中国成人2型糖尿病患者糖化血红蛋白控制目标及达标策略专家共识

糖化血红蛋白(HbA1C)控制目标应遵循患者为中心的个体化原则,即根据患者的年龄、病程、健康状况、药物不良反应风险等因素实施分层管理。本共识建议一般成人2型糖尿病(T2DM)患者的HbA1C控制目标为<7.0%,并对其他情况下的HbA1C目标值作出推荐。本共识建议将二甲双胍作为T2DM患者单药治疗的首选,α-糖苷酶抑制剂(AGI)或胰岛素促泌剂作为单药治疗的备选。进行联合治疗时,建议根据患者是否合并动脉粥样硬化性心血管疾病(ASCVD)、心力衰竭(HF)或慢性肾脏疾病(CKD)进行分层。如患者合并ASCVD,建议在具备条件的情况下联合有心血管获益证据的胰升糖素样肽-1受体激动剂(GLP-1RA)或钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)。如患者合并CKD,建议联合用药时在条件允许的情况下首选有肾脏获益证据的SGLT2i,在患者不能使用SGLT2i时可选择有肾脏获益证据的GLP-1RA。如患者合并HF,建议在条件允许时选择SGLT2i。如患者未合并ASCVD、HF或CKD时,可根据基线HbA1C水平、低血糖风险、体重、经济状况、药物可及性等因素选择联合的药物。

Expert consensus on glycated hemoglobin A1c targets and management algorithm for Chinese adults with type 2 diabetes

The hemoglobin A1c(HbA1C)targets of diabetics should be individualized based on the patient-centered approach,according to numerous factors,such as age,duration of diabetes,comorbid conditions,patient motivation,risk of adverse effects.This consensus recommends a general HbA1C target of<7.0%for most adults with type 2 diabetes mellitus(T2DM).More stringent HbA1C goals are considered if these can be achieved in a safe and affordable manner without significant adverse effects of treatment.Less stringent HbA1C goals may be appropriate for certain individuals.This consensus recommends metformin as the preferred drug for monotherapy in patients with T2DM,andα-glucosidase inhibitors or insulin secretagogues as options for monotherapy.For combination therapy,it is recommended to stratify patients based on the presence of concomitant atherosclerotic cardiovascular disease(ASCVD),heart failure(HF),or chronic kidney disease(CKD).For patients with concomitant ASCVD,combination therapy with glucagon-like peptide 1 receptor agonist(GLP-1RA)or sodium-glucose co-transporter 2 inhibitor(SGLT2i)with evidence of cardiovascular benefit is recommended if available.For patients with concomitant CKD,SGLT2i with evidence of renal benefit is recommended as the preferred drug for use in combination therapy.GLP-1RA with evidence of renal benefit could be used in patients who cannot receive SGLT2i.For patients with concomitant HF,SGLT2i is recommended if conditions allow.For patients without concomitant ASCVD,HF,or CKD,the drugs for combination therapy should be selected based on factors such as baseline HbA1C levels,risk of hypoglycemia,body weight,financial situation,and drug availability.