临床文献
2型糖尿病的管理
CONTENTS
Purpose
About The Guideline
Summary
CHAPTERS
1 Type 2 Diabetes In New Zealand
2 Lifestyle Management
3 Glycaemic Control
4 Diabetic Cardiovascular Disease
5 Diabetic Renal Disease
6 Diabetic Eye Disease
7 Diabetic Foot Disease
8 Mäori Perspectives
9 Pacifi c Perspectives
10 Implementation
APPENDICES
Abbreviations
Glossary
References
PURPOSE
The aim of the diabetes guideline is to provide anevidence-based summary of best practice in themanagement of some key aspects of type 2 diabetesin order to improve the outcome for people withdiabetes. It seeks to assist decision-making by healthcare providers and people with type 2 diabetes.
This guideline is intended for use by primary carepractitioners involved in the care of people withtype 2 diabetes, including general practitioners andpractice nurses. It may also be useful to other healthcare practitioners involved in the care of peoplewith diabetes in the community, such as podiatrists,dietitians and optometrists, as well as to all healthcare practitioners working in the secondary andtertiary care sectors.
This guideline does not review the evidence forthe effectiveness of screening programmes todetect diabetes in asymptomatic people. It doesnot review the evidence for the effectiveness oflifestyle or drug interventions aimed at preventingor slowing the progression from impaired glucosetolerance to diabetes. Both these issues arecovered in the New Zealand Guideline on TheAssessment and Management of CardiovascularRisk. These guidelines will include this evidencewhen updated.
ABOUT THE GUIDELINE
FOREWORD
The previous New Zealand diabetes guidelines, written in 1998, were launchedas part of the government’s free annual check initiative for diabetes in 2000.1 The ‘Primary care guidelines for the management of core aspects of diabetes care’ were a set of four guidelines: glycaemic control, retinal screening, microalbuminuria screening and foot screening. This 2003 guideline updates the previous set of four guidelines and additional chapters are included.
SUMMARY
KEY MESSAGES
The estimated number of people in New Zealand with diagnosed diabetes ispredicted to increase substantially in the next 20 years, from 115,000 to over160,000.
The prevalence of diagnosed diabetes is higher among M?ori and Pacifi cpeoples and complications are more common and more severe.
About half the people with diabetes are thought to be undiagnosed. Many ofthese people will be asymptomatic.
Lifestyle change is central to the management of all people with diabetes andrequires advice on energy intake and dietary pattern, physical activity, andsmoking cessation, where appropriate.
nvolving families in diabetes management planning is of particular importanceto M?ori and Pacifi c people with diabetes.
Regular screening for renal, retinal and foot complications should occur fromdiagnosis of type 2 diabetes.
Tight glycaemic control reduces the risk of and slows the progression ofmicrovascular and macrovascular complications. A stepped approach isrecommended to lower and maintain HbA1c to as close to physiological levelsas possible, preferably less than 7%, without hypoglycaemia.
Optimum blood pressure control, below 130/80 mm Hg, reduces the risk ofand slows the progression of microvascular and macrovascular complications.Intensive blood pressure management is recommended in people with diabetesand overt nephropathy, microalbuminuria or other renal disease, with mostrequiring more than one blood pressure lowering agent.
Any sustained reduction in both HbA1c and blood pressure is worthwhile.
Annual cardiovascular risk assessment is recommended for all people withdiabetes. The National Heart Foundation cardiovascular risk chart should beused to calculate cardiovascular risk. Clinically, people with diabetes andovert nephropathy or other renal disease are at high risk of cardiovasculardisease.
For all people with diabetes the 5-year cardiovascular risk should be less than15% and, where possible, the goal is to achieve: total cholesterol less than 4mmol/L; triglycerides less than 1.7 mmo/L and blood pressure less than 130/80mm Hg.
People with diabetes and microalbuminuria or overt nephropathy should beon an ACE-inhibitor or A2 receptor-blocker, if tolerated, to prevent diseaseprogression.
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