【正文】 gterm benefits, costeffectiveness,andrisksofbariatricsurgeryinindividualswithtype2diabetesshould be studied in welldesignedcontrolled trials with optimal medicaland lifestyle therapy as the parator.(E)免疫接種l 年齡≥6個(gè)月的糖尿病患者每年都要接種流感疫苗。（E）l 盡管小型研究表明BMI在3035kg/m2之間的2型糖尿病患者接受減肥手術(shù)也可更好控制血糖，但目前沒有充足的循證醫(yī)學(xué)證據(jù)建議，除研究之外對(duì)BMI＜35 kg/m2 的2型糖尿病患者進(jìn)行減肥手術(shù)。（B）Hypoglycemia● Glucose (15–20 g) is the preferredtreatment for the conscious individualwithhypoglycemia,althoughanyformof carbohydrate that contains glucosemay be used. If SMBG 15 min aftertreatmentshowscontinuedhypoglycemia, the treatment should be repeated.OnceSMBGglucosereturnstonormal,the individual should consume a mealorsnacktopreventrecurrenceofhypoglycemia. (E)● Glucagon should be prescribed for allindividuals at significant risk of severehypoglycemia,andcaregiversorfamilymembersoftheseindividualsshouldbegon administration is not limited tohealth care professionals. (E)● Individuals with hypoglycemia unawareness or one or more episodes ofseverehypoglycemiashouldbeadvisedtoraisetheirglycemictargetstostrictlyavoid further hypoglycemia for at leastseveralweeks,topartiallyreversehypoglycemia unawareness and reduce therisk of future episodes. (B)減肥手術(shù)l BMI≥35 kg/m2的2型糖尿病患者，特別是糖尿病或相關(guān)并發(fā)癥通過生活方式和藥物治療仍難以控制者，可以考慮進(jìn)行減肥手術(shù)治療。胰高血糖素不要求必須由專業(yè)人員給予。一旦SMBG血糖正常后，患者應(yīng)該繼續(xù)追加一次正常飲食或點(diǎn)心，以預(yù)防低血糖復(fù)發(fā)。（C）Psychosocial assessment and care● Assessment of psychological and socialsituation should be included as an ongoing part of the medical managementof diabetes. (E)● Psychosocial screening and followupshould include, but is not limited to,attitudesabouttheillness,expectationsfor medical management and outes, affect/mood,general and diabetesrelated quality of life, resources(financial, social, and emotional), andpsychiatric history. (E)● Screen for psychosocial problems suchas depression and diabetesrelated distress, anxiety, eating disorders, andcognitive impairment when selfmanagement is poor. (C)證據(jù)級(jí)別提升低血糖l 治療癥狀性低血糖首選葡萄糖（15～20g），也可選用任何含有葡萄糖的碳水化合物。（E）l 心理篩查應(yīng)該包括但不限于：對(duì)疾病的態(tài)度、對(duì)治療和預(yù)后的期望值、情感/情緒狀態(tài)、一般的及與糖尿病相關(guān)的生活質(zhì)量、生活來源（經(jīng)濟(jì)上、社會(huì)和情感方面）以及精神病史。（A）l 對(duì)無禁忌證的2型糖尿病患者鼓勵(lì)每周進(jìn)行3次耐力運(yùn)動(dòng)。（A）l 個(gè)體化的飲食計(jì)劃應(yīng)包括優(yōu)化食物選擇，以滿足所有微量元素的每日建議容許量（RDAs）/飲食參考攝入量（DRI）。 therefore, intake of trans fatshould be minimized. (E)其他營養(yǎng)建議l 成年糖尿病患者如果想飲酒，每日攝入量應(yīng)限少量（成年女性每天≤1杯，成年男性≤2杯）。（A）● Saturated fat intake should be7% oftotal calories. (A)● 減少反式脂肪攝入量能降低LDL膽固醇，增加HDL膽固醇；所以應(yīng)減少反式脂肪的攝入量。（A）● Monitoring carbohydrate, whether bycarbohydrate counting, choices, or experiencebased estimation, remains akey strategy in achieving glycemic control. (A)● 對(duì)糖尿病患者，當(dāng)僅考慮碳水化合物總量時(shí)，用血糖指數(shù)和血糖負(fù)荷，可能更有助于血糖控制。