【正文】 in patients whose therapy has changed orwhoarenotmeetingglycemicgoals.(E)● UseofpointofcaretestingforA1Callows for timely decisions on therapychanges, when needed. (E)成人的血糖控制目標(biāo)● 已有證據(jù)顯示降低A1C到7%左右或以下可減少糖尿病微血管和神經(jīng)并發(fā)癥，如果在診斷糖尿病后立即治療，可以減少遠(yuǎn)期大血管疾病。（B）Glycemic goals in adults● Lowering A1C to below or around 7%hasbeenshowntoreducemicrovascular and neuropathic plications ofdiabetes and,if implemented soon afterthe diagnosis of diabetes, is associatedwith longterm reduction in macrovascular disease. Therefore, a reasonableA1Cgoal for many nonpregnant adultsis7%. (B)● 因?yàn)閷?duì)多個(gè)隨機(jī)試驗(yàn)進(jìn)行進(jìn)一步分析提示，A1C值接近正常在微血管結(jié)局方面確實(shí)可以獲得小的益處，因此在某些患者如果沒有明顯低血糖或其他副作用，建議更嚴(yán)格的A1C目標(biāo)或許也是合理的。（B）● Because additional analyses from several randomized trials suggest a smallbut incremental benefit in microvascular outes withA1C value scloser tonormal, providers might reasonablysuggest more stringent A1C goals forselected individual patients, if this canbe achieved without significant hypoglycemia or other adverse effects ofthose with short duration of diabetes,longlifeexpectancy,andnosignificantcardiovascular disease. (B)● 相反，對(duì)于有嚴(yán)重低血糖病史、預(yù)期壽命有限、有晚期微血管或大血管病發(fā)癥、同時(shí)患伴發(fā)其他嚴(yán)重疾病及糖尿病病史多年的患者，盡管實(shí)施了糖尿病自我管理教育、合適的血糖檢測(cè)、應(yīng)用了包括胰島素在內(nèi)的多種有效劑量的降糖藥物，而血糖仍難達(dá)標(biāo)者，其A1C目標(biāo)控制不需太嚴(yán)。（B）l 自我管理和生活治療的效果是DSME結(jié)局的關(guān)鍵，應(yīng)該作為治療的一部分進(jìn)行評(píng)估和監(jiān)測(cè)。（C）因DSME可以節(jié)省花費(fèi)并能改善預(yù)后（B），所以費(fèi)用應(yīng)該由第三方支付者負(fù)責(zé)。（A）● 因?yàn)榭梢怨?jié)省花費(fèi)并可改善預(yù)后的原因（B），MNT應(yīng)該被相關(guān)保險(xiǎn)公司及其他支付所覆蓋。因此，建議所有超重或肥胖的糖尿病患者或有糖尿病危險(xiǎn)因素的患者減輕體重。（A）Energy balance, overweight, andobesity● In overweight and obese insulinresistant individuals, modest weightloss has been shown to reduce insulinresistance. Thus, weight loss is remended for all overweight or obese individuals who have or are at risk fordiabetes. (A)● For weight loss, either lowcarbohydrate, lowfat calorierestricted, orMediterranean dietsmaybeeffectiveinthe short term (up to 2 years). (A)● 對(duì)于低碳水化合物飲食的患者，監(jiān)測(cè)其血脂、腎功能和蛋白質(zhì)攝取（有腎病患者）情況，并及時(shí)調(diào)整降糖治療方案。（A）● 對(duì)于2型糖尿病高危人群，應(yīng)該鼓勵(lì)食用美國(guó)農(nóng)業(yè)部推薦的膳食纖維高含量食品及全谷食物。（E）Remendations for managementof diabetes: macronutrients indiabetes management● The best mix of carbohydrate, protein,and fat may be adjusted to meet themetabolic goals and individual preferences of the person with diabetes. (E)● 無論采用計(jì)算法、食品交換份法或經(jīng)驗(yàn)估算來監(jiān)測(cè)碳水化合物的攝入量，也是血糖控制達(dá)標(biāo)的關(guān)鍵策略。（B）● For individuals with diabetes, the use ofthe glycemic index and glycemic loadmay provide a modest additional benefit for glycemic control over that observed when total carbohydrate isconsidered alone. (B)● 飽和脂肪攝入量不應(yīng)該超過總攝入能量的7%。（B）● Reducing intake of trans fat lowersLDLcholesterol and increases HDL cholesterol (A)。（E）l 不建議常規(guī)補(bǔ)充抗氧化劑如維生素E、C和胡蘿卜素，因?yàn)槿狈τ行院烷L(zhǎng)期安全性的證據(jù)。（E）Other nutrition remendations● If adults with diabetes choose to usealcohol, daily intake should be limitedto a moderate amount (one drink perday or less for adult women and twodrinks per day or less for adult men).