【正文】 （A）Retinopathy screening and treatmentGeneral remendations● Toreducetheriskorslowtheprogression of retinopathy, optimize glycemiccontrol. (A)● Toreducetheriskorslowtheprogres。（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。min/ m2時，評估和處理慢性腎臟疾病的潛在并發(fā)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）● 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。（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）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。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）。（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。（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。（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。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)。（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。（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 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）。（C）l 這個年齡段具有多項危險因素的患者（如10年風險在5~10%），則需要進行臨床判斷。這包括大部分男性50歲或女性60歲，并至少合并一項其他主要危險因素（CVD家族史、高血壓、吸煙、血脂異?；虻鞍啄颍?。 weight loss(if indicated)。（E）Treatment remendations and goals● Lifestylemodificationfocusingonthereduction of saturated fat, trans fat,andcholesterolintake。（C）l 如果最大耐受劑量他汀沒有達標，可考慮聯(lián)用他汀和其他降脂藥物使血脂達標，但尚未有評估其CVD結(jié)局和安全性的研究。（A）l 其他指標的治療目標是TG 150 mg/dl（ mmol/l），男性HDLC40 mg/dl（ mmol/l），女性HDLC50mg/dl（ mmol/l）。（A）l 伴有CVD的糖尿病患者，應(yīng)使用大劑量他汀使LDLC70 mg/dl（ mmol/l）。（A）l 對上述低風險人群（如沒有明確CVD及年齡在40歲以下者），如果患者LDLC≥100 mg/dl或者具有多個CVD危險因素，建議在生活方式干預(yù)的前提下，考慮使用他汀類藥物治療。（A）l 所有下列糖尿病患者，無論血脂水平如何，應(yīng)該在生活方式干預(yù)的基礎(chǔ)上使用他汀類藥物：n 有明確的CVD。處于血脂異常低危狀態(tài)的成人（LDLC100mg/dl（），HDLC50mg/dl（），TG150mg/dl（）），可以每兩年評估血脂一次。妊娠期間，ACEI和ARBs均屬禁忌。（B）l 如果已經(jīng)應(yīng)用ACEI、ARBs或者利尿劑，應(yīng)監(jiān)測腎功能和血鉀水平。min/ m2時，應(yīng)該加用袢利尿劑。如果血壓仍然未達標，當患者腎小球濾過率（GFR）≥30 ml and increasedphysical activity. (B)l 合并糖尿病的高血壓患者藥物治療方案應(yīng)該包括一種血管緊張素轉(zhuǎn)化酶抑制劑（ACEI）或者血管緊張素受體拮抗劑（ARB）。DASH(Dietary Approaches to Stop Hypertension)style dietary pattern, including reducing sodium andincreasing potassium intake。（A）Treatment● Patients with a systolic blood pressureOf 130–139mmHg or a diastolicbloodPressure of 80–89mmHg maybe givenlifestyle therapy alone for a maximumof 3 months and then,iftargetsarenotachieved, be treated with the additionof pharmacological agents. (E)● Patientswithmoreseverehypertension(systolic blood pressure140 or diastolic blood pressure90 mmHg) atdiagnosis or followup should receivepharmacologic therapy in addition tolifestyle therapy. (A)l 高血壓的生活方式治療包括超重者減輕體重，包含低鹽飲食、增加鉀的攝入的DASH飲食方式；適量飲酒以及增加體力活動。（B）Goals● A goal systolic blood pressure130mmHg is appropriate for most patientswith diabetes. (C)● Based on patient characteristics and reSponse to therapy,higher or lower systolic blood pressure targets may beappropriate. (B)本條為新增● Patients with diabetes should be treatedto a diastolic blood pressure80mmHg. (B)治療l 收縮壓130～139 mmHg或者舒張壓80～89 mmHg的患者可以僅接受生活方式治療，如果3個月血壓仍然不達標，則加用降壓藥物治療。（C）l 基于患者特點和對治療的應(yīng)答，較高或較低的舒張壓目標可能合適的。再次測量仍收縮壓≥130mmHg或舒張壓≥80mmHg，可確診為高血壓。（C）Immunization● Annually provide an influenza vaccineto all diabetic patients6 months ofage. (C)● Administer pneumococcal polysaccharide vaccine to all diabetic patients2remended for individuals64years of age previously immunizedwhentheywere65yearsofageifthevaccine was administered5 yearsnation include nephrotic syndrome,chronicrenaldisease,andotherimmunopromised states, such as aftertransplantation. (C)高血壓／血壓控制篩查和診斷糖尿病患者每次隨訪時均應(yīng)測量血壓。年齡64歲者，如5年前接種過疫苗需再接種一次。（E）● The lon