丰富中国2型糖尿病防治措施的临床证据链，建立基于中国人群证据的糖尿病防治指南——纪念第1版《中国2型糖尿病防治指南》发布10周年

2013版《中国2型糖尿病防治指南（征求意见版）》（下称“指南”）已公布。新版指南公布距离我国第1版《2型糖尿病防治指南》发布整整10年。2003年,中华医学会糖尿病学分会在中国糖尿病杂志名誉主编,时任中华医学会糖尿病学分会主任委员钱荣立教授的领导下制定了第1版《中国2型糖尿病防治指南》。该指南的出台结束了像中国这样的“糖尿病大国”依靠国际上的指南来指导中国糖尿病防治的历史,并为中国的糖尿病防治提供了临床证据。     

让中国糖尿病防治工作更上一层楼：兼评《中国2型糖尿病防治指南（2013年版）》

在2013年11月刚闭幕的中华医学会糖尿病学分会（CDS）第17次全国学术会议上,专场发布了《中国2型糖尿病防治指南（2013版）》征求意见稿（下称“指南”）。本届CDS主任委员翁建平教授在发布会上指出：“我国指南是在汇聚国内证据和参考国外证据基础上编撰的。从2003年编撰我国第1版指南开始,历经2007年和2010年第2、3版至今第4版,这一过程反映来自国内的资料越来越多。     

利拉鲁肽对2型糖尿病患者血清炎性因子的影响

随着我国人口老龄化和人们生活方式的改变,糖尿病患病率逐年升高.2017 版中国2 型糖尿病( T2DM)防治指南[1]显示,我国T2DM患病率为10. 4％.近年研究表明,T2DM是一种慢性低度炎症反应性疾病,多种炎性因子共同参与T2DM及其并发症的发生发展:可溶性CD163(sCD163)水平与T2DM患者的胰岛素抵...     

《中国2型糖尿病防治指南》10个亮点解释

2010版中国2型糖尿病防治指南（意见征集稿）（以下简称新版指南）基于全球最新最详实的糖尿病研究与实践进展，结合了许多被国际同行认可与借鉴的中国原创研究结果，在内容有以下10大亮点：     

腹腔镜Roux-en-Y胃旁路术规范化手术操作指南（2019版）

目前中国肥胖症和2型糖尿病（T2DM）的患病人数已居全球首位，大量的循证医学证据表明腹腔镜Roux-en-Y胃旁路手术（LRYGB）可显著减轻病态肥胖症患者体重，并有效改善T2DM等一系列肥胖相关合并症。尽管LRYGB手术在国内已有超过14年历史，然而仍缺少规范化的手术操作指南，因此，中国医师协会外科医师分会肥胖和糖尿病外科医师委员会（CSMBS）发起编写首版《腹腔镜Roux-en-Y胃旁路术规范化手术操作指南》，旨在推荐标准化的LRYGB手术操作，为肥胖与代谢病外科领域的临床医生提供规范化手术操作的参考。     

丰富中国2型糖尿病防治措施的临床证据链,建立基于中国人群证据的糖尿病防治指南——纪念第1版《中国2型糖尿病防治指南》发布10周年

正2013版《中国2型糖尿病防治指南(征求意见版)》(下称"指南")已公布。新版指南公布距离我国第1版《2型糖尿病防治指南》发布整整10年。2003年,中华医学会糖尿病学分会在中国糖尿病杂志名誉主编,时任中华医学会糖尿病学分会主任委员钱荣立教授的领导下制定了第1版《中国2型糖尿病防治指南》。该指南的出台结束了像中国这样的"糖尿病大国"依靠国际上的指南来指导中国     

《中国2型糖尿病防治指南（2020年版）》读后感

《中国2型糖尿病防治指南（2020年版）》对2017年版进行了一些必要的和重要的修改及补充。40年来我国糖尿病流行病学调查的患病率和知晓率数据显示,糖尿病防治任务异常艰巨。对糖尿病患者采取个体化控制目标至关重要,随机对照试验研究证据推动了个体化降糖目标的选择,新技术和新方法的应用也有望提高血糖控制水平。     

稳妥推进糖尿病血糖控制进程的策略与方法

2008年是2型糖尿病（T2DM）心血管并发症防治寻证医学证据大餐年,可以说有喜有忧。喜的是在T2DM血糖控制对全因死亡和心血管死亡风险防治方面,终于看到了与早期的针对T2DM进行的DCCT／EDIC研究相似的结果。从UKPDS结束后10年流行病学调查研究（UKPDS-88）看到了早期实现良好血糖控制对全因死亡和大血管病变防治方面的作用、     

中国2型糖尿病防治指南（2020年版）

随着国内外2型糖尿病的研究取得了重大进展,获得了更多关于糖尿病及其慢性并发症预防、诊断、监测及治疗的循证医学新证据。中华医学会糖尿病学分会特组织专家对原有指南进行修订,形成了《中国2型糖尿病防治指南（2020年版）》,旨在及时传递重要进展,指导临床。本指南共19章,内容涵盖中国糖尿病流行病学、糖尿病的诊断与分型、2型糖...     

