Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians
Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians
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DOI：
10.7326/m17-0939
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发表时间：
2018-04-17
影响因子：
39.2
通讯作者：
Forciea, Mary Ann
中科院分区：
文献类型：
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作者：
Qaseem, Amir;Wilt, Timothy J.;Forciea, Mary Ann
产品描述：美国医师学会制定了这份指南声明，以指导临床医生选择2型糖尿病药物治疗的靶点。方法：在美国国家指南信息中心和指南国际网络图书馆中检索（2017年5月）以英文发表的国家指南，该指南涉及治疗非妊娠门诊成人2型糖尿病的血红蛋白A（1c）（HbA（1c））靶点。作者确定了国家健康和护理卓越研究所和临床系统改进研究所的指导方针。此外，还对美国临床内分泌学家协会和美国内分泌学会、美国糖尿病协会、苏格兰校际指南网络以及美国退伍军人事务部和国防部的4项常用指南进行了审查。第二个协议指南1：临床医生应根据药物治疗的利弊、患者的偏好、患者的一般健康状况和预期寿命、治疗负担和护理费用的讨论，对2型糖尿病患者的血糖控制目标进行个性化。指南2：对于大多数2型糖尿病患者，临床医生的目标应是使HbA（1c）水平达到7%至8%。指南声明3：对于HbA（1c）水平低于6.5%的2型糖尿病患者，临床医生应考虑降低药物治疗的强度。临床医生应治疗2型糖尿病患者，以尽量减少与高血糖相关的症状，并避免将HbA（1c）水平作为因高龄而预期寿命低于10年的患者的目标（80岁或以上），居住在养老院，或慢性疾病（如痴呆症，癌症，终末期肾病，或严重的慢性阻塞性肺病或充血性心力衰竭），因为在这一人群中危害大于益处。
Description: The American College of Physicians developed this guidance statement to guide clinicians in selecting targets for pharmacologic treatment of type 2 diabetes.Methods: The National Guideline Clearinghouse and the Guidelines International Network library were searched (May 2017) for national guidelines, published in English, that addressed hemoglobin A(1c) (HbA(1c)) targets for treating type 2 diabetes in nonpregnant outpatient adults. The authors identified guidelines from the National Institute for Health and Care Excellence and the Institute for Clinical Systems Improvement. In addition, 4 commonly used guidelines were reviewed, from the American Association of Clinical Endocrinologists and American College of Endocrinology, the American Diabetes Association, the Scottish Intercollegiate Guidelines Network, and the U.S. Department of Veterans Affairs and Department of Defense. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the guidelines.Guidance Statement 1: Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care.Guidance Statement 2: Clinicians should aim to achieve an HbA(1c) level between 7% and 8% in most patients with type 2 diabetes.Guidance Statement 3: Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA(1c) levels less than 6.5%.Guidance Statement 4: Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA(1c) level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population.