Bouma M, Rutten G E H M, de Grauw W J C, Wiersma Tj, Goudswaard A N
Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschapsbeleid, Postbus 3231, 3502, GE Utrecht.
Ned Tijdschr Geneeskd. 2006 Oct 14;150(41):2251-6.
The practice guideline 'Diabetes mellitus type 2' (second revision) addresses the diagnosis, treatment and management of adults with diabetes mellitus type 2 in general practice. The aim of management is the prevention and treatment of diabetes-related symptoms and complications such as cardiovascular disease, nephro-, retino- and neuropathy. The general practitioner gives the patient education and lifestyle advice and repeats this regularly. In addition, the general practitioner and the patient strive to achieve good glycaemic control. The agent of first choice in the medicinal treatment of all type 2 diabetic patients is metformin. This is continued even after the addition of a sulphonylurea derivative or insulin. This represents a change compared to the previous version of the practice guideline. The indications for thiazolidinediones are limited. To reduce the cardiovascular risk, it is advised to aim at a systolic blood pressure below 140 mmHg. It is also recommended that each patient be prescribed a statin, unless the patient belongs to a subgroup in which the indication for cholesterol lowering therapy is weak or the patient refuses it. Compared to the former guideline, more emphasis is placed on the prevention of nephropathy. The general practitioner is advised to calculate the creatinine clearance yearly and to test for relevant albuminuria in each patient with a life expectancy of 10 years or more. If microalbuminuria is present, the patient is prescribed an angiotensin converting enzyme (ACE) inhibitor, even if the blood pressure is not elevated. The detection of patients with a high risk of diabetic ulcer is also given more emphasis.
《2型糖尿病实践指南》（第二版修订本）阐述了全科医疗中成年2型糖尿病患者的诊断、治疗及管理。管理的目标是预防和治疗与糖尿病相关的症状及并发症，如心血管疾病、肾病、视网膜病变和神经病变。全科医生为患者提供教育及生活方式建议，并定期重复。此外，全科医生和患者努力实现良好的血糖控制。所有2型糖尿病患者药物治疗的首选药物是二甲双胍。即使加用了磺脲类衍生物或胰岛素后，仍继续使用二甲双胍。这与实践指南的上一版本相比有所变化。噻唑烷二酮类药物的适应证有限。为降低心血管风险，建议将收缩压控制在140 mmHg以下。还建议为每位患者开具他汀类药物，除非患者属于胆固醇降低治疗适应证较弱的亚组或患者拒绝使用。与前一版指南相比，更加强调了肾病的预防。建议全科医生每年计算肌酐清除率，并对预期寿命10年或更长的每位患者检测相关蛋白尿。如果存在微量白蛋白尿，即使血压未升高，也为患者开具血管紧张素转换酶（ACE）抑制剂。对糖尿病溃疡高危患者的检测也更加重视。