《糖尿病运动治疗指南》糖尿病防治新添两指南

2012年8月11日,在重庆国际会议展览中心,中华医学会糖尿病分会召开了《2010版中国2型糖尿病防治指南（科普版）》征求意见版与《糖尿病运动治疗指南》征求意见版的新书发布会。中华医学会糖尿病学分会主任委员纪立农、中华医学会糖尿病学分会副主任委员陆菊明、中华医学会糖尿病学会常委（兼秘书长）、糖尿病教育与管理学组组长郭晓蕙、中华医学会糖尿病学会委员、糖尿病教育与管理学组副组长孙子林教授和中华医学电子音像出版社史红社长出席了会议并对指南的内容进行了相关介绍。     

重视预防,规范管理——2007年版《中国2型糖尿病防治指南》

我国的2型糖尿病患病率正呈现迅猛增长的态势,已成为威胁国民健康的主要疾病之一.中华医学会糖尿病学分会为了更好地应对2型糖尿病防治工作的巨大挑战,组织全国专家,以循证医学为基础,借鉴近年来多个国际新指南,结合中国的糖尿病实践,制定了2007年版<中国2型糖尿病防治指南>.新指南明确了我国糖尿病的诊断标准,突出预防为主的方针,强调糖尿病的管理及多种心血管危险因素的综合防治.同时制定了更为严格的血糖控制目标以及符合中国2型糖尿病发病特点的治疗方案.该指南将推广"重视预防、规范管理"的糖尿病防治理念,培养更多合格的糖尿病防治骨干,提高我国的糖尿病防治水平.     

预防为主,规范诊疗,安全达标的糖尿病防治理念——解析2007年版《中国2型糖尿病防治指南》

中国的2型糖尿病患病率和糖尿病患者人数正在快速增长.为了更好地适应我国糖尿病防治工作的需要,符合和适应当今糖尿病防治认识进展水平,中华医学会糖尿病学分会组织专家编写出版了2007年版<中国2型糖尿病防治指南>,该指南以循证医学为基础,借鉴国际指南的优点,并结合中国的糖尿病实践,突出预防为主的方针,强调糖尿病的诊疗管理及多种心血管危险因素的综合防治,制定了更为严格的血糖控制目标,强调早期达标、安全降糖的重要性,并绘制出符合中国2型糖尿病发病特点的治疗流程.新指南的推广应用将会进一步提高我国的糖尿病防治水平.     

Diabetes UK evidence‐based nutrition guidelines for the prevention and management of diabetes

A summary of the latest evidence‐based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for education and care delivery, prevention of Type 2 diabetes, glycaemic control for Type 1 and Type 2 diabetes, cardiovascular disease risk management, management of diabetes‐related complications, other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods and nutritive and non‐nutritive sweeteners are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted ‘GRADE’ methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at www.diabetes.org.uk/nutrition-guidelines .     

Emerging concepts in clinical practice guidelines

The German Society for Digestive and Metabolic Diseases (Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, DGVS) has already published an impressive number of clinical practice guidelines, with more topics currently being under development. The guideline method within the DGVS as well as between medical professional societies varies greatly. In particular, the levels of evidence as well as the grades of recommendations are often applied very differently. Most guidelines in Germany use the grades of the US Agency for Health Care Policy and Research (AHCPR), which were first published in 1992. Some newer guidelines, e.g., the ulcerative colitis guideline of the DGVS or the guidelines of the German Diabetes Association, try to circumvent problems of this method. They adopted variations of the very simple AHCPR grades. Sometimes these new grading methods have serious shortcomings too. They may not be reproducible, ignore important parts of the consensus process, can only be applied to therapeutic interventions, or they do not adequately distinguish between the strength of a recommendation and the quality of evidence. Meanwhile, an enormous number of different and partially contradictory methodologies for the grading of guideline recommendations are being used. In the GRADE working group several renowned clinical epidemiologists came together to develop a uniform grading systematic that avoids the problems of earlier guideline methods. With GRADE first the quality of evidence is assessed in a systematic manner. The quality of each study plays an important role in this process. Hence randomised trials of poor quality can end up with a lower overall quality rating than well performed observational trials. The strength of recommendation is based on the balance between the expected benefit and harm of the intervention in the respective population for which the recommendations of the guideline are made. The quality of evidence is only one factor contributing to the strength of recommendation. The GRADE method can be more cumbersome in its application compared to older methods. Nevertheless, more and more organisations are adopting GRADE for their guidelines and recommendations. Possibly the DGVS guidelines could benefit from this new system too.     

