【原】指南共识 l 2022ADA糖尿病诊疗标准-内容修订摘要**

CK医学Pro 2022-04-05

展开全文

2022版ADA糖尿病诊治标准于2021年年末发布，总体延续了2019-2021版本以来的架构，而主要的结构变更是慢性肾脏疾病从以往微血管疾病的章节独立出来，在内容上较2021版有较多更新，也体现出糖尿病领域的飞速进展。CK经典文献翻译组依然会在2019-2021版标准的中文译文基础上，将启动2022版ADA糖尿病医学诊治标准的翻译。

CK注：以往ADA标准全文译文：

指南共识 l 2022

ADA糖尿病诊疗标准

修订内容摘要

编译：陈康

General Changes

一般变更

The field of diabetes care is rapidlychanging as new research, technology, and treatments that can improve thehealth and well-being of people with diabetes continue to emerge. With annualupdates since 1989, the American Diabetes Association (ADA) has long been aleader in producing guidelines that capture the most current state of thefield.

随着能够改善糖尿病患者健康和福祉的新研究、技术和治疗不断涌现，糖尿病护理领域正在迅速变化。自1989年以来，美国糖尿病协会(ADA)每年都进行更新，长期以来一直作为制定反映该领域最新状况的指南的领导者。

Althoughlevels of evidence for several recommendations have been updated, these changesare not outlined below where the clinical recommendation has remained the same.That is, changes in evidence level from, for example,EtoCare notnoted below. The 2022 Standards of Care contains, in addition to many minorchanges that clarify recommendations or reflect new evidence, the followingmore substantive revisions.

尽管已更新了几项推荐的证据水平，但在临床推荐保持不变的情况下，正文未列出这些变化。也就是说，以下未提及的来自例如EtoCare的证据水平变化。《2022年诊治标准》除了包含许多澄清推荐或反映新证据的小改动外，还包含以下更具实质性的修订。

Section Changes

各部分变更

Section1. Improving Care and Promoting Health in Populations

第一部分改善护理促进人群健康

(https:///10.2337/dc22-S001)

Additional information has been includedon online platforms to support behavior change and well-being. The renamed“Cost Considerations for Medication-Taking Behaviors” subsection has been expandedto include more discussion about costs of medications and treatment goals.

在线平台还提供其他信息，以支持行为改变和福祉。更名后的“服药行为的费用考虑”小节已经扩展，纳入了更多关于药物费用和治疗目标的讨论。

The concept of health numeracy and itsrole in diabetes prevention and management was added to the newly named “HealthLiteracy and Numeracy” subsection.

健康算术的概念及其在糖尿病预防和管理中的作用已添加到新命名的“健康读写算”小节中。

The community health workers content wasexpanded.

社区卫生工作者的内容得到拓展。

Section2. Classification and Diagnosis of Diabetes

第二部分糖尿病的分类与诊断

(https:///10.2337/dc22-S002)

A recommendation about adequatecarbohydrate intake prior to oral glucose tolerance testing as a screen fordiabetes was added, with supportive references added to the text (Recommendations2.4 and 2.12).

增加关于口服葡萄糖耐量试验前适当摄入碳水化合物作为糖尿病筛查的推荐，并在文本中增加了支持性参考文献(推荐2.4和2.12)。

The discussion regarding use ofpoint-of-care A1C assays for the diagnosis of diabetes has been revised.

关于使用护理点/快速A1C检测诊断糖尿病的讨论已经过修订。

More information has been added to the“Race/Ethnicity/Hemoglobinopathies” subsection.

更多信息已添加至“种族/民族/血红蛋白病”小节。

The “Type 1 Diabetes” subsection and therecommendations within have been updated based on the publication of “TheManagement of Type 1 Diabetes in Adults. A Consensus Report by the AmericanDiabetes Association (ADA) and the European Association for the Study ofDiabetes (EASD)” (https:///10.2337/dci21-0043).

“1型糖尿病”小节和其中的推荐已根据文献《成人1型糖尿病的管理-美国糖尿病协会(ADA)和欧洲糖尿病研究协会(EASD)的共识报告》进行更新。

Under “Classification,” immunecheckpoint inhibitors have been added as a cause of medication-induceddiabetes. Additional evidence and discussion have been added to the subsection“Screening for Type 1 Diabetes Risk.”

在“分类”下，添加免疫检查点抑制剂作为药物诱发糖尿病的病因（CK注，2020中国糖尿病指南归类于特殊类型的药物诱导类，在此次ADA标准主要在1型糖尿病中讨论）。在“1型糖尿病风险筛查”小节中增加了其他证据和讨论。

Recommendation 2.9 has been revised torecommend that, for all people, screening for prediabetes and diabetes shouldbegin at age 35 years.

