American College of Physicians, Philadelphia, Pennsylvania (A.Q.).
Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.).
Ann Intern Med. 2018 Apr 17;168(8):569-576. doi: 10.7326/M17-0939. Epub 2018 Mar 6.
The American College of Physicians developed this guidance statement to guide clinicians in selecting targets for pharmacologic treatment of type 2 diabetes.
The National Guideline Clearinghouse and the Guidelines International Network library were searched (May 2017) for national guidelines, published in English, that addressed hemoglobin A1c (HbA1c) targets for treating type 2 diabetes in nonpregnant outpatient adults. The authors identified guidelines from the National Institute for Health and Care Excellence and the Institute for Clinical Systems Improvement. In addition, 4 commonly used guidelines were reviewed, from the American Association of Clinical Endocrinologists and American College of Endocrinology, the American Diabetes Association, the Scottish Intercollegiate Guidelines Network, and the U.S. Department of Veterans Affairs and Department of Defense. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the guidelines.
GUIDANCE STATEMENT 1: Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care.
GUIDANCE STATEMENT 2: Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.
GUIDANCE STATEMENT 3: Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5%.
GUIDANCE STATEMENT 4: Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA1c level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population.
美国医师学院制定本指南，旨在指导临床医生选择 2 型糖尿病药物治疗的目标。
检索国家指南数据库和指南国际网络数据库（2017 年 5 月），以寻找针对非妊娠门诊成年 2 型糖尿病患者糖化血红蛋白（HbA1c）目标值的英文发表的国家指南。作者确定了来自英国国家卫生与保健卓越研究所和临床系统改进研究所的指南。此外，还回顾了美国临床内分泌医师协会和美国内分泌学会、美国糖尿病协会、苏格兰校际指南网络以及美国退伍军人事务部和国防部使用的 4 种常用指南。使用 AGREE II（评估研究和评价指南 II）工具评估指南。
指南声明 1：临床医生应根据药物治疗的获益和危害、患者的偏好、患者的总体健康和预期寿命、治疗负担以及医疗费用等方面，对 2 型糖尿病患者的血糖控制目标进行个体化。
指南声明 2：大多数 2 型糖尿病患者的 HbA1c 目标应设定在 7%至 8%之间。
指南声明 3：对于 HbA1c 水平低于 6.5%的 2 型糖尿病患者，临床医生应考虑减少药物治疗强度。
指南声明 4：临床医生应治疗 2 型糖尿病患者，以最大程度减少与高血糖相关的症状，并避免针对预期寿命少于 10 年的患者（由于年龄较大[80 岁或以上]、居住在养老院或患有慢性疾病[如痴呆、癌症、终末期肾病或严重慢性阻塞性肺病或充血性心力衰竭]）设定 HbA1c 目标值，因为在这一人群中，获益可能不及危害。
