2019年美國糖尿病學會針對糖尿病血糖控制目標之標準治療建議

10.6666/ClinMed.202003_85(3).0031

郝立智；張雅椅；范麒惠；陳宣恩；馬瀰嘉；潘潔慧；吳明瑞；周劍文；邱酩淳；楊純宜

糖化血色素（glycated Hemoglobin, A1C） ； 自我監測血糖（self-monitoring of blood glucose, SMBG） ； 美國糖尿病學會（American Diabetes Association, ADA） ； 連續血糖監測（continuous glucose monitoring, CGM）

臨床醫學月刊

85卷3期（2020 / 03 / 27）

166 - 180

繁體中文

此次美國糖尿病學會標準治療指引更新部分首先討論糖化血色素測試（A1C tests），以突顯出A1C測試在血糖管理中的重要性。自我監測血糖和連續血糖監測的內文和建議已被轉移刊載到新的糖尿病技術（diabetes technology）章節部分。為了強調血糖目標的風險和好處會隨著糖尿病的進展和患者年齡的增長而改變，建議增加血糖目標隨時間的變動應作重新的評估。並針對低血糖的章節部分進行了修改，以符合2018年4月所更新的糖尿病生活標準（diabetes living standards）中關於低血糖定義的共識。

1. (2017).Standards of medical care in diabetes--2017.Diabetes,40,S48-S56.
2. (2017).Practice Bulletin No. 180: Gestational DiabetesMellitus.Obstet Gynecol,130,e17-e37.
3. (2012).Global guideline for Type 2 diabetes.Brussels:International Diabetes Federation.
4. Agiostratidou, G,Anhalt, H,Ball, D(2017).Standardizing clinically meaningful outcome measures beyond HbA1c for type 1 diabetes: a consensus report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange.Diabetes Care,40,1622-1630.
5. American Diabetes Association(2019).Glycemic targets: Standards of Medical Care in Diabetes—2019.Diabetes Care,42,S61-S70.
6. American Diabetes Association(2018).Introduction: Standards of Medical Care in Diabetes-2018.Diabetes Care,41,S1-S2.
7. American Diabetes Association(2018).11. Older adults: standards of medical care in diabetes - 2018.Diabetes Care,41,S119-S125.
8. Beck, RW,Connor, CG,Mullen, DM(2017).The fallacy of average: how using HbA1c alone to assess glycemic control can be misleading.Diabetes Care,40,994-999.
9. Bergenstal, RM,Gal, RL,Connor, CG(2017).T1D Exchange Racial Differences Study Group. Racial differences in the relationship of glucose concentrations and hemoglobin A1c levels.Ann Intern Med,167,95-102.
10. Buse, JB,Kaufman, FR,Linder, B(2013).HEALTHY Study Group. Diabetes screening with hemoglobin A1c versus fasting plasma glucose in a multiethnic middle-school cohort.Diabetes Care,36,429-435.
11. Davies, MJ,D’Alessio, DA,Fradkin, J(2018).Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association(ADA) and the European Association for the Study of Diabetes(EASD).Diabetes Care,41,2669-2701.
12. Diabetes Association Of The Republic Of China Taiwan(2018).Executive summary of the DAROC clinical practice guidelines for diabetes care- 2018.J Formos Med Assoc,119(2),577-586.
13. Diabetes Control and Complications Trial Research Group(1993).The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.N Engl J Med,329,977-986.
14. Duckworth, WC,Abraira, C,Moritz, TE(2011).Investigators of the VADT. The duration of diabetes affects the response to intensive glucose control in type 2 subjects: the VA Diabetes Trial.J Diabetes Complications,25,355-361.
15. Hayward, RA,Reaven, PD,Wiitala, WL,VADT Investigators(2015).Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes.N Engl J Med,372,2197-2206.
16. Huang, ES,Zhang, Q,Gandra, N(2008).The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: a decision analysis.Ann Intern Med,149,11-19.
17. Huang, Hsuan,Lin, Yi-Hsin(2018).Type 2 Diabetes Mellitus in Older Adults: A Literature Review.J Intern Med Taiwan,29,374-380.
18. Inzucchi, SE,Bergenstal, RM,Buse, JB(2015).Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes.Diabetes Care,38,140-149.
19. Ismail-Beigi, F,Craven, T,Banerji, MA,ACCORD trial group(2010).Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial.Lancet,376,419-430.
