【正文】 should not 低位人群中明確提出不建議使用be remendedfor CVD prevention for adults with diabetes at low CVD risk (10year CVDrisk5%,suchasinmen50yearsofage and women60 years of age withno major additional CVD risk factors),since the potential adverse effects frombleeding likely offset the potentialbenefits. (C)● In patients in these agegroups withMultiple other risk factors(risk 5–10%), clinical judgment is required. (E)新增，證據(jù)級別降低l 有CVD病史的糖尿病患者用阿司匹林（劑量75~162 mg/天）作為二級預(yù)防治療。（A）l 有CVD史且對阿司匹林過敏的糖尿病患者，應(yīng)該使用氯吡格雷（劑量75 mg/天）。（B）l 發(fā)生急性冠脈綜合征后，阿司匹林（劑量75162 mg/天）聯(lián)合氯吡格雷（劑量75 mg/天）治療一年是合理的。（B）● Use aspirin therapy (75–162 mg/day)as a secondary prevention strategy inthose with diabetes with a history ofCVD. (A)● For patients with CVD and docuMented aspirin allergy,clopidogrel(75mg/day) should be used. (B)● Combination therapy with ASA (75–162 mg/day) and clopidogrel (75 mg/day) is reasonable for up to a year afteran acute coronary syndrome. (B)戒煙l 勸告所有患者戒煙。（A）l 戒煙咨詢和其他形式的戒煙治療是糖尿病常規(guī)治療的一個組成部分。（B）Smoking cessation● Advise all patients not to smoke. (A)● Include smoking cessation counselingand other forms of treatment as a routine ponent of diabetes care. (B)冠心病篩查和治療篩查l 對于無癥狀的患者，不建議常規(guī)篩查冠心病，因為只要心血管危險因素給予治療，并未證明這會改善結(jié)局。（A）Coronary heart disease (CHD)screening and treatmentScreening● In asymptomatic patients, routinescreening for CAD is not remended明確提出不建議篩查冠心病, as it does not improve outes as long as CVD risk factors aretreated. (A)治療l 確診伴有CVD患者，應(yīng)該使用ACEI（C）、阿司匹林（A）和他汀類降脂藥（A）（如果沒有禁忌證）以減少心血管事件的風(fēng)險。l 對于既往曾有心肌梗死的患者，應(yīng)該使用β受體阻滯劑至少2年（B）Treatment● In patients with known CVD, ACE inhibitor (C) and aspirin and statin therapy (A) (if not contraindicated) shouldbeusedtoreducetheriskofcardiovascular events.● In patients with a prior myocardial infarction,blockers should be continued for at least 2 years after the event.(B)l 無高血壓的患者長期應(yīng)用β受體阻滯劑（如果能夠耐受）也是合理的，但缺乏數(shù)據(jù)。（E）l 對于有癥狀的心力衰竭患者，避免使用噻唑烷二酮類藥物。（C）l 對于病情穩(wěn)定的充血性心力衰竭（CHF）者，如果腎功能正常，可以應(yīng)用二甲雙胍。在CHF病情不穩(wěn)定或因CHF住院的患者，應(yīng)避免使用二甲雙胍。（C）● Longerterm use ofblockers in theabsenceofhypertensionisreasonableifwelltolerated,butdataarelacking.(E)● Avoid thiazolidinedione (TZD) treatment in patients with symptomaticheart failure. (C)● Metformin may be used in patients withstable congestive heart failure (CHF) ifrenal function is normal. It should beavoidedinunstableorhospitalizedpatients with CHF. (C)腎病篩查和治療整體建議● 為了減少和或延緩腎病的進展，應(yīng)該優(yōu)化血糖控制。（A）● 為了減少和或延緩腎病的進展，應(yīng)該優(yōu)化血壓控制。（A）Nephropathy screening andtreatmentGeneral remendations● Toreducetheriskorslowtheprogression of nephropathy, optimize glucosecontrol. (A)● Toreducetheriskorslowtheprogression of nephropathy, optimize bloodpressure control. (A)篩查● 對于1型糖尿病病程5年以上及所有2型糖尿病患者從診斷開始，應(yīng)該每年評估尿白蛋白排泄率。（E）● 對于所有成人糖尿病不管其尿白蛋白排泄率多少，至少每年測定血清肌酐。血清肌酐應(yīng)該用于評估腎小球濾過率（GFR）及對慢性腎臟病進行分期（如果有CKD）。