推荐2.9已经过修订，推荐对所有人而言，糖尿病前期和糖尿病的筛查应从35岁开始。

Recommendation 2.24 regarding genetictesting for those who do not have typical characteristics of type 1 or type 2diabetes has been revised based on the publication of “The Management of Type 1Diabetes in Adults. A Consensus Report by the American Diabetes Association(ADA) and the European Association for the Study of Diabetes (EASD)” (https:///10.2337/dci21-0043).

关于对不具有1型或2型糖尿病典型特征的患者进行基因检测的推荐2.24已根据文献《成人1型糖尿病的管理-美国糖尿病协会(ADA)和欧洲糖尿病研究协会(EASD)的共识报告》进行了修订。

The gestational diabetes mellitusrecommendations have been revised with changes made regarding preconception andearly pregnancy screening for diabetes and abnormal glucose metabolism, withsupporting evidence added to the text.

已对妊娠糖尿病推荐进行了修订，对孕前和早孕筛查糖尿病和糖代谢异常进行了更改，并在文本中添加支持证据。

Section3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities

第三部分预防或延缓2型糖尿病及相关合并症

(https:///10.2337/dc22-S003)

The title has been changed to“Prevention or Delay of Type 2 Diabetes and Associated Comorbidities.”

标题已更改为“预防或延缓2型糖尿病及相关合并症”。

Recommendation 3.1 has been modified tobetter individualize monitoring for the development of type 2 diabetes in thosewith prediabetes.

对推荐3.1进行修改，以更好地对糖尿病前期患者的2型糖尿病发生情况进行个体化监测。

Adults with overweight/obesity arerecommended to be referred to an intensive lifestyle behavior change program(Recommendation 3.2).

推荐将超重/肥胖成人转诊至强化生活方式行为改变项目(推荐3.2)。

Additional considerations have beenadded to the recommendation regarding metformin therapy (Recommendation 3.6).

关于二甲双胍治疗的推荐(推荐3.6)中增加了其他考虑事项。

More discussion was added on vitamin Dsupplementation in the “Pharmacologic Interventions” subsection.

在“药物干预”小节中增加了关于维生素D补充的更多讨论。

There is a new subsection andrecommendation on patient-centered care aimed at weight loss or prevention ofweight gain, minimizing progression of hyperglycemia, and attention tocardiovascular risk and associated comorbidities.

有一个关于以患者为中心的护理的新小节和推荐，旨在减轻体重或预防体重增加，将高血糖症的进展降至最低，并关注心血管风险和相关合并症。

Section4. Comprehensive Medical Evaluation and Assessment of Comorbidities

第四部分综合医学评估和合并症评估

(https:///10.2337/dc22-S004)

The “Immunizations” subsection has been revised, and moreinformation and evidence on the influenza vaccine for people with diabetes andcardiovascular disease has been added to the “Influenza” subsection. Withinthis subsection, coronavirus disease 2019 (COVID-19) vaccination informationhas been added based on evolving evidence.

对“免疫接种”小节进行了修订，并在“流感”小节中添加了更多关于糖尿病和心血管疾病患者流感疫苗的信息和证据。在本小节中，基于不断发生的证据，添加了冠状病毒疾病2019(新冠肺炎)疫苗接种信息。

Table 4.6,management of patients with nonalcoholic fatty liver disease (NAFLD) andnonalcoholic steatohepatitis (NASH), and Table 4.7,summary of published NAFLD guidelines, reproduced from “Preparing for the NASHEpidemic: A Call to Action” (https:///10.2337/dci21-0020), provide more information on how to manage these diseases.Developed following an American Gastroenterological Association conference onthe burden, screening, risk stratification, diagnosis, and management ofindividuals with NAFLD, the Call to Action informed other revisions to the“Nonalcoholic Fatty Liver Disease” subsection.

表4.6，非酒精性脂肪性肝病(NAFLD)和非酒精性脂肪性肝炎(NASH)患者的管理，表4.7，已发布的NAFLD指南摘要，摘自“为NASH流行病做好准备:行动呼吁”(https:///10.2337/dci21-0020；提供更多关于如何管理这些疾病的信息。在美国胃肠病学协会关于NAFLD患者的负担、筛查、风险分层、诊断和管理的会议之后制定了《行动呼吁》，据此，对“非酒精性脂肪肝”小节进行了其他修订

Section5. Facilitating Behavior Change and Well-being to Improve Health Outcomes

第五部分促进行为改变和福祉以改善健康结局

(https:///10.2337/dc22-S005)

Recommendation 5.5 has been added to the“Diabetes Self-Management Education and Support” subsection to address digitalcoaching and digital self-management interviews as effective methods ofeducation and support.

