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冠心病合并2型糖尿病患者血糖管理的共识

Consensus on glycemic management for patients with coronary heart disease and type 2 diabetes.

作者信息

Ji Li-Nong, Chen Yun-Dai

出版信息

J Geriatr Cardiol. 2024 Jul 28;21(7):689-702. doi: 10.26599/1671-5411.2024.07.007.

Abstract

The prevalence of patients with coronary heart disease (CHD) and diabetes mellitus is notably high, posing significant residual cardiovascular risks even after routine interventions such as antihypertensive, lipid-lowering, and antithrombotic treatments. Recent studies have demonstrated that certain glucose-lowering medications confer cardiovascular benefits for patients with type 2 diabetes. However, a survey indicates that cardiologists may not be fully acquainted with the optimal screening timing, indicators, and diagnostic criteria for type 2 diabetes, and there is insufficient awareness and a low rate of prescription of novel glucose-lowering medications with proven cardiovascular efficacy, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT-2i). In this context, based on domestic and international guidelines or consensus and the latest evidence-based evidence, this consensus aims to standardize the glycemic management for patients with acute coronary syndrome, chronic coronary syndrome, and perioperative management for percutaneous coronary intervention. It highlights the key points of screening and diagnosis of type 2 diabetes, and the comprehensive management of cardiovascular risk in patients with CHD. The consensus elaborates on the principles and algorithms of glycemic management for CHD patients, without involving acute complications of diabetes, clarifies the clinical practice of glucose-lowering medications with cardiovascular benefits, and promotes the standardized use of these medications in cardiovascular and other related specialty fields. Additionally, it addresses the glucose-lowering treatment to comprehensively reduce cardiovascular risks.

摘要

冠心病(CHD)和糖尿病患者的患病率显著较高,即使在进行了如降压、降脂和抗血栓治疗等常规干预后,仍存在重大的残余心血管风险。最近的研究表明,某些降糖药物对2型糖尿病患者具有心血管益处。然而,一项调查显示,心脏病专家可能并不完全熟悉2型糖尿病的最佳筛查时机、指标和诊断标准,对于已证实具有心血管疗效的新型降糖药物,如胰高血糖素样肽-1受体激动剂(GLP-1 RAs)和钠-葡萄糖协同转运蛋白-2抑制剂(SGLT-2i),认识不足且处方率较低。在此背景下,基于国内外指南或共识以及最新的循证证据,本共识旨在规范急性冠状动脉综合征、慢性冠状动脉综合征患者的血糖管理以及经皮冠状动脉介入治疗的围手术期管理。它突出了2型糖尿病的筛查和诊断要点以及冠心病患者心血管风险的综合管理。本共识阐述了冠心病患者血糖管理的原则和算法,不涉及糖尿病急性并发症,阐明了具有心血管益处的降糖药物的临床应用,并促进这些药物在心血管及其他相关专业领域的规范使用。此外,它还涉及降糖治疗以全面降低心血管风险。

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