Snow Vincenza, Aronson Mark D, Hornbake E Rodney, Mottur-Pilson Christel, Weiss Kevin B
American College of Physicians, Philadelphia, Pennsylvania 19106, USA.
Ann Intern Med. 2004 Apr 20;140(8):644-9. doi: 10.7326/0003-4819-140-8-200404200-00012.
In an effort to provide internists and other primary care physicians with effective management strategies for diabetes care, the Clinical Efficacy Assessment Subcommittee (CEAS) of the American College of Physicians (ACP) decided to develop guidelines on the management of dyslipidemia, particularly hypercholesterolemia, in people with type 2 diabetes mellitus. The CEAS commissioned a systematic review of the currently available evidence on the management of lipids in type 2 diabetes mellitus. The evidence review is presented in a background paper in this issue. On the basis of this systematic review, the CEAS developed recommendations that the ACP Board of Regents then approved as policy. The target audience for this guideline is all clinicians who care for patients with type 2 diabetes. The target patient population is all persons with type 2 diabetes, including those who already have some form of microvascular complication and, of particular importance, premenopausal women. The recommendations are as follows. RECOMMENDATION 1: Lipid-lowering therapy should be used for secondary prevention of cardiovascular mortality and morbidity for all patients (both men and women) with known coronary artery disease and type 2 diabetes. RECOMMENDATION 2: Statins should be used for primary prevention against macrovascular complications in patients (both men and women) with type 2 diabetes and other cardiovascular risk factors. RECOMMENDATION 3: Once lipid-lowering therapy is initiated, patients with type 2 diabetes mellitus should be taking at least moderate doses of a statin. RECOMMENDATION 4: For those patients with type 2 diabetes who are taking statins, routine monitoring of liver function tests or muscle enzymes is not recommended except in specific circumstances.
为了向内科医生和其他初级保健医生提供有效的糖尿病护理管理策略，美国医师协会（ACP）临床疗效评估小组委员会（CEAS）决定制定关于2型糖尿病患者血脂异常（尤其是高胆固醇血症）管理的指南。CEAS委托对目前可用的关于2型糖尿病患者血脂管理的证据进行系统综述。本期刊的一篇背景文章中呈现了证据综述。基于这一系统综述，CEAS制定了相关建议，随后ACP董事会将其批准为政策。本指南的目标受众是所有照料2型糖尿病患者的临床医生。目标患者群体是所有2型糖尿病患者，包括那些已经有某种形式微血管并发症的患者，尤其重要的是绝经前女性。建议如下。建议1：对于所有已知患有冠状动脉疾病和2型糖尿病的患者（男性和女性），应使用降脂疗法进行心血管疾病死亡率和发病率的二级预防。建议2：对于患有2型糖尿病和其他心血管危险因素的患者（男性和女性），应使用他汀类药物进行大血管并发症的一级预防。建议3：一旦开始降脂治疗，2型糖尿病患者应至少服用中等剂量的他汀类药物。建议4：对于正在服用他汀类药物的2型糖尿病患者，除特殊情况外，不建议常规监测肝功能检查或肌肉酶。
