【医脉通】2022 ADA 糖尿病医学诊疗标准.pdf

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1、ISSN 0149-5992A M E R I C A N D I A B E TE S A S S O C I ATI O NSTANDARDS OFMEDICAL CAREIN DIABETES2022SUPPLEMENTSPPLEMME EN NT T T1VOLUME 45 | SUPPLEMENT 1 | PAGES S1S264THE JOURNAL OF CLINICAL AND APPLIED RESEARCH AND EDUCATIONVOLUME 45 | SUPPLEMENT 1WWW.DIABETES.ORG/DIABETESCAREJANUARY 2022JANUAR

2、Y 2022January 2022 Volume 45, Supplement 1 The simple word Care may suffice to express the journals philosophical mission. The new journal is designed to promote better patient care by serving the expanded needs of all health professionals committed to the care of patients with diabetes. As such, th

3、e American Diabetes Association views Diabetes Care as a reaffirmation of Francis Weld Peabodys contention that “the secret of the care of the patient is in caring for the patient.” Norbert Freinkel, Diabetes Care, January-February 1978 EDITOR IN CHIEF Matthew C. Riddle, MD ASSOCIATE EDITORS Vanita

4、R. Aroda, MD George Bakris, MD Lawrence Blonde, MD, FACP Andrew J.M. Boulton, MD Jessica R. Castle, MD Linda A. DiMeglio, MA, MD, MPH Linda Gonder-Frederick, PhD Frank B. Hu, MD, MPH, PhD Steven E. Kahn, MB, ChB Sanjay Kaul, MD, FACC, FAHA Robert G. Moses, MD Stephen S. Rich, PhD Julio Rosenstock, M

5、D Elizabeth Selvin, PhD, MPH Adrian Vella, MD Judith Wylie-Rosett, EdD, RD AMERICAN DIABETES ASSOCIATION OFFICERS CHAIR OF THE BOARD John Schlosser PRESIDENT, MEDICINE & SCIENCE Ruth Weinstock, MD, PhD PRESIDENT, HEALTH CARE & EDUCATION Cynthia Mu noz, PhD, MPH SECRETARY/TREASURER Christopher Ralsto

6、n, JD CHAIR OF THE BOARD-ELECT Glen Tullman PRESIDENT-ELECT, MEDICINE & SCIENCE Guillermo Umpierrez, MD, CDE, FACP, FACE PRESIDENT-ELECT, HEALTH CARE & EDUCATION Otis Kirksey, PharmD, RPh, CDE, BC-ADM SECRETARY/TREASURER-ELECT Marshall Case CHIEF SCIENTIFIC & MEDICAL OFFICER Robert A. Gabbay, MD, Ph

7、D EDITORIAL BOARD Fida Bacha, MD Katharine Barnard-Kelly, PhD Ananda Basu, MD, FRCP Tadej Battelino, MD, PhD Petter Bjornstad, MD Fiona Bragg, BSc, MBChB, MRCP, MSc, DPhil, FFPH John B. Buse, MD, PhD Mark Emmanuel Cooper, MB BS, PhD Matthew J. Crowley, MD, MHS J. Hans DeVries, MD, PhD Kimberly A. Dr

8、iscoll, PhD Kathleen M. Dungan, MD, MPH Hertzel C. Gerstein, MD, MSc, FRCOC Jessica Lee Harding, PhD Stewart B. Harris, CM, MD, MPH, FCFP, FACPM Byron J. Hoogwerf, MD, FACP, FACE Sarah S. Jaser, PhD M. Sue Kirkman, MD Richard David Graham Leslie, MD, FRCP, FAoP John J.V. McMurray, MD, FRCP, FESC, FA

9、CC, FAHA, FRSE, FMedSci Mark E. Molitch, MD Helen R. Murphy, MBBChBAO, FRACP, MD Katherine Ogurtsova, PhD Bruce A. Perkins, MD, MPH Casey M. Rebholz, PhD, MS, MNSP, MPH Maria Jose Redondo, MD, PhD, MPH Peter Rossing, MD, DMSc Desmond Schatz, MD Guntram Schernthaner, MD Jonathan Shaw, MD, FRCP, FRACP