在“糖尿病自我管理教育和支持”小节中增加了推荐5.5，以将数字辅导和数字自我管理访谈作为有效的教育和支持方法。

In the “Carbohydrates” subsection, moreemphasis has been placed on the quality of carbohydrates selected. InRecommendation 5.15, a fiber goal has been added for additional clarity.Evidence on consumption of mixed meals, insulin dosing, and impact on glycemiahas also been added to this subsection.

在“碳水化合物”小节中，更加强调了所选碳水化合物的质量。在推荐5.15中，增加了一个（有关）纤维目标以进一步澄清。本小节中还增加关于混合餐消耗量、胰岛素剂量以及对血糖影响的证据。

A new subsection on cognitivecapacity/impairment has been added, with recommendations for monitoring(Recommendation 5.51) and referral (Recommendation 5.52) for formal assessment,and a discussion of the evidence regarding cognitive impairment and diabetes.

增加关于认知能力/障碍的新章节，包括正式评估的监测推荐(推荐5.51)和转诊推荐(推荐5.52)，以及关于认知障碍和糖尿病证据的讨论。

Section6. Glycemic Targets

第6部分血糖目标

(https:///10.2337/dc22-S006)

Time in range has been more fullyincorporated into the “Glycemic Assessment” subsection.

范围内时间（TIR）已更全面地纳入“血糖评估”小节。

Time in range thresholds were removedfrom Recommendation 6.4, and the reader is directed to Table 6.2 forthose values.

从推荐6.4中删除了范围内时间阈值，这些值请读者参考表6.2。

Glucose variability and the associationof hypoglycemia was added to the “Hypoglycemia” subsection, as well asinformation on hypoglycemia prevention, including the Blood Glucose AwarenessTraining, Dose Adjusted for Normal Eating (DAFNE), and DAFNEplus programs.

“低血糖”小节中增加葡萄糖变异性和低血糖相关性，以及低血糖预防信息，包括血糖意识培训、针对正常饮食调整的剂量(DAFNE)和DAFNEplus计划。

Section7. Diabetes Technology

第7部分糖尿病技术

https:///10.2337/dc22-S007

General recommendations on the selectionof technology based on individual and caregiver preferences (Recommendation7.1), ongoing education on use of devices (Recommendation 7.2), continuedaccess to devices across payers (Recommendation 7.3), support of students usingdevices in school settings (Recommendation 7.4), and early initiation oftechnology (Recommendation 7.5) now introduce the technology section, whenpreviously these concepts were distributed throughout the section.

关于根据个人和照护人的喜好选择技术的一般性推荐(推荐7.1)、关于设备使用的持续教育(推荐7.2)、支付与继续使用设备(推荐7.3)、支持学生在学校环境中使用设备(推荐7.4)以及技术的早期启动(推荐7.5)现在引入到技术部分，而以前这些概念在整个部分中都有介绍。

“Self-monitoring of blood glucose(SMBG)” was replaced with the more commonly used “blood glucose monitoring(BGM)” throughout, and more information based on the U.S. Food and DrugAdministration recommendation regarding when an individual might need access toBGM was added to the “Blood Glucose Monitoring” subsection.

“血糖自我监测(SMBG)”在全文中被替换为更常用的“血糖监测(BGM)”，并且在“血糖监测”小节中添加了更多基于美国美国食品药品监督管理局关于个人可能需要何时访问BGM的推荐的信息。

The recommendations regarding use ofcontinuous glucose monitoring (CGM) were divided between adults(Recommendations 7.11 and 7.12) and youth (Recommendations 7.13 and 7.14), andthe recommendation regarding periodic use of CGM or the use of professional CGMhas been simplified (Recommendation 7.17). Frequency of sensor use has alsobeen added to the text of the “Continuous Glucose Monitoring Devices”subsection, as well as a restructuring of the text in this section based onstudy design.

关于使用连续血糖监测(CGM)的推荐分为成人(推荐7.11和7.12)和青年(推荐7.13和7.14)，关于定期使用CGM或使用专业CGM的推荐已被简化(推荐7.17)。“连续血糖监测设备”小节的文本中还增加了传感器使用频率，以及本节中基于研究设计的文本重构。

“Smart pens” are now referred to as“connected insulin pens,” and more discussion and evidence has been added tothe insulin pens content.

