美国糖尿病降糖标准变了

中文解说 https://mp.weixin.qq.com/s/dD6Uu_3Ww16Q5lC6mpu3Og

要点：美国医师学会（ACP）建议大部分患者的控糖目标放宽到7%-8%之间就可以了，没有必要一定要控制在6.5%以下。因为研究表明，把糖化血红蛋白水平控制低于7%，会导致糖尿病患者过量使用降糖药。而且也并没有减少视力丧失、晚期肾病、疼痛性神经病变和死亡。而过量用药带来的副作用包括肠胃问题、血糖过低、体重增加，甚至充血性心力衰竭。

 

ACP recommends moderate blood sugar control targets for most patients with type 2 diabetes https://www.acponline.org/acp-newsroom/acp-recommends-moderate-blood-sugar-control-targets-for-most-patients-with-type-2-diabetes

要点：

An A1C test measures a person’s average blood sugar level over the past two or three months. An A1C of 6.5 percent indicates diabetes.

“ACP’s analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7 percent or less compared to targets of about 8 percent did not reduce deaths or macrovascular complications such as heart attack or stroke but did result in substantial harms,” said Dr. Jack Ende, president, ACP. “The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7 percent and 8 percent will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs.”

ACP recommends that clinicians should personalize goals for blood sugar control in patients with type 2 diabetes based on a discussion of benefits and harms of drug therapy, patients’ preferences, patients’ general health and life expectancy, treatment burden, and costs of care.

The rationale in guidelines that recommended lower treatment targets (below 7 percent or below 6.5 percent) is that more intensive blood sugar control would reduce microvascular complications over many years of treatment. However, the evidence for reduction is inconsistent and reductions were seen only in surrogate microvascular complications such as the presence of excess proteins in the urine.

If patients with type 2 diabetes achieve an A1C of less than 6.5 percent, ACP recommends that clinicians consider de-intensifying drug therapy by reducing the dosage of current treatment, removing a medication if the patient is currently taking more than one drug, or discontinuing drug treatment.