美國糖尿病降糖標準變了

中文解說 https://mp.weixin.qq.com/s/dD6Uu_3Ww16Q5lC6mpu3Og

要點：美國醫師學會（ACP）建議大部分患者的控糖目標放寬到7%-8%之間就可以了，沒有必要一定要控製在6.5%以下。因為研究表明，把糖化血紅蛋白水平控製低於7%，會導致糖尿病患者過量使用降糖藥。而且也並沒有減少視力喪失、晚期腎病、疼痛性神經病變和死亡。而過量用藥帶來的副作用包括腸胃問題、血糖過低、體重增加，甚至充血性心力衰竭。

 

ACP recommends moderate blood sugar control targets for most patients with type 2 diabetes https://www.acponline.org/acp-newsroom/acp-recommends-moderate-blood-sugar-control-targets-for-most-patients-with-type-2-diabetes

要點：

An A1C test measures a person’s average blood sugar level over the past two or three months. An A1C of 6.5 percent indicates diabetes.

“ACP’s analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7 percent or less compared to targets of about 8 percent did not reduce deaths or macrovascular complications such as heart attack or stroke but did result in substantial harms,” said Dr. Jack Ende, president, ACP. “The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7 percent and 8 percent will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs.”

ACP recommends that clinicians should personalize goals for blood sugar control in patients with type 2 diabetes based on a discussion of benefits and harms of drug therapy, patients’ preferences, patients’ general health and life expectancy, treatment burden, and costs of care.

The rationale in guidelines that recommended lower treatment targets (below 7 percent or below 6.5 percent) is that more intensive blood sugar control would reduce microvascular complications over many years of treatment. However, the evidence for reduction is inconsistent and reductions were seen only in surrogate microvascular complications such as the presence of excess proteins in the urine.

If patients with type 2 diabetes achieve an A1C of less than 6.5 percent, ACP recommends that clinicians consider de-intensifying drug therapy by reducing the dosage of current treatment, removing a medication if the patient is currently taking more than one drug, or discontinuing drug treatment.