International Diabetes Federation guideline for management of postmeal glucose: a review of recommendations

Diabetes is a significant and growing concern, with over 246 million people around the world living with the disease and another 308 million with impaired glucose tolerance. Depending on the resources of different nations, intervention has generally focused on optimizing overall glycaemic control as assessed by glycated haemoglobin (HbA_1c) and fasting plasma glucose (FPG) values. Nevertheless, increasing evidence supports the importance of controlling all three members of the glucose triad, namely HbA_1c, FPG and postmeal glucose (PMG) in order to improve outcome in diabetes. As part of its global mission to promote diabetes care and prevention and to find a cure, the International Diabetes Federation (IDF) recently developed a guideline that reviews evidence to date on PMG and the development of diabetic complications. Based on an extensive database search of the literature, and guided by a Steering and Development Committee including experts from around the world, the IDF Guideline for Management of Postmeal Glucose offers recommendations for appropriate clinical management of PMG. These recommendations are intended to help clinicians and organizations in developing strategies for effective management of PMG in individuals with Type 1 and Type 2 diabetes. The following review highlights the recommendations of the guideline, the supporting evidence provided and the major conclusions drawn. The full guideline is available for download at http://www.idf.org .     

Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians

DESCRIPTION: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the comparative effectiveness and safety of type 2 diabetes medications. METHODS: This guideline is based on a systematic evidence review evaluating literature published on this topic from 1966 through April 2010 that was identified by using MEDLINE (updated through December 2010), EMBASE, and the Cochrane Central Register of Controlled Trials. Searches were limited to English-language publications. The clinical outcomes evaluated for this guideline included all-cause mortality, cardiovascular morbidity and mortality, cerebrovascular morbidity, neuropathy, nephropathy, and retinopathy. This guideline grades the evidence and recommendations by using the American College of Physicians clinical practice guidelines grading system. RECOMMENDATION 1: ACP recommends that clinicians add oral pharmacologic therapy in patients diagnosed with type 2 diabetes when lifestyle modifications, including diet, exercise, and weight loss, have failed to adequately improve hyperglycemia (Grade: strong recommendation; high-quality evidence). RECOMMENDATION 2: ACP recommends that clinicians prescribe monotherapy with metformin for initial pharmacologic therapy to treat most patients with type 2 diabetes (Grade: strong recommendation; high-quality evidence). RECOMMENDATION 3: ACP recommends that clinicians add a second agent to metformin to treat patients with persistent hyperglycemia when lifestyle modifications and monotherapy with metformin fail to control hyperglycemia (Grade: strong recommendation; high-quality evidence).     

The benefit of aspirin therapy in type 2 diabetes: what is the evidence?

Many clinical guidelines recommend aspirin therapy for the prevention of cardiovascular events in individuals with type 2 diabetes. However it is unclear whether the level of evidence in guidelines is derived from studies carried out among individuals with diabetes. Medline and Embase databases were searched to retrieve studies published since 1990, evaluating the effect of aspirin on cardiovascular outcomes in subjects with type 2 diabetes. Four studies corresponded to the inclusion criteria. The three clinical trials retrieved could not prove from a statistical point of view, the benefits of aspirin therapy for subjects with type 2 diabetes. Reduction in cardiac mortality was found only in one observational study. Consequently, these findings suggest that the clinical guidelines have based their recommendations upon the expected benefit previously observed in other high-risk populations. Given the lack of hard evidence and the different well-known platelet physiology encountered in patients with diabetes, use of aspirin as a standard treatment at the highest level of evidence in guidelines for subjects with type 2 diabetes should be revisited.     

Standards of medical care for type 2 diabetes in China 2019

The prevalence of diabetes in China has increased rapidly from 0.67% in 1980 to 10.4% in 2013, with the aging of the population and westernization of lifestyle. Since its foundation in 1991, the Chinese Diabetes Society (CDS) has been dedicated to improving academic exchange and the academic level of diabetes research in China. From 2003 to 2014, four versions of Chinese diabetes care guidelines have been published. The guidelines have played an important role in standardizing clinical practice and improving the status quo of diabetes prevention and control in China. Since September 2016, the CDS has invited experts in cardiovascular diseases, psychiatric diseases, nutrition, and traditional Chinese medicine to work with endocrinologists from the CDS to review the new clinical research evidence related to diabetes over the previous 4 years. Over a year of careful revision, this has resulted in the present, new version of guidelines for prevention and care of type 2 diabetes in China. The main contents include epidemiology of type 2 diabetes in China; diagnosis and classification of diabetes; primary, secondary, and tertiary diabetes prevention; diabetes education and management support; blood glucose monitoring; integrated control targets for type 2 diabetes and treatments for hyperglycaemia; medical nutrition therapy; exercise therapy for type 2 diabetes; smoking cessation; pharmacologic therapy for hyperglycaemia; metabolic surgery for type 2 diabetes; prevention and treatment of cardiovascular and cerebrovascular diseases in patients with type 2 diabetes; hypoglycaemia; chronic diabetic complications; special types of diabetes; metabolic syndrome; and diabetes and traditional Chinese medicine.