纪教授：2015-ADA糖尿病指南及其对中国临床实践的价值.ppt

1、,STANDARDS OF MEDICAL CAREIN DIABETES2015,ADA position statement. A position statement is an official point of view or belief that contains clinical or research recommendations. ADA scientific statement. A scientific statement is an official ADA point of view or belief that may or may not contain cl

2、inical or research recommendations. Consensus report. A consensus report contains a comprehensive examination by an expert panel (i.e., consensus panel) of a scientific or medical issue related to diabetes. Systematic review. A systematic review is a balanced review and analysis of the literature on

3、 a scientific or medical topic related to diabetes.,ADA Document related with diabetes care and research,“Standards of Medical Care in Diabetes”,-ADA position statement that provides key clinical practice recommendations.,A position statement is an official ADA point of view or belief that contains

4、clinical or research recommendations. Position statements are issued on scientific or medical issues related to diabetes.,Consensus report,2014,The need for a consensus report arises when clinicians or scientists desire guidance on a subject for which the evidence is contradictory or incomplete. A c

5、onsensus report is typically developed immediately following a consensus conference where the controversial issue is extensively discussed.,ADA Scientific Statement,2014,A scientific statement is an official ADA point of view or belief that may or may not contain clinical or research recommendations

6、.,Diabetes is a complex, chronic illness Diabetes requires continuous medical care -Multifactorial risk-reduction strategies beyond glycemic control. Ongoing patient self-management education and support are critical to -preventing acute complications -reducing the risk of long-term complications. S

7、ignificant evidence exists that supports a range of interventions to improve diabetes outcomes.,Diabetes and diabetes care,ADA Evidence Grading System for Clinical Practice Recommendations,ADA. Diabetes Care 2015;38(suppl 1):S2; Table 1,Trends in the Number and Proportion of Higher and Lower Level R

8、ecommendations,Higher level recommendations defined as A or B evidence grades Lower level recommendations defined as C or E evidence grades,Grant R W , and Kirkman M S Dia Care 2015;38:6-8,Trends in the Proportion of Higher Level Recommendations by Category,Grant R W , and Kirkman M S Dia Care 2015;

9、38:6-8,1. STRATEGIES FOR IMPROVINGDIABETES CARE,Recommendations: Strategies forImproving Diabetes Care (1),ADA. 1. Strategies for Improving Diabetes Care. Diabetes Care 2015;38(suppl 1):S5,Care should be aligned with components of the Chronic Care Model to ensure productive interactions between a pr

10、epared proactive practice team and an informed activated patient A When feasible, care systems should support team-based care, community involvement, patient registries, and embedded decision support tools to meet patient needs B,Recommendations: Strategies forImproving Diabetes Care (2),Treatment d

11、ecisions should be timely, based on evidence-based guidelines tailored to individual patient preferences, prognoses, and comorbidities B A patient-centered communication style should be employed that incorporates patient preferences, assesses literacy and numeracy, and addresses cultural barriers to

12、 care B,ADA. 1. Strategies for Improving Diabetes Care. Diabetes Care 2015;38(suppl 1):S5,Supportive, Integrated Community,Productive Interactions,Functional and Clinical Outcomes,DeliverySystem Design,Decision Support,ClinicalInformationSystems,Health System,Resources and Policies,Community,Health

13、Care Organization,The Chronic Care Model,Family Education 38(suppl 1):S5,Care team should prioritize timely, appropriate intensification of lifestyle and/or pharmaceutical therapy Patients who have not achieved beneficial levels of blood pressure, lipid, or glucose control Strategies include Explici

14、t goal setting with patients Identifying and addressing barriers to care Integrating evidence-based guidelines Incorporating care management teams,Objective 1:Optimize Provider and Team Behavior,ADA. 1. Strategies for Improving Diabetes Care. Diabetes Care 2014;38(suppl 1):S6,Objective 2:Support Pat

15、ient Behavior Change,Implement a systematic approach to support patient behavior change efforts Healthy lifestyle: physical activity, healthy eating, nonuse of tobacco, weight management, effective coping Disease self-management: medication taking and management, self-monitoring of glucose and blood

16、 pressure when clinically appropriate Prevention of diabetes complications: self-monitoring of foot health, active participation in screening for eye, foot, and renal complications, and immunizations,ADA. 1. Strategies for Improving Diabetes Care. Diabetes Care 2015;38(suppl 1):S6,The most successfu

17、l practices have an institutional priority for providing high quality of care Basing care on evidence-based guidelines Expanding the role of teams and staff Redesigning the processes of care Implementing electronic health record tools Activating and educating patients Identifying and/or developing c

18、ommunity resources and public policy that supports healthy lifestyles Alterations in reimbursement,Objective 3:Change the System of Care,ADA. 1. Strategies for Improving Diabetes Care. Diabetes Care 2015;38(suppl 1):S6,已经获得充分循证医学证据的糖尿病标准防治措施,19,糖尿病标准化诊疗的核心成分,影响临床决策的检查： A（A1C）：血糖 （A1C、空腹血糖、餐后血糖） B（BP）：血压 C（Ch）：血脂（主要包括LDL-c, TG） 视网膜病变筛查 肾病筛查 足病筛查