（B）Remendations for primaryprevention of diabetes● Among individuals at high risk for developing type 2 diabetes, structuredprograms that emphasize lifestylechanges that include moderate weightloss (7% of body weight) and regularphysical activity (150 min/week), withdietary strategies including reducedcalories and reduced intake of dietaryfat, can reduce the risk for developingdiabetes and are therefore remended. (A)● Individuals at high risk for type 2 diabetes should be encouraged to achievethe . Department of Agriculture(USDA)remendationfordietaryfiber (14 g fiber/1,000 kcal) and foodscontaining whole grains (onehalf ofgrain intake). (B)糖尿病的治療建議：糖尿病治療中的營養(yǎng)素● 碳水化合物、蛋白質(zhì)和脂肪最佳比例或許應(yīng)該調(diào)整，以滿足糖尿病患者的代謝目標(biāo)和個(gè)人喜好。（E）● 體力活動(dòng)和行為矯正是控制體重的重要組成部分，同時(shí)最有助于保持減輕的體重（B）● Forpatients on lowcarbohydrate diets,monitor lipid profiles, renal function,and protein intake (in those with nephropathy) and adjust hypoglycemictherapy as needed. (E)● Physical activity and behavior modification are important ponents ofweight loss programs and are mosthelpful in maintenance of weight loss.(B)糖尿病的一級(jí)預(yù)防● 在2型糖尿病高危人群中，預(yù)防措施重點(diǎn)應(yīng)強(qiáng)調(diào)生活方式的改變，包括適度的減輕體重（7%）和規(guī)律的體力活動(dòng)（每周150分鐘），飲食控制如減少碳水化合物的攝取、低脂飲食能夠減少發(fā)生2型糖尿病的風(fēng)險(xiǎn)，因此建議糖尿病高危人群進(jìn)行生活方式的改變。（A）● 對(duì)于減輕體重，低碳水化合物飲食、低卡路里脂肪限制飲食或地中海飲食在短期內(nèi)（至少2年）或許有效。（E）Medical nutrition therapy (MNT)General remendations● Individualswhohaveprediabetesordiabetes should receive individualizedMNT as needed to achieve treatmentgoals, preferably provided by a registereddietitianfamiliarwiththeponents of diabetes MNT. (A)● BecauseMNTcanresultincostsavingsand improved outes (B), MNTshouldbeadequatelycoveredbyinsurance and other payors. (E)能量平衡、超重與肥胖● 在超重和肥胖的胰島素抵抗患者，已經(jīng)證實(shí)適度減輕體重能有效減輕胰島素抵抗。（E）Diabetes selfmanagement education(DSME)● People with diabetes should receiveDSME according to national standardswhentheirdiabetesisdiagnosedandasneeded thereafter. (B)● Effective selfmanagement and qualityof life are the key outes of DSMEand should be measured and monitored as part of care. (C)● DSME should address psychosocial issues, since emotional wellbeing is associated with positive diabetesoutes. (C)● Because DSME can result in costsavings and improved outes (B),DSME should be adequately reimbursed by thirdparty payors. (E)醫(yī)學(xué)營養(yǎng)治療整體建議● 任何糖尿病及糖尿病前期患者都需要依據(jù)治療目標(biāo)接受個(gè)體化的MNT，如果能在熟悉糖尿病知識(shí)的注冊(cè)營養(yǎng)師指導(dǎo)下完成更好。（C）l DSME必須有心理課，因?yàn)榍榫w會(huì)明顯影響糖尿病預(yù)后。（C）● Conversely, less stringent A1C goalsmay be appropriate for patients with ahistoryofseverehypoglycemia,limitedlife expectancy, advanced microvascularormacrovascularplications,extensiveorbidconditions,andthosewith longstanding diabetes in whomthe general goal is difficult to attain despite diabetes selfmanagement education, appropriate glucose monitoring,and effective doses of multiple glucoselowering agents including insulin. (C)糖尿病自我管理教育l 糖尿病診斷確定后應(yīng)該按國家標(biāo)準(zhǔn)接受DSME。這些患者或許包括那些糖尿病史較短、預(yù)期壽命較長、無明顯心血管并發(fā)癥的病人。所以，在許多非妊娠成人合理的A1C控制目標(biāo)是7%。（E）● 在需要改變治療方案時(shí)可適時(shí)檢測(cè)A1C。（EGlucose monitoring● Selfmonitoring of blood glucose(SMBG) should be carried out three ormoretimesdailyforpatientsusingmultipleinsulininjectionsorinsulinpumpther