An Evaluation of the Current Type 2 Diabetes Guidelines: Where They Converge and Diverge
An Evaluation of the Current Type 2 Diabetes Guidelines: Where They Converge and Diverge
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当前 2 型糖尿病指南的评估：它们的趋同和分歧之处
DOI：
10.2337/diaclin.32.3.133
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发表时间：
2014
影响因子：
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通讯作者：
L. J. Woodard
中科院分区：
文献类型：
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作者：
E. Tan;J. Polello;L. J. Woodard
在为患者提供最佳护理时，医疗保健提供者 (HCP) 依靠临床经验和判断、已发表的文献以及循证临床指南来指导决策并作为实现最佳患者治疗结果的基准。有几份已发布的指南可支持 HCP 护理 2 型糖尿病患者。其中包括美国糖尿病协会 (ADA)、1 世界卫生组织 (WHO)、2 美国临床内分泌学家协会 (AACE)、3 印度卫生服务局 (IHS)、4 以及医疗补助和医疗保险服务中心 (CMS) 的建议。5 这些指南通过定期审查现有文献和研究来保持最新，以确保它们是最新的并基于最新的可用证据。
在治疗像 2 型糖尿病这样复杂的疾病患者时，执业临床医生和各个指南制定委员会对于如何最好地将已发表的研究成果纳入临床实践有着不同的观点。我们进行了一项评估，以确定非妊娠成人 2 型糖尿病指南在筛查、诊断、管理和预防领域的一致性和差异。
ADA、WHO 和 IHS 指南建议，如果成人超重（BMI ≥ 25 kg/m2）并具有以下一个或多个危险因素，则应进行 2 型糖尿病评估：一级亲属患有糖尿病、分娩体重 > 9 磅的妇女、诊断为高血压 > 140/90 mmHg、诊断为多囊卵巢综合征、妊娠期糖尿病 (GDM) 病史或黑棘皮病（表 1）.1,2,4 然而，这些指南之间确实存在一些细微的差异。 ADA1 建议每年对患有前驱糖尿病的成年人进行一次筛查，对 45 岁以上且无既往病史的成年人每 3 年进行一次筛查。 WHO2 建议成年人……
In providing the best care for patients, health care providers (HCPs) rely on clinical experience and judgment, published literature, and evidence-based clinical guidelines to direct decisions and serve as benchmarks for achieving optimal patient outcomes. Several published guidelines are available to support HCPs in caring for patients with type 2 diabetes. These include recommendations from the American Diabetes Association (ADA),1 the World Health Organization (WHO),2 the American Association of Clinical Endocrinologists (AACE),3 the Indian Health Service (IHS),4 and the Center for Medicaid and Medicare Services (CMS).5 These guidelines are kept current through periodic review of available literature and research to ensure that they are up to date and based on the latest available evidence.
Practicing clinicians and the various guideline development committees have diverse perspectives regarding how best to incorporate published research findings into clinical practice when managing patients with a disease as complex as type 2 diabetes. We conducted an evaluation to identify consistencies and discrepancies among the guidelines for nonpregnant adults with type 2 diabetes in the areas of screening, diagnosis, management, and prevention.
The ADA, WHO, and IHS guidelines recommend that adults be evaluated for type 2 diabetes if they are overweight (BMI ≥ 25 kg/m2) and have one or more of the following risk factors: first-degree relative with diabetes, women who delivered a baby weighing > 9 lb, diagnosis of hypertension > 140/90 mmHg, diagnosis of polycystic ovarian syndrome, history of gestational diabetes mellitus (GDM), or acanthosis nigricans (Table 1).1,2,4 However, several minor differences do exist among the guidelines. The ADA1 recommends that adults with prediabetes be screened annually and that adults who are ≥ 45 years of age without preexisting conditions be screened every 3 years. The WHO2 recommends that adults …