“智能笔”现在被称为“连接型胰岛素笔”，有关胰岛素笔内容的讨论和证据越来越多。

The discussion of automated insulindelivery (AID) systems has been combined with the insulin pumps subsection andis separate from the “Do-It-Yourself Closed-Loop Systems” subsection.

关于自动胰岛素输送(AID)系统的讨论已与胰岛素泵小节结合在一起，并与“自己动手闭环系统”小节分开。

Recommendation 7.29 has been modified toinclude outpatient procedures and the consideration that people should beallowed continued use of diabetes devices during inpatient or outpatientprocedures when they can safely use them and supervision is available.

对推荐7.29进行修改，以纳入门诊程序，并考虑到应允许人们在住院或门诊程序中继续使用糖尿病设备，只要他们能够安全使用这些设备并且有监管。

Section8. Obesity and Weight Management for the Prevention and Treatment of Type 2Diabetes

第8部分为预防和治疗2型糖尿病而进行的肥胖和体重管理

(https:///10.2337/dc22-S008)

The title has been changed to “Obesityand Weight Management for the Prevention and Treatment of Type 2 Diabetes.”

标题已更改为“为预防和治疗2型糖尿病而进行的肥胖和体重管理”。

Evidence has been added regarding theimportance of addressing obesity, as both obesity and diabetes increase riskfor more severe COVID-19 infections.

已有证据表明解决肥胖问题的重要性，因为肥胖和糖尿病都会增加更严重的新冠肺炎感染的风险。

The concept of weight distribution andweight gain pattern and trajectory, in addition to weight and BMI, has beenadded to the “Assessment” subsection.

“评估”小节中除体重和BMI外，还增加了体重分布和体重增加模式及轨迹的概念。

Recommendation 8.12 and its associatedtext discussion added to the “Diet, Physical Activity, and Behavioral Therapy”subsection address the lack of clear evidence that dietary supplements areeffective for weight loss.

添加到“饮食、体育活动和行为治疗”小节的推荐8.12及其相关文本讨论解决了缺乏明确证据表明膳食补充剂对减肥有效的问题。

The “Medical Devices for Weight Loss”subsection has been revised to include more information on a newly approvedoral hydrogel.

对“减肥医疗器械”小节进行了修订，增加了关于新批准的口服水凝胶的更多信息。

Recommendation 8.21 has been revised to include behavioralsupport and routine monitoring of metabolic status.

推荐8.21已经过修订，纳入了行为支持和代谢状态的常规监测。

A new recommendation (Recommendation8.22) and discussion on postbariatric hypoglycemia, its causes, diagnosis, andmanagement have been added.

增加了关于减重手术后低血糖症、其原因、诊断和管理的新推荐(推荐8.22)和讨论。

Table 8.2,medications approved by the FDA for the treatment of obesity, has been updatedto include semaglutide.

表8.2(FDA批准的治疗肥胖的药物)已更新，增加了司美格鲁肽。

Section9. Pharmacologic Approaches to Glycemic Treatment

第9部分血糖治疗的药物途径

(https:///10.2337/dc22-S009)

Recommendation 9.3 has been revised toinclude fat and protein content, in addition to carbohydrates, as part ofeducation on matching mealtime insulin dosing.

推荐9.3已经过修订，除碳水化合物外，还包括脂肪和蛋白质含量，作为匹配进餐时间胰岛素剂量教育的一部分。

Fig. 9.1,“Choices of insulin regimens in people with type 1 diabetes,” Fig. 9.2,“Simplified overview of indications for β-cell replacement therapy in peoplewith type 1 diabetes,” and Table 9.1, “Examples of subcutaneous insulinregimens,” from “The Management of Type 1 Diabetes in Adults. A ConsensusReport by the American Diabetes Association (ADA) and the European Associationfor the Study of Diabetes (EASD)” (https:///10.2337/dci21-0043), have been added to the “Pharmacologic Therapy for Adults withType 1 Diabetes” subsection.

图9.1，“1型糖尿病患者胰岛素治疗方案的选择”，图9.2，“1型糖尿病患者β细胞替代治疗适应症的简化概述”，以及表9.1，“皮下胰岛素治疗方案的示例”，内容来自“成人1型糖尿病的管理-美国糖尿病协会(ADA)和欧洲糖尿病研究协会(EASD)的共识报告”，已添加到“成人1型糖尿病药物治疗”小节。

Table 9.2 hasbeen updated.

表9.2已更新。

Recommendation 9.4 has been revised andis now two recommendations (Recommendations 9.4a and 9.4b) on first-linetherapies and initial therapies, all based on comorbidities, patient-centeredtreatment factors, and management needs.

