Brunton Stephen
University of North Carolina, Chapel Hill, NC, USA.
Postgrad Med. 2009 Mar;121(2):125-38. doi: 10.3810/pgm.2009.03.1985.
The task of managing the ever-growing problem of type 2 diabetes falls mainly to primary care physicians. The currently available guidelines from the American Diabetes Association and the American College of Endocrinology/American Association of Clinical Endocrinologists aim to improve glycemic control, thus reducing morbidity and mortality associated with this chronic and progressive disease. However, the guidelines differ markedly in focus and depth. This review provides a clear summary of the guidelines and recommends how they can be implemented at the primary care level, explaining the different treatment options and providing practical advice on how commonly encountered situations should be approached in clinical practice. There is also a troubleshooting section on how to overcome obstacles to optimum therapy, and details on implementation strategies that will encourage the aggressive, stringent, and patient-centered, treat-to-target approach recommended in the guidelines.
管理日益严重的2型糖尿病问题的任务主要落在初级保健医生身上。美国糖尿病协会以及美国内分泌学会/美国临床内分泌学家协会目前发布的指南旨在改善血糖控制，从而降低与这种慢性进展性疾病相关的发病率和死亡率。然而，这些指南在重点和深度上存在显著差异。本综述清晰地总结了这些指南，并就如何在初级保健层面实施这些指南提出建议，解释了不同的治疗选择，并针对临床实践中常见情况的处理提供实用建议。此外，还有一个关于如何克服最佳治疗障碍的故障排除部分，以及关于实施策略的详细信息，这些策略将鼓励采用指南中推荐的积极、严格且以患者为中心的达标治疗方法。