（E）Screening● Perform an annual test to assess urinealbuminexcretionintype1diabeticpatients with diabetes duration of5yearsandinalltype2diabeticpatientsstarting at diagnosis. (E)● Measureserumcreatinineatleastannually in all adults with diabetes regardless of the degree of urine albuminbe used to estimate GFR and stage thelevel of chronic kidney disease (CKD),if present. (E)治療l 除了妊娠期間外，應(yīng)該使用ACEI或ARBs治療微量或大量蛋白尿。（A）Treatment● In the treatment of the nonpregnantpaTient with microor macroalbuminuria,either ACE inhibitors or ARBs shouldbe used. (A)l 盡管目前尚無ACEI和ARB二者直接頭對頭的比較研究，但已有臨床試驗支持下列觀點：n 對于伴有高血壓和任何程度白蛋白尿的1型糖尿病患者， ACEI顯示能夠延緩腎病的進展。（A）● While there are no adequate headtohead parisons of ACE inhibitorsandARBs,thereisclinicaltrialsupportfor each of the following statements:● Inpatientswithtype1diabetes,withhypertensionandanydegreeofalbuminuria, ACE inhibitors have beenshowntodelaytheprogressionofnephropathy. (A)n 對于伴有高血壓、微量白蛋白尿的2型糖尿病患者，ACEI和ARBs均顯示能夠延緩向大量白蛋白進展。（A）n 對于伴有高血壓、大量白蛋白尿和腎功能不全（血肌酐＞ mg/dl）的2型糖尿病患者，ARBs顯示能夠延緩腎病的進展。（A）n 如果任何一種不能耐受，則應(yīng)該用另一種替代。（E）● In patients with type 2 diabetes, hypertension, and microalbuminuria,both ACE inhibitors and ARBs havebeen shown to delay the progressionto macroalbuminuria. (A)● In patients with type 2 diabetes, hypertension, macroalbuminuria, andrenal insufficiency (serum ),ARBshavebeenshownto delay the progression of nephropathy. (A)● If one class is not tolerated, the othershould be substituted. (E)l 對于糖尿病伴有早期慢性腎病和晚期慢性腎病患者，～（尿白蛋白排泄率、GFR），因此受到推薦。（B）● Reduction of protein intake to ––1 –1g kg body wt day in individualswith diabetes and the earlier stages of–1 –1inthelaterstagesofCKDmayimprovemeasuresofrenalfunction(urinealbuminexcretionrate,GFR)andisremended. (B)l 應(yīng)用ACEI、ARBs、利尿劑者，監(jiān)測血清肌酐及血鉀水平防止發(fā)生急性腎病和高鉀血癥。（E）l 建議持續(xù)監(jiān)測尿白蛋白排泄率，以便評估療效和腎病進展。（E）● WhenACEinhibitors,ARBs,ordiuretics are used, monitor serum creatinineand potassium levels for the development of acute kidney disease and hyperkalemia. (E)● Continued monitoring of urine albumin excretion to assess both responsetotherapyandprogressionofdiseaseisremended. (E)l 當估計GFR（eGFR）＜60 mlmin/ m2時，評估和處理慢性腎臟疾病的潛在并發(fā)癥。（E）l 如果腎病發(fā)病原因不明確（大量蛋白尿、活動性尿沉渣、無視網(wǎng)膜病變、GFR快速下降）、處理困難或者晚期腎臟疾病時，應(yīng)該把患者轉(zhuǎn)診給腎病專家。（B）● When estimated GFR (eGFR) is602, evaluate and managepotential plications of CKD. (E)新增● Consider referral to a physician experienced in the care of kidney diseasewhen there is uncertaintyabout the etiology of kidney disease(heavyproteinuria, active urine sediment, absence ofretinopathy,rapiddeclineinGFR),difficult management issues, or advancedkidney disease. (B)視網(wǎng)膜病篩查和治療整體建議l 優(yōu)化患者血糖控制能夠降低糖尿病視網(wǎng)膜病患病危險并延緩其進展。（A）l 優(yōu)化患者血壓控制能夠降低糖尿病視網(wǎng)膜病患病危險并延緩其進展。（A）Retinopathy screening and treatmentGeneral remendations● Toreducetheriskorslowtheprogression of retinopathy, optimize glycemiccontrol. (A)● Toreducetheriskorslowtheprogres