推荐9.4已经过修订，目前是关于一线治疗和初始治疗的两项推荐(推荐9.4a和9.4b)，均基于合并症、以患者为中心的治疗因素和管理需求。

Recommendation 9.5 has been updated withother considerations for the continuation of metformin therapy after patientshave been initiated on insulin.

已对推荐9.5进行更新，纳入了患者开始使用胰岛素后继续二甲双胍治疗的其他考虑因素。

A new recommendation has been addedregarding the use of insulin and combination therapy with a glucagon-likepeptide 1 (GLP-1) receptor agonist for greater efficacy and durability(Recommendation 9.11).

增加关于使用胰岛素和胰高血糖素样肽1(GLP-1)受体激动剂联合治疗以提高疗效和持久性的新推荐(推荐9.11)。

The section now concludes with anoverview of changes made to Fig. 9.3, “Pharmacologic treatment of hyperglycemiain adults with type 2 diabetes,” to reconcile emerging evidence and supportharmonization of guidelines recognizing alternative initial treatmentapproaches to metformin as acceptable, depending on comorbidities,patient-centered treatment factors, and glycemic and comorbidity managementneeds. The principle of medication incorporation is emphasized throughout Fig. 9.3—notall treatment intensification results in sequential add-on therapy, and insteadmay involve switching therapy or weaning current therapy to accommodatetherapeutic changes.

本节最后概述对图9.3“2型糖尿病成人高血糖症的药物治疗”所做的更改，以协调新出现的证据，并支持统一指南，根据合并症、以患者为中心的治疗因素以及血糖和合并症管理需求，确认二甲双胍的替代初始治疗方法是可接受的。在整个图9.3中强调了药物并入的原则-并非所有治疗强化都会导致顺序附加治疗，而是可能涉及切换治疗或停用当前治疗以适应治疗变化。（CK注：终于……）

Section10. Cardiovascular Disease and Risk Management

第10部分心血管疾病与风险管理

（https:///10.2337/dc22-S010）

This section is endorsed for the fourthconsecutive year by the American College of Cardiology.

本部分已连续第四年获得美国心脏病学会的认可。

A new figure (Fig. 10.1) hasbeen added to depict the recommended comprehensive approach to the reduction inrisk of diabetes-related complications.

增加了一个新图表(图10.1)，以描述降低糖尿病相关并发症风险的推荐综合方法。

Recommendation 10.1 on screening anddiagnosis of blood pressure has been revised to include diagnosis ofhypertension at a single health care visit for individuals with blood pressuremeasuring ≥180/110 mmHg and cardiovascular disease.

修订了关于血压筛查和诊断的推荐10.1，将在单次医疗访视时血压测量值≥180/110 mmHg伴心血管疾病的个体诊断为高血压。

More information on low diastolic bloodpressure and blood pressure management has been added to the “Individualizationof Treatment Targets” subsection under “Hypertension/Blood Pressure Control.”

关于低舒张压和血压管理的更多信息已添加到“高血压/血压控制”下的“治疗目标的个体化”小节。

In the “Treatment Strategies: LifestyleInterventions” subsection under “Hypertension/Blood Pressure Control,”discussion has been added on the use of internet or mobile-based digitalplatforms to reinforce healthy behaviors and their ability to enhance theefficacy of medical therapy for hypertension.

在“高血压/血压控制”下的“治疗策略:生活方式干预”小节中，增加了关于使用互联网或基于移动的数字平台来加强健康行为及其提高高血压药物治疗效果的能力的讨论。

More information on use of ACEinhibitors and angiotensin receptor blocker (ARB) therapy for those with kidneyfunction decline has been added to the “Pharmacologic Interventions” subsectionunder “Hypertension/Blood Pressure Control.”

关于使用ACE抑制剂和血管紧张素受体阻滞剂(ARB)治疗肾功能减退患者的更多信息，已添加到“高血压/血压控制”下的“药物干预”小节。

Ezetimibe being preferential due to itslower cost has been removed from Recommendation 10.24.

依折麦布因成本较低而具有优势的内容已从推荐10.24中删除。

More discussion was added on use ofevolocumab therapy and reduction in all strokes and ischemic stroke.

增加了更多关于evolocumab治疗的使用和减少所有卒中和缺血性卒中的讨论。

A new subsection on statins andbempedoic acid has been added.

增加了关于他汀类药物和bempedoicacid的新章节。

A discussion of the ADAPTABLE (AspirinDosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness)trial has been added to the “Aspirin Dosing” subsection.

