Diabet Med. 1997 Jul;14(7):611-21. doi: 10.1002/(SICI)1096-9136(199707)14:7<611::AID-DIA422>3.0.CO;2-9.
People with Type 2 (non-insulin-dependent) diabetes mellitus die mainly from cardiovascular and cerebrovascular disease. Furthermore, the major burden of their symptoms arise from arterial disease, including peripheral vascular disease. However, management guidelines for Type 2 diabetes continue to focus on blood glucose control, which is only one of a number of arterial risk factors found with this type of diabetes. Clinically it is evident that blood glucose control continues to occupy centre-stage in the management of Type 2 diabetes as practised by many physicians. Even when arterial risk factors such as smoking or raised serum triglycerides are noted, their management is often relatively neglected. As part of the St Vincent Declaration Action Programme, a working group has sought consensus on the number and relative importance of arterial risk factors requiring management in quality diabetes care. The group seeks to assist those devising protocols and guidelines, records and quality systems, and those charged with directly advising and educating people with diabetes. Arterial risk factors that can be routinely identified and monitored, and modified by application of management protocols, include high blood pressure, high serum total and LDL cholesterol, low serum HDL cholesterol and raised serum triglycerides, poor blood glucose control, smoking, high body mass index and body fat distribution. Aspirin can modify hypercoagulability, but this is not easily monitored. Arterial risk factors that cannot be modified, but which have an impact on the intensity of management of other factors, include ethnic group, gender, and family history of arterial disease. Raised albumin excretion is an arterial risk factor and can be modified, but it is not clear whether this reduces cardiovascular risk. For many of the risk factors, levels of high, medium, and low risk can be set. These can be used, in consultation with the patient, to determine appropriate interventions and provide feedback on risk reduction resulting from successful management.
2型（非胰岛素依赖型）糖尿病患者主要死于心血管和脑血管疾病。此外，他们症状的主要负担源于动脉疾病，包括外周血管疾病。然而，2型糖尿病的管理指南仍继续侧重于血糖控制，而血糖控制只是这类糖尿病所发现的众多动脉危险因素之一。临床上很明显，血糖控制在许多医生对2型糖尿病的管理中仍然占据核心地位。即使注意到吸烟或血清甘油三酯升高等动脉危险因素，其管理往往也相对被忽视。作为《圣文森特宣言行动计划》的一部分，一个工作组已就优质糖尿病护理中需要管理的动脉危险因素的数量和相对重要性达成共识。该小组旨在协助那些制定方案和指南、记录和质量体系的人员，以及那些负责直接为糖尿病患者提供建议和教育的人员。可以通过应用管理方案进行常规识别、监测和改变的动脉危险因素包括高血压、血清总胆固醇和低密度脂蛋白胆固醇升高、血清高密度脂蛋白胆固醇降低、血清甘油三酯升高、血糖控制不佳、吸烟、高体重指数和体脂分布。阿司匹林可以改变血液高凝状态，但这不易监测。无法改变但会影响其他因素管理强度的动脉危险因素包括种族、性别和动脉疾病家族史。白蛋白排泄增加是一种动脉危险因素且可以改变，但尚不清楚这是否能降低心血管风险。对于许多危险因素，可以设定高、中、低风险水平。这些水平可与患者协商后用于确定适当的干预措施，并就成功管理导致的风险降低情况提供反馈。