(E)● Routine supplementation with antioxidants, such as vitamins E and C andcarotene,is not advised because of lackof evidence of efficacy and concern related to longterm safety. (A)● Individualized meal planning shouldInclude optimization of food choices tomeet remended daily allowance(RDA)/dietary reference intake (DRI)for all micronutrients. (E)體力活動(dòng)l 糖尿病患者應(yīng)該每周至少進(jìn)行中等強(qiáng)度有氧體力活動(dòng)（50％～70％最大心率）150 分鐘。（A）Physical activity● Peoplewithdiabetesshouldbeadvisedto perform at least 150 min/week ofmoderateintensityaerobicphysicalactivity (50–70% of maximum heartrate). (A)● In the absence of contraindications,people with type 2 diabetes should beencouragedtoperformresistancetraining three times per week. (A)心理評(píng)估與治療l 糖尿病治療應(yīng)包括心理學(xué)和社會(huì)狀態(tài)的評(píng)估。（E）l 當(dāng)自我管理較差時(shí)，應(yīng)篩查如抑郁和糖尿病相關(guān)的壓抑、焦慮、飲食障礙以及認(rèn)知障礙等心理問題。如果治療15分鐘后SMBG依然為低血糖，應(yīng)該再次給藥。（E）l 所有嚴(yán)重低血糖高危的患者、照護(hù)者或家人均應(yīng)給予胰高血糖素，并教會(huì)如何用藥。（E）l 對(duì)于無癥狀低血糖或出現(xiàn)過一次或多次嚴(yán)重低血糖的糖尿病患者，應(yīng)該降低血糖控制目標(biāo)，以嚴(yán)格避免至少在近幾周內(nèi)再次發(fā)生低血糖，還可以部分逆轉(zhuǎn)無癥狀性低血糖并減少將來發(fā)生低血糖的風(fēng)險(xiǎn)。（B）Bariatric surgery● Bariatric surgery may be considered for2 adults with BMI35kg/m and type2diabetes, especially if the diabetes or associated orbidities are difficult tocontrol with lifestyle and pharmacologic therapy. (B)l 接受了減肥手術(shù)的2型糖尿病患者應(yīng)接受長(zhǎng)期生活方式咨詢與醫(yī)學(xué)監(jiān)測(cè)。（E）● Patientswithtype2diabeteswhohaveundergone bariatric surgery need lifelong lifestyle support and medicalmonitoring. (E)● Although small trials have shown glycemicbenefitofbariatricsurgeryinpatients with type 2 diabetes and BMI of230–35 kg/m , there is currently insufficient evidence to generally remendsurgeryinpatientswithBMI352kg/m outside of a research protocol.(E)l 2型糖尿病患者減肥手術(shù)的長(zhǎng)期獲益、花費(fèi)效益比及風(fēng)險(xiǎn)，應(yīng)該通過設(shè)計(jì)良好的隨機(jī)對(duì)照試驗(yàn)與合適的藥物及生活方式治療加以比較研究。（C）l 所有2歲以上的糖尿病患者須接種肺炎球菌疫苗。再接種指征還包括腎病綜合征、慢性腎病及其他免疫損害者如器官移植后。收縮壓≥130mmHg或舒張壓≥80mmHg的患者，應(yīng)該改天重復(fù)測(cè)量。（C）Hypertension/blood pressure controlScreening and diagnosis● Blood pressure should be measured atevery routine diabetes visit. Patientsfound to have systolic blood pressure130 mmHg or diastolic blood pressure80 mmHg should have bloodpressure confirmed on a separate day.Repeat systolic blood pressure130mmHg or diastolic blood pressure 80mmHg confirms a diagnosis of hypertension. (C)目標(biāo)血壓l 大多數(shù)糖尿病患者收縮壓控制目標(biāo)為130 mmHg是合適的。（B）l 糖尿病患者舒張壓應(yīng)該控制在80 mmHg。（E）l 在診斷或隨訪時(shí)，較重的高血壓患者（收縮壓≥140mmHg，或者舒張壓≥90mmHg），除了接受生活方式治療外，還應(yīng)接受藥物治療。（B）● Lifestyle therapy for hypertension consists of: weight loss, if overweight。 moderation of alcohol intake。如果其中的一種不能耐受，應(yīng)該用另一種代替。min/ m2時(shí)，應(yīng)該加用噻嗪類利尿劑，當(dāng)患者GFR＜30 ml（C）● Pharmacologic therapy for patientsWith diabetes and hypertensions houldbe with a regimen that includes eitheran ACE inhibitoror an ARB. Ifoneclassis not tolerated, the other should besubstituted. If needed to achieve bloodpressure targets, a thiazide diureticshould be added to those with an estimated glomerular filtration rate (GFR)230 ml/min/ m and a loop diuretic for those with an estimated GFR230 ml/min/ m . (C)l 常需多種藥物聯(lián)合治療（最大劑量的2種或更多種藥物）以使血壓控制達(dá)標(biāo)。