在“阿司匹林给药”小节中增加了对ADAPTABLE (阿司匹林给药:以患者为中心评估获益和长期有效性的试验)试验的讨论。

A discussion of the TWILIGHT (TicagrelorWith Aspirin or Alone in High-Risk Patients After Coronary Intervention) trialhas been added to the “Indications for P2Y12 Receptor Antagonist Use”subsection.

在“使用P2Y12受体拮抗剂的适应症”小节中增加了对TWILIGHT (替卡格雷联合阿司匹林或单独用于冠状动脉介入术后高危患者)试验的讨论。

Recommendation 10.42c has been added tothe “Cardiovascular Disease: Treatment” subsection, providing guidance forpatients with type 2 diabetes and established atherosclerotic cardiovasculardisease (ASCVD) or multiple risk factors for ASCVD on the use of combinedtherapy with a sodium–glucose cotransporter 2 (SGLT2) inhibitor withdemonstrated cardiovascular benefit and a GLP-1 receptor agonist withdemonstrated cardiovascular benefit.

在“心血管疾病:治疗”小节中增加了推荐10.42c，为患有2型糖尿病伴已确定的动脉粥样硬化性心血管疾病(ASCVD)或ASCVD的多种风险因素的患者使用联合治疗提供指导，联合治疗包括已证明对心血管有益的钠-葡萄糖共转运体2 (SGLT2)抑制剂和已证明对心血管有益的GLP-1受体激动剂。

A discussion of the Dapagliflozin andPrevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial, theEffect of Sotagliflozin on Cardiovascular Events in Patients With Type 2Diabetes Post Worsening Heart Failure (SOLOIST-WHF) trial, and the Effect ofEfpeglenatide on Cardiovascular Outcomes (AMPLITUDE-O) have been added, inaddition to the results of the Dapagliflozin and Prevention of Adverse Outcomesin Heart Failure (DAPA-HF) trial, the Evaluation of Ertugliflozin Efficacy andSafety Cardiovascular Outcomes Trial (VERTIS CV), and the Effect ofSotagliflozin on Cardiovascular and Renal Events in Patients With Type 2Diabetes and Moderate Renal Impairment Who Are at Cardiovascular Risk (SCORED)trial, which were added as a Living Standards update in June 2021.

除了作为2021年6月的动态标准更新而增加达格列净和预防心力衰竭不良结局(DAPA-HF)试验、Ertugliflozin疗效和安全性心血管结局评价(VERTIS CV) 以及Sotagliflozin对有心血管风险的2型糖尿病和中度肾功能损害患者的心血管和肾脏事件的影响(SCORED)试验的结果之外，还增加了对达格列净和预防慢性肾病不良结局(DAPA-CKD)试验、Sotagliflozin对2型糖尿病恶化后心力衰竭患者心血管事件的影响(SOLOIST-WHF)试验以及Efpeglenatide对心血管结局(AMPLITUDE-O)的影响的讨论。

Table 10.3C has been updated.

表10.3C已更新。

A new subsection, “Clinical Approach,”now concludes this section on risk reduction with SGLT2 inhibitors or GLP-1receptor agonist therapy. Fig. 10.3 has been reproduced from the ADA-endorsedAmerican College of Cardiology “2020 Expert Consensus Decision Pathway on NovelTherapies for Cardiovascular Risk Reduction in Patients with Type 2 Diabetes” (https:///10.1016/j.jacc.2020.05.037) and outlines the approach to risk reduction with SGLT2inhibitor or GLP-1 receptor agonist therapy in conjunction with othertraditional, guideline-based preventive medical therapies for blood pressure aswell as lipid, glycemic, and antiplatelet therapy.

本节关于SGLT2抑制剂或GLP-1受体激动剂治疗降低风险的内容进行总结，新增加一小节“临床方法”。图10.3摘自ADA认可的美国心脏病学会“2020年2型糖尿病患者心血管风险降低新疗法专家共识决策路径”，并概述了使用SGLT2抑制剂或GLP-1受体激动剂治疗以及其他传统的、基于指南的预防性药物治疗降低血压、血脂、血糖和抗血小板治疗风险的方法。

Section11. Chronic Kidney Disease and Risk Management

第11部分慢性肾脏疾病及其风险管理

(https:///10.2337/dc22-S011)

Formerly, Section 11, “MicrovascularComplications and Foot Care,” contained content on chronic kidney disease,retinopathy, neuropathy, and foot care. This section has now been divided intotwo sections: Section 11, “Chronic Kidney Disease and Risk Management” (https:///10.2337/dc22-S011), and Section 12, “Retinopathy, Neuropathy, and Foot Care” (https:///10.2337/dc22-S012).

以前，第11部分“微血管并发症和足部护理”包含关于慢性肾病、视网膜病、神经病和足部护理的内容。本节现分为两节:第十一部分“慢性肾脏疾病及风险管理”和第十二部分“视网膜病变，神经病变和足病”

Recommendation 11.3a has been revised toinclude lower glomular filtration rates and lower urinary albumin as indicatorsfor use of SGLT2 inhibitors to reduce chronic kidney disease (CKD) progressionand cardiovascular events.

已修订推荐11.3a，将较低的肾小球滤过率和较低的尿白蛋白作为使用SGLT2抑制剂以减少慢性肾病(CKD)进展和心血管事件的指标。

Recommendation 11.3c has also beenrevised to include therapy options (nonsteroidal mineralocorticoid receptorantagonist [finerenone]), and a new recommendation has been added(Recommendation 11.3d) regarding reduction of urinary albumin to slow CKDprogression.

修订了推荐11.3c，以纳入治疗方案(非甾体盐皮质激素受体拮抗剂[finerenone，非奈利酮])，并增加了一项新推荐(推荐11.3d)，即减少尿白蛋白以减缓CKD进展。

The concept of blood pressurevariability has been added to Recommendation 11.4.

推荐11.4中增加了血压变异性的概念。

More discussion has been added to the“Acute Kidney Injury” subsection regarding use of ACE inhibitors or ARBs.

关于ACE抑制剂或ARB的使用，在“急性肾损伤”小节中增加了更多讨论。

Section12. Retinopathy, Neuropathy, and Foot Care

第12部分视网膜病、神经病和足部护理

(https:///10.2337/dc22-S012)

以前，第11节“微血管并发症和足部护理”包含关于慢性肾病、视网膜病、神经病和足部护理的内容。本节现分为两部分:第十一部分“慢性肾脏疾病及风险管理” 和第十二部分“视网膜病变，神经病变和足病”

More discussion was added to the“Diabetic Retinopathy” subsection regarding use of GLP-1 receptor agonists andretinopathy.

在“糖尿病视网膜病变”小节中增加了更多关于使用GLP-1受体激动剂和视网膜病变的讨论。

Recommendation 12.11 was updated toindicate that intravitreous injections of anti–vascular endothelial growthfactor are a reasonable alternative to traditional panretinal laserphotocoagulation for some patients with proliferative diabetic retinopathy andalso reduce the risk of vision loss in these patients.

更新了推荐12.11，以表明玻璃体内注射抗血管内皮生长因子是治疗某些增生性糖尿病视网膜病变患者的传统全视网膜激光光凝术的合理替代方法，并可降低这些患者的视力丧失风险。

Recommendation 12.12 was also updated torecommend intravitreous injections of anti–vascular endothelial growth factoras first-line treatment for most eyes with diabetic macular edema that involvesthe foveal center and impairs visions acuity.

还更新了推荐12.12，推荐玻璃体内注射抗血管内皮生长因子作为大多数糖尿病黄斑水肿眼(累及视网膜中央凹中心并损害视力)的一线治疗。

A new recommendation (Recommendation12.13) was added on macular focal/grid photocoagulation and intravitrealinjections of corticosteroid.

增加了关于黄斑局灶性/格栅光凝和玻璃体内注射皮质类固醇的新推荐(推荐12.13)。

Section13. Older Adults

第13部分老年人

(https:///10.2337/dc22-S013)

In the “Hypoglycemia” subsection,glycemic variability and older adults with physical or cognitive limitationswas added to the discussion of use of CGM.

在“低血糖”小节中，将血糖变异性和有身体或认知障碍的老年人添加到CGM使用的讨论中。

The upper threshold of 8.5% (69mmol/mol) was removed from the example of less stringent goals for those withmultiple coexisting chronic illnesses, cognitive impairment, or functionaldependence in Recommendation 13.6.

在推荐13.6中，从针对患有多种共存慢性疾病、认知障碍或功能依赖性的患者的较宽松目标示例中移除了8.5% (69 mmol/mol)的上限阈值。

More discussion was added onclassification of older adults in the “Patients With Complications and ReducedFunctionality” subsection.

在“并发症和功能减退患者”小节中增加了关于老年人分类的更多讨论。

The benefits of a structured exerciseprogram (as in the Lifestyle Interventions and Independence for Elders [LIFE]Study) was incorporated into the “Lifestyle Management” subsection.

结构化锻炼计划的益处(如“老年人生活方式干预和独立性[LIFE]研究”中所述)已纳入“生活方式管理”小节。

More discussion of overtreatment wasadded to the “Pharmacologic Therapy” subsection, as was the consideration thatfor those taking metformin long term, monitoring vitamin B12 deficiency shouldbe considered. The insulin therapy discussion was also updated with moreinformation on avoidance of hypoglycemia.

