【正文】 apy. (A)● Forpatientsusinglessfrequentinsulininjections, noninsulin therapies, ormedical nutrition therapy (MNT)alone,SMBGmaybeusefulasaguidetothe success of therapy. (E)● To achieve postprandial glucose targets,postprandialSMBGmaybeappropriate. (E)● When prescribing SMBG, ensure thatpatients receive initial instruction in,and routine followup evaluation of,SMBGtechniqueandtheirabilitytousedata to adjust therapy. (E)● Continuousglucosemonitoring(CGM)in conjunction with intensive insulinregimens can be a useful tool to lowerA1Cinselectedadults(age25years)with type 1 diabetes. (A)● Although the evidence for A1Clowering is less strong in children,teens, and younger adults, CGM mayrelates with adherence to ongoing useof the device. (C)● CGM may be a supplemental tool toSMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes. (E)A1C● 對(duì)于治療達(dá)標(biāo)（血糖控制穩(wěn)定）患者，每年應(yīng)該至少進(jìn)行兩次A1C檢測。這種儀器的應(yīng)用與成功的治療具有相關(guān)性。（E）● 對(duì)于年齡25歲以上的1型糖尿病患者進(jìn)行動(dòng)態(tài)血糖監(jiān)測（CGM）并聯(lián)合胰島素強(qiáng)化治療，是降低A1C水平的有效方法。（E）● 餐后SMBG或許有助于餐后血糖控制達(dá)標(biāo)。（E）● Based on potential costsavings of diabetes prevention, such programsshould be covered by thirdparty payors. (E)● Metformin therapy for prevention oftype 2 diabetes may be considered inthose at highest risk for developing diabetes,such as those with multiple riskfactors, especially if they demonstrateprogression of hyperglycemia(%) despite lifestyle interventions.(B)● Monitoring for the development of diAbetes in those with prediabetes shouldbe performed every year. (E)血糖監(jiān)測● 每日多次胰島素注射或采用胰島素泵治療的患者，應(yīng)該進(jìn)行自我檢測血糖（SMBG）每天3次或以上。（E）● 對(duì)于那些可能發(fā)展為糖尿病的高危人群，如具有多種危險(xiǎn)因素，尤其是盡管進(jìn)行了生活方式的干預(yù)后血糖仍進(jìn)展（如A1C＞6%），可以考慮使用二甲雙胍治療以預(yù)防2型糖尿病。（B）● 定期隨訪咨詢對(duì)成功非常重要。（E）● 有妊娠糖尿病病史的婦女應(yīng)至少每3年篩查是否發(fā)展為糖尿病或糖尿病前期。（B）● 在未知是否具有糖尿病的懷孕婦女中，在妊娠24~28周用75g 2h OGTT篩查妊娠糖尿病，診斷切點(diǎn)見“2011年糖尿病診療標(biāo)準(zhǔn)”表6。（B）● 對(duì)于那些已經(jīng)確定未來糖尿病風(fēng)險(xiǎn)增加的人群，應(yīng)該進(jìn)一步評(píng)估并治療其他心血管疾病（CVD）危險(xiǎn)因素。（E）● 為篩查糖尿病或評(píng)估未來糖尿病的風(fēng)險(xiǎn)，A1C、對(duì)沒有這些危險(xiǎn)因素的人群，應(yīng)從45歲開始篩查。試驗(yàn)應(yīng)按照世界衛(wèi)生組織（WHO）的標(biāo)準(zhǔn)進(jìn)行，用75 g無水葡萄糖溶于水作為糖負(fù)荷l 有高血糖的典型癥狀或高血糖危象，隨機(jī)血糖≥ mmol/Ll 如無明確的高血糖癥狀，結(jié)果應(yīng)重復(fù)檢測確認(rèn)。并與（Diabetes Control and Complications Trial，DCCT）的檢測進(jìn)行標(biāo)化l 空腹血糖（FPG）≥ mmol/L。2011年ADA糖尿病診療標(biāo)準(zhǔn)執(zhí)行綱要美國糖尿病協(xié)會(huì)王新軍 于文 譯濱州醫(yī)學(xué)院附屬濱州市人民醫(yī)院內(nèi)分泌科，濱州，256610目前糖尿病的診斷標(biāo)準(zhǔn)l A1C≥%。試驗(yàn)應(yīng)該用美國糖化血紅蛋白標(biāo)準(zhǔn)化計(jì)劃組織（National Glycohemoglobin Standardization Program，NGSP）認(rèn)證的方法進(jìn)行。空腹的定義是至少8小時(shí)未攝入熱量，或l OGTT 2h血糖≥ mmol/L。Current criteria for the diagnosis ofdiabetes● %. The test should be performed in a laboratory using a methodthatisNationalGlycohemoglobinStandardization Program (NGSP)certifiedand standardized to the Diabetes Control and Complications Trial (DCCT)assay● fasting plasma glucose (FPG)126mg/dl ( mmol/l). Fasting is definedas no caloric intake for at least 8 h, or● 2h plasma glucose200 mg/dl (mmol/l) during an oral glucose tolerance test (OGTT). The test should beperformed as described by the WorldHealth Organization, using a glucoseload containing the equivalent of 75 ganhydrous glucose dissolved in water● in a patient with classic symptoms ofhyperglycemiaorhyperglycemiccrisis,a random plasma glucose200 mg/dl( mmol/l)● intheabsenceofunequivocalhyperglycemia, result should be confirmed byrepeat testing.new在無癥狀患者中進(jìn)行糖尿病篩查● 在無癥狀的成人，如超重或肥胖（BMI≥25kg/m2）并有一個(gè)以上其他糖尿病危險(xiǎn)因素（見“2011年糖尿病診療標(biāo)準(zhǔn)”中的表4），應(yīng)該從任何年齡開始篩查糖尿病并評(píng)估將來糖尿病的風(fēng)險(xiǎn)。