胍或其他一线药

＋三联疗法GLP-1受体激动剂TZD!SGLT-2!基础胰岛素!

DPP-1抑制剂考来维仑溴隐亭

AG-ISU/GLN!

二甲双胍或其他一线药

＋第二种药HbA1c>9.0%有症状无症状两联疗法三联疗法胰岛素±药物治疗或AG-I：α-糖苷酶抑制剂SGLT-2：葡萄糖转运体2TZD:噻唑烷二酮类SU/GLN:磺脲类/格列奈类

不良反应少或有潜在收益谨慎使用!糖尿病药物安全性整体评价一览表Garber