在“药物治疗”小节中增加了更多关于过度治疗的讨论，同时考虑到长期服用二甲双胍的患者应考虑监测维生素B12缺乏。胰岛素治疗讨论也更新了更多关于避免低血糖的信息。

Section14. Children and Adolescents

第14部分儿童和青少年

(https:///10.2337/dc22-S014)

Table 14.1A and Table 14.1B havebeen newly created and provide an overview of the recommendations for screeningand treatment of complications and related conditions in pediatric type 1diabetes (Table 14.1A) and type 2 diabetes (Table 14.1B).

新创建的表14.1A和表14.1B概述了儿科1型糖尿病(表14.1A)和2型糖尿病(表14.1B)并发症和相关疾病的筛查和治疗推荐。

The “Diabetes Self-Management Educationand Support” subsection now discusses adult caregivers as critical to diabetesself-management in youth, and how they should be engaged to ensure there is nota premature transfer of responsibility for self-management to the youth.

“糖尿病自我管理教育和支持”小节讨论了成人护理人员对青少年糖尿病自我管理的重要性，以及应如何让他们参与进来，以确保不会将自我管理的责任过早移交给青少年。

Recommendation 14.7 has been simplified.

推荐14.7已经简化。

Recommendations in the renamed “GlycemicMonitoring, Insulin Delivery, and Targets” subsection (Recommendations14.18–14.27) have been reorganized and revised to better align withrecommendations in Section 7, “Diabetes Technology” (https:///10.2337/dc22-S007).

更名后的“血糖监测、胰岛素输送和目标”小节中的推荐(推荐14.18–14.27)已进行重组和修订，以更好地与第7节“糖尿病技术”中的推荐保持一致

The recommendations in the type 1diabetes “Management of Cardiovascular Risk Factors” subsection(Recommendations 14.34–14.42) have been revised to include more information ontiming of screening and treatment and updates to indicators for screening andtreatment.

1型糖尿病“心血管风险因素的管理”小节中的推荐(推荐14.34-14.42)已经过修订，纳入了更多关于筛选和治疗时间的信息以及筛选和治疗指标的更新。

Throughout the section, more has beenadded regarding reproductive counseling in female youth considering ACEinhibitors and ARBs.

在整个章节中，增加了更多关于考虑ACE抑制剂和ARB的女性青年生殖咨询的内容。

A new recommendation (Recommendation14.49) was added to the “Retinopathy” subsection for type 1 diabetes regardingretinal photography.

在1型糖尿病的“视网膜病变”小节中增加了关于视网膜摄影的新推荐(推荐14.49)。

A new recommendation (Recommendation14.61) has been added on the use of CGM for youth with type 2 diabetes onmultiple daily injections or continuous subcutaneous insulin infusion.

增加了一项新推荐(推荐14.61)，即2型糖尿病青年每日多次注射或持续皮下胰岛素输注时应使用CGM。

The recommendations for hypertensionscreening and management (Recommendations 14.77–14.80) for type 2 diabetes havebeen revised.

针对2型糖尿病的高血压筛查和管理推荐(推荐14.77-14.80)已经过修订。

Fig. 14.1 hasbeen updated.

图14.1已更新。

Section15. Management of Diabetes in Pregnancy

第15部分妊娠期糖尿病的处理

(https:///10.2337/dc22-S015)

A new recommendation (Recommendation15.16) and discussion of the evidence on telehealth visits for pregnant womenwith gestational diabetes mellitus has been added to the “Management ofGestational Diabetes Mellitus” subsection.

“妊娠糖尿病的管理”小节中增加了一项新推荐(推荐15.16)以及对妊娠糖尿病孕妇远程健康访视证据的讨论。

A new subsection on “Physical Activity”has been added.

增加了一个关于“身体活动”的新小节。

Additional discussion was addedregarding insulin as the preferred treatment for type 2 diabetes in pregnancy.

增加了关于胰岛素作为妊娠2型糖尿病首选治疗的其他讨论。

Section16. Diabetes Care in the Hospital

第16部分院内糖尿病诊治

(https:///10.2337/dc22-S016)

Additional information has been added onthe use of CGM during the COVID-19 pandemic to minimize contact between healthcare providers and patients, especially those in the intensive care unit.

增加了关于在新冠肺炎疫情期间使用CGM的其他信息，以尽量减少医疗服务提供者和患者之间的接触，尤其是重症监护室中的患者。