20. Jacobson, AM,Musen, G,Ryan, CM(2007).Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group. Long-term effect of diabetes and its treatment on cognitive function.N Engl J Med,356,1842-1852.
21. Jovanovič, L,Savas, H,Mehta, M(2011).Frequentmonitoring of A1C during pregnancy as a treatment tool to guide therapy.Diabetes Care,34,53-54.
22. Karter, AJ,Moffet, HH,Liu, JY(2018).Surveillance of hypoglycemia-limitations of emergency department and hospital utilization data.JAMA Intern Med,178,987-988.
23. Kashiwagi, A,Kasuga, M,Araki, E(2012).International clinical harmonization of glycated hemoglobin in Japan: From Japan Diabetes Society to National Glycohemoglobin Standardization Program values.J Diabetes Investig,3,39-40.
24. Layman, DK,Clifton, P,Gannon, MC(2008).Protein in optimal health: heart disease and type 2 diabetes.Am J Clin Nutr,87,1571S-1575S.
25. Lee, AK,Warren, B,Lee, CJ(2018).The associationfsevere hypoglycemia with incident cardiovascular events and mortality in adults with type 2 diabetes.Diabetes Care,41,104-111.
26. Lipska, KJ,Ross, JS,Miao, Y(2015).Potential overtreatment of diabetes mellitus in older adults with tight glycemic control.JAMA Intern Med,175,356-362.
27. Little, RR,Rohlfing, CL,Sacks, DB(2011).Glycohemoglobin Standardization Program (NGSP) Steering Committee. Status of hemoglobin A1c measurement and goals for improvement: from chaos to order for improving diabetes care.Clin Chem,57,205-214.
28. McCoy, RG,Van Houten, HK,Ziegenfuss, JY(2012).Increased mortality of patients with diabetes reporting severe hypoglycemia.Diabetes Care,35,1897-1901.
29. Mosca, A,Paleari, R,Dalfrà, MG(2006).Reference intervals for hemoglobin A1c in pregnant women: data from an Italian multicenter study.Clin Chem,52,1138-1143.
30. Nathan, DM,Cleary, PA,Backlund, J-YC(2005).Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications(DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes.N Engl J Med,353,2643-2653.
31. Nielsen, LR,Ekbom, P,Damm, P(2004).HbA1c levels are significantly lower in early and late pregnancy.Diabetes Care,27,1200-1201.
32. Orchard, TJ,Nathan, DM,Zinman, B(2015).Writing Group for the DCCT/EDIC Research Group. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality.JAMA,313,45-53.
33. Raz, I,Wilson, PWF,Strojek, K(2009).Effects of prandial versus fasting glycemia on cardiovascular outcomes in type 2 diabetes: the HEART2D trial.Diabetes Care,32,381-386.
34. Rohlfing, C,Hanson, S,Little, RR(2017).Measurement ofhemoglobin A1c in patients with sickle cell trait.JAMA,317,22-37.
35. Schleicher, ED,Olgemöller, B,Wiedenmann, E(1993).Specific glycation of albumin depends on its half-life.Clin Chem,39,625-628.
36. Selvin, E,Rawlings, AM,Lutsey, PL(2015).Fructosamine and Glycated Albumin and the Risk of Cardiovascular Outcomes and Death.Circulation,132,269-277.
37. Skyler, JS,Bergenstal, R,Bonow, RO(2009).American Diabetes Association; American College of Cardiology Foundation; American Heart Association. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement ofthe American College of Cardiology Foundation and the American Heart Association.Diabetes Care,32,187-192.
38. Tahara, Y(2009).Analysis of the method for conversion between levels of HbA1c and glycated albumin by linear regression analysis using a measurement error model.Diabetes Res Clin Pract,84,224-229.
39. Wheeler, E,Leong, A,Liu, C-T(2017).EPIC-CVD Consortium; EPIC-InterAct Consortium; Lifelines Cohort Study. Impact of common genetic determinants of hemoglobin A1c on type 2 diabetes risk and diagnosis in ancestrally diