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英国临床糖尿病学家协会和肾脏协会关于实体器官移植后糖尿病的检测和管理指南。

Association of British Clinical Diabetologists and Renal Association guidelines on the detection and management of diabetes post solid organ transplantation.

机构信息

Royal London Hospital, London, UK.

St Helier Hospital, London, UK.

出版信息

Diabet Med. 2021 Jun;38(6):e14523. doi: 10.1111/dme.14523. Epub 2021 Feb 11.

Abstract

Post-transplant diabetes mellitus (PTDM) is common after solid organ transplantation (SOT) and associated with increased morbidity and mortality for allograft recipients. Despite the significant burden of disease, there is a paucity of literature with regards to detection, prevention and management. Evidence from the general population with diabetes may not be translatable to the unique context of SOT. In light of emerging clinical evidence and novel anti-diabetic agents, there is an urgent need for updated guidance and recommendations in this high-risk cohort. The Association of British Clinical Diabetologists (ABCD) and Renal Association (RA) Diabetic Kidney Disease Clinical Speciality Group has undertaken a systematic review and critical appraisal of the available evidence. Areas of focus are; (1) epidemiology, (2) pathogenesis, (3) detection, (4) management, (5) modification of immunosuppression, (6) prevention, and (7) PTDM in the non-renal setting. Evidence-graded recommendations are provided for the detection, management and prevention of PTDM, with suggested areas for future research and potential audit standards. The guidelines are endorsed by Diabetes UK, the British Transplantation Society and the Royal College of Physicians of London. The full guidelines are available freely online for the diabetes, renal and transplantation community using the link below. The aim of this review article is to introduce an abridged version of this new clinical guideline ( https://abcd.care/sites/abcd.care/files/site_uploads/Resources/Position-Papers/ABCD-RA%20PTDM%20v14.pdf).

摘要

移植后糖尿病(PTDM)是实体器官移植(SOT)后的常见并发症,会增加移植物受者的发病率和死亡率。尽管疾病负担沉重,但关于其检测、预防和管理的文献却很少。来自一般糖尿病患者的证据可能无法转化为 SOT 独特环境的证据。鉴于新兴的临床证据和新型抗糖尿病药物,在这一高危人群中急需更新的指导和建议。英国临床糖尿病协会(ABCD)和肾脏协会(RA)糖尿病肾病临床专业组对现有证据进行了系统审查和关键评估。重点领域包括:(1)流行病学;(2)发病机制;(3)检测;(4)管理;(5)免疫抑制的改变;(6)预防;(7)非肾脏环境中的 PTDM。为 PTDM 的检测、管理和预防提供了证据分级建议,并为未来的研究和潜在的审计标准提出了建议领域。该指南得到了英国糖尿病协会、英国移植协会和伦敦皇家内科医师学院的认可。该指南全文可免费在线获取,供糖尿病、肾脏和移植社区使用,网址如下:https://abcd.care/sites/abcd.care/files/site_uploads/Resources/Position-Papers/ABCD-RA%20PTDM%20v14.pdf。本文旨在介绍该新临床指南的简编版本(https://abcd.care/sites/abcd.care/files/site_uploads/Resources/Position-Papers/ABCD-RA%20PTDM%20v14.pdf)。

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