（B）● 如果檢查結(jié)果正常，至少每3年復(fù)查一次。FPG或2h 75g OGTT均是適用的。（B）Testing for diabetes in asymptomaticpatients● Testing to detect type 2 diabetes andassess risk for future diabetes in asymptomaticpeople should be considered inadults of any age who are overweight orobese (BMI _25 kg/m2) and who haveone or more additional risk factors fordiabetes (see Table 4 of the “Standardsof Medical Care in Diabetes—2011”).In those without these risk factors, testingshould begin at age 45 years. (B)● If tests are normal, repeat testing carriedout at least at 3year intervals isreasonable. (E)● To test for diabetes or to assess risk offuture diabetes, A1C, FPG, or 2h 75gOGTT are appropriate. (B)● In those identified with increased riskfor future diabetes, identify and, if appropriateappropriate,treat other cardiovasculardisease (CVD) risk factors. (B)妊娠期糖尿病的篩查和診斷● 在有危險(xiǎn)因素的個(gè)體中，產(chǎn)前首次就診時(shí)用標(biāo)準(zhǔn)的診斷標(biāo)準(zhǔn)篩查未診斷的2型糖尿病。（B）Detection and diagnosis ofgestational diabetes mellitus (GDM)● Screen for undiagnosed type 2 diabetesat the first prenatal visit in those withrisk factors, using standard diagnosticcriteria. (B)● In pregnant women not known to havediabetes, screen for GDM at 24–28weeks of gestation, using a 75g 2hOGTT and the diagnostic cut points inTable 6 of the “Standards of MedicalCare in Diabetes—2011”. (B)● 妊娠糖尿病的婦女在產(chǎn)后6~12周篩查永久性糖尿病。（E）● Screen women with GDM for persistentdiabetes 6–12 weeks postpartum. (E)● Women with a history of GDM shouldHave life long screening for the developMent of diabetes or prediabetes at leastevery 3 years. (E)預(yù)防/延緩2型糖尿病● 對(duì)于糖耐量異常（IGT）（A）、空腹血糖受損（IFG）（E）或A1C ～%之間（E）的患者，應(yīng)該制定長期計(jì)劃，以減輕體重7%，增加體力活動(dòng)，每周進(jìn)行至少150分鐘中等強(qiáng)度（如步行）的體力活動(dòng)。（B）Prevention/delay of type 2 diabetes● Patients with impaired glucose tolerance (IGT) (A), impaired fasting glucose(IFG)(E),–%(E) should be referred to an effectiveongoing support program targetingweight loss of 7% of body weight andincreasing physical activity to at least150 min/week of moderate activitysuch as walking.● Followup counseling appears to be important for success. (B)● 基于節(jié)約糖尿病預(yù)防的潛在醫(yī)療費(fèi)用，這種咨詢的費(fèi)用應(yīng)由第三方支付。（B）● 糖尿病前期患者應(yīng)該每年進(jìn)行檢測以觀察是否進(jìn)展為糖尿病。（A）● 對(duì)于胰島素注射次數(shù)少或僅采用口服藥物或醫(yī)學(xué)營養(yǎng)治療（MNT）的患者，SMBG或許有助于治療成功。（E）● SMBG醫(yī)囑后，應(yīng)確?；颊攉@得SMBG的初始指導(dǎo)和定期隨訪評(píng)估，并用SMBG數(shù)據(jù)指導(dǎo)和調(diào)整治療。（A）● 雖然在兒童、青少年和青年患者中降低A1C的證據(jù)不強(qiáng)，但是CGM或許有助于該人群的治療。（C）● CGM可以作為SMBG的一種補(bǔ)充，特別適宜無癥狀低血糖和／或頻發(fā)低血糖的患者。（E）● 對(duì)更改治療方案或血糖控制未達(dá)標(biāo)患者，應(yīng)每季度進(jìn)行一次A1C檢測。（E）A1C● PerformtheA1Ctestatleasttwotimesayearinpatientswhoaremeetingtreatmentgoals(andwhohavestableglycemic control). (E)● Perform the A1C test quarterly