Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy.
Diabetes Metab Res Rev. 2010 May;26(4):239-44. doi: 10.1002/dmrr.1092.
Recent intervention trials (Veterans Affairs Diabetes Trial, Action to Control Cardiovascular Risk in Diabetes, Action in Diabetes and Vascular Disease) have underscored problems surrounding the risk-benefit balance of most therapeutic strategies in type 2 diabetes given, especially the limited cardiovascular advantage of tight glycaemic control when set against the co-incident risk of severe hypoglycaemia and weight gain. Consequently, therapy should to tailored to the individual. While attractive, such an approach remains highly empiric and to some extent difficult to implement without practical guidance, in particular for the inexperienced physician. To provide a user-friendly guide for a personalized therapeutic approach to type 2 diabetes, we performed a systematic review of the literature and elaborated a simple rule that was debated at a large independent University Symposium on the occasion of the European Association for the Study of Diabetes held in Vienna 2009. As a result of that process, we now propose an A1C and ABCD of glycaemia management in type 2 diabetes to determine appropriate glycaemic targets based on Age, Body weight, Complications and Disease Duration. 'A1C and ABCD' aims to guide clinicians in the use of therapeutic agents more effectively, efficiently and safely. While no regulatory-approved drug can be excluded, given its proven efficacy, there is a need to better phenotype patients, paying particular attention to ABCD. Based on these parameters, physicians can select the therapeutic strategy with minimum risk and maximum benefit for each individual.
最近的干预试验（退伍军人事务部糖尿病试验、控制心血管风险行动糖尿病试验、糖尿病和血管疾病行动）强调了 2 型糖尿病大多数治疗策略的风险效益平衡问题，尤其是在强化血糖控制的有限心血管优势与低血糖和体重增加的并发风险相比时。因此，治疗应该个体化。虽然这种方法很有吸引力，但它仍然高度经验性，在没有实际指导的情况下，在某种程度上难以实施，特别是对于没有经验的医生。为了为 2 型糖尿病的个体化治疗方法提供一个用户友好的指南，我们对文献进行了系统评价，并制定了一个简单的规则，该规则在 2009 年维也纳举行的欧洲糖尿病研究协会会议上的一次大型独立大学研讨会上进行了辩论。作为这一过程的结果，我们现在提出了 2 型糖尿病血糖管理的 A1C 和 ABCD，以根据年龄、体重、并发症和疾病持续时间确定适当的血糖目标。“A1C 和 ABCD”旨在指导临床医生更有效地、高效地和安全地使用治疗药物。虽然没有一种经过监管批准的药物可以被排除在外，但鉴于其已被证实的疗效，有必要更好地对患者进行表型分析，特别注意 ABCD。基于这些参数，医生可以为每个个体选择风险最小、效益最大的治疗策略。