10、, FAAHMS Jay M. Sosenko, MD, MS Samy Suissa, PhD Giovanni Targher, MD Kristina M. Utzschneider, MD Daniel H. van Raalte, MD, PhD Joseph I. Wolsdorf, MB, BCh Daisuke Yabe, MD, PhD Sophia Zoungas, MBBS (Hons), PhD, FRACP The mission of the American Diabetes Association is to prevent and cure diabetes

11、and to improve the lives of all people affected by diabetes. AMERICAN DIABETES ASSOCIATION PERSONNEL AND CONTACTS ASSOCIATE PUBLISHER, SCHOLARLY JOURNALS Christian S. Kohler EDITORIAL OFFICE DIRECTOR Lyn Reynolds PEER REVIEW MANAGER Shannon Potts ASSOCIATE MANAGER, PEER REVIEW Larissa M. Pouch DIREC

12、TOR, SCHOLARLY JOURNALS Heather Norton Blackburn ASSOCIATE DIRECTOR, SCHOLARLY JOURNALS Keang Hok TECHNICAL EDITOR Theresa M. Cooper PRODUCTION COORDINATOR Saleha Malik DIRECTOR, MEMBERSHIP/SUBSCRIPTION SERVICES Donald Crowl SENIOR ADVERTISING MANAGER Julie DeVoss Graff jgraffdiabetes.org (703) 299-

13、5511 SENIOR MANAGER, BILLING & COLLECTIONS Josh Flores jfloresdiabetes.org (703) 549-1500, ext. 2110 PHARMACEUTICAL & DEVICE PRINT ADVERTISING Lisa Morton Senior Account Manager lmortondiabetes.org (312) 346-1805, ext. 6571 PHARMACEUTICAL & DEVICE DIGITAL ADVERTISING eHealthcare Solutions R.J. Lewis

14、 President and CEO (609) 882-8887, ext. 101 Diabetes Care is a journal for the health care practitioner that is intended to increase knowledge, stimulate research, and promote better management of people with diabetes. To achieve these goals, the journal publishes original research on human studies

15、in the following categories: Clinical Care/Education/Nutrition/ Psychosocial Research, Epidemiology/Health Services Research, Emerging Technologies and Therapeutics, Pathophysiology/Complications, and Cardiovascular and Metabolic Risk. The journal also publishes ADA statements, consensus reports, cl

16、inically relevant review articles, letters to the editor, and health/medical news or points of view. Topics covered are of interest to clinically oriented physicians, researchers, epidemiologists, psychologists, diabetes educators, and other health professionals. More information about the journal c

17、an be found online at care.diabetesjournals.org. Copyright 2021 by the American Diabetes Association, Inc. All rights reserved. Printed in the USA. Requests for permission to reuse content should be sent to Copyright Clearance Center at or 222 Rosewood Dr., Danvers, MA 01923; phone: (978) 750-8400;

18、fax: (978) 646-8600. Requests for permission to translate should be sent to Permissions Editor, American Diabetes Association, at permissionsdiabetes.org. The American Diabetes Association reserves the right to reject any advertisement for any reason, which need not be disclosed to the party submitt

19、ing the advertisement. Commercial reprint orders should be directed to Sheridan Content Services, (800) 635-7181, ext. 8065. Single issues of Diabetes Care can be ordered by calling toll-free (800) 232-3472, 8:30 A.M. to 5:00 P.M. EST, Monday through Friday. Outside the United States, call (703) 549

20、-1500. Rates: $75 in the United States, $95 in Canada and Mexico, and $125 for all other countries. Diabetes Care is available online at care.diabetesjournals.org. Please call the numbers listed above, e-mail membershipdiabetes.org, or visit the online journal for more information about submitting m

21、anuscripts, publication charges, ordering reprints, subscribing to the journal, becoming an ADA member, advertising, permission to reuse content, and the journals publication policies. Periodicals postage paid at Arlington, VA, and additional mailing offices. PRINT ISSN 0149-5992 ONLINE ISSN 1935-55

22、48 PRINTED IN THE USA January 2022 Volume 45, Supplement 1 S1 Introduction S3 Professional Practice Committee S4 Summary of Revisions S8 1. Improving Care and Promoting Health in Populations Diabetes and Population Health Tailoring Treatment for Social Context S17 2. Classification and Diagnosis of

23、Diabetes Classification Diagnostic Tests for Diabetes Type 1 Diabetes Prediabetes and Type 2 Diabetes Cystic FibrosisRelated Diabetes Posttransplantation Diabetes Mellitus Monogenic Diabetes Syndromes Pancreatic Diabetes or Diabetes in the Context of Disease of the Exocrine Pancreas Gestational Diab

24、etes Mellitus S39 3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities Lifestyle Behavior Change for Diabetes Prevention Pharmacologic Interventions Prevention of Vascular Disease and Mortality Patient-Centered Care Goals S46 4. Comprehensive Medical Evaluation and Assessment of Co

25、morbidities Patient-Centered Collaborative Care Comprehensive Medical Evaluation Immunizations Assessment of Comorbidities S60 5. Facilitating Behavior Change and Well-being to Improve Health Outcomes Diabetes Self-management Education and Support Medical Nutrition Therapy Physical Activity Smoking

26、Cessation: Tobacco and e-Cigarettes Psychosocial Issues S83 6. Glycemic Targets Assessment of Glycemic Control Glycemic Goals Hypoglycemia Intercurrent Illness S97 7. Diabetes Technology General Device Principles Blood Glucose Monitoring Continuous Glucose Monitoring Devices Insulin Delivery S113 8.

27、 Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes Assessment Diet, Physical Activity, and Behavioral Therapy Pharmacotherapy Medical Devices for Weight Loss Metabolic Surgery S125 9. Pharmacologic Approaches to Glycemic Treatment Pharmacologic Therapy for Adults With

28、 Type 1 Diabetes Surgical Treatment for Type 1 Diabetes Pharmacologic Therapy for Adults With Type 2 Diabetes S144 10. Cardiovascular Disease and Risk Management The Risk Calculator Hypertension/Blood Pressure Control Lipid Management Statin Treatment Antiplatelet Agents Cardiovascular Disease S175

29、11. Chronic Kidney Disease and Risk Management Chronic Kidney Disease Epidemiology of Diabetes and Chronic Kidney Disease Assessment of Albuminuria and Estimated Glomerular Filtration Rate Diagnosis of Diabetic Kidney Disease Staging of Chronic Kidney Disease Acute Kidney Injury Surveillance Interve

30、ntions S185 12. Retinopathy, Neuropathy, and Foot Care Diabetic Retinopathy Neuropathy Foot Care S195 13. Older Adults Neurocognitive Function Hypoglycemia Treatment Goals Lifestyle Management Pharmacologic Therapy Special Considerations for Older Adults With Type 1 Diabetes Treatment in Skilled Nur

31、sing Facilities and Nursing Homes End-of-Life Care S208 14. Children and Adolescents Type 1 Diabetes Type 2 Diabetes Transition From Pediatric to Adult Care S232 15. Management of Diabetes in Pregnancy Diabetes in Pregnancy Preconception Counseling Glycemic Targets in Pregnancy Management of Gestati

32、onal Diabetes Mellitus Management of Preexisting Type 1 Diabetes and Type 2 Diabetes in Pregnancy Preeclampsia and Aspirin Pregnancy and Drug Considerations Postpartum Care S244 16. Diabetes Care in the Hospital Hospital Care Delivery Standards Glycemic Targets in Hospitalized Patients Bedside Blood

33、 Glucose Monitoring Glucose-Lowering Treatment in Hospitalized Patients Hypoglycemia Standards of Medical Care in Diabetes2022 Medical Nutrition Therapy in the Hospital Self-management in the Hospital Standards for Special Situations Transition From the Hospital to the Ambulatory Setting Preventing

34、Admissions and Readmissions S254 17. Diabetes Advocacy Advocacy Statements S256 Disclosures S259 Index This issue is freely accessible online at https:/diabetesjournals.org/care/issue/45/Supplement_1. Keep up with the latest information for Diabetes Care and other ADA titles via Facebook (/ADAPublic

35、ations) and Twitter (ADA_Pubs). Introduction:Standards ofMedical Care in Diabetes2022Diabetes Care 2022;45(Suppl. 1):S1S2 | https:/doi.org/10.2337/dc22-SINTAmerican Diabetes AssociationDiabetes is a complex, chronic illnessrequiring continuous medical care withmultifactorial risk-reduction strategie

36、sbeyond glycemic control. Ongoing dia-betes self-management education andsupport are critical to preventing acutecomplications and reducing the riskof long-term complications. Significantevidence exists that supports a rangeof interventions to improve diabetesoutcomes.The American Diabetes Associati

37、on(ADA) “Standards of Medical Care in Dia-betes,” referred to as the Standards ofCare, is intended to provide clinicians,researchers, policy makers, and otherinterested individuals with the compo-nents of diabetes care, general treat-ment goals, and tools to evaluate thequality of care. The Standard

38、s of Carerecommendations are not intended topreclude clinical judgment and must beapplied in the context of excellent clini-cal care, with adjustments for individualpreferences, comorbidities, and otherpatient factors. For more detailed infor-mation about the management of diabe-tes, please refer to

39、 Medical Managementof Type 1 Diabetes (1) and Medical Man-agement of Type 2 Diabetes (2).The recommendations in the Stand-ards of Care include screening, diagnos-tic, and therapeutic actions that areknown or believed to favorably affecthealth outcomes of patients with diabe-tes. Many of these interv

40、entions havealso been shown to be cost-effective(3,4). As indicated, the recommenda-tions encompass care for youth (childrenages birth to 11 years and adolescentsages 1218 years) and older adults (65years and older).The ADA strives to improve andupdate the Standards of Care to ensurethat clinicians,

41、 health plans, and policymakers can continue to rely on it as themost authoritative source for currentguidelines for diabetes care.ADA STANDARDS, STATEMENTS,REPORTS, AND REVIEWSThe ADA has been actively involved inthe development and dissemination ofdiabetes care clinical practice recommen-dations a

42、nd related documents for morethan 30 years. The ADAs Standards ofMedical Care is viewed as an importantresource for health care professionalswho care for people with diabetes.Standards of CareThe annual Standards of Caresupplement to Diabetes Care containsofficial ADA position, is authored bythe ADA

43、, and provides all of theADAs current clinical practicerecommendations.To update the Standards of Care, theADAs Professional Practice Committee(PPC) performs an extensive clinical diabe-tes literature search, supplemented withinput from ADA staff and the medicalcommunity at large. The PPC updates th

44、eStandards of Care annually and strives toinclude discussion of emerging clinicalconsiderations in the text, and as evi-dence evolves, clinical guidance may beincluded in the recommendations. How-ever, the Standards of Care is a “living”document,whereimportantupdatesare published online should the P

45、PCdetermine that new evidence or regula-tory changes (e.g., drug approvals, labelchanges)meritimmediateinclusion.More information on the “living Stand-ards” can be found on the ADAs profes-sional website DiabetesPro at professional.diabetes.org/content-page/living-standards.The Standards of Care sup

46、ersedes all previ-ous ADA position statementsand the rec-ommendations thereinon clinical topicswithin the purview of the Standards ofCare; ADA position statements, while stillcontaining valuable analysis, should not beconsidered the ADAs current position. TheStandards of Care receives annual reviewa

47、nd approval by the ADAs Board of Direc-tors and is reviewed by ADAs clinical staffleadership.ADA StatementAn ADA statement is an officialADA point of view or belief thatdoes not contain clinical practicerecommendations and may be issuedon advocacy, policy, economic, ormedical issues related to diabe

48、tes.ADAstatementsundergoaformalreview process, including a review bythe appropriate ADA national commit-tee, ADA science and health care staff,and the ADAs Board of Directors.Consensus ReportA consensus report of a particulartopic contains a comprehensiveexamination and is authored by anexpert panel

49、 (i.e., consensus panel)and represents the panels collectiveanalysis, evaluation, and opinion.The need for a consensus report ariseswhen clinicians, scientists, regulators,The “Standards of Medical Care in Diabetes” was originally approved in 1988. Most recent review/revision: December 2021. 2021 by

50、 the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and notfor profit, and the work is not altered. More information is available at https:/diabetesjournals.org/journals/pages/license.INTRODUCTIONDiabetes Care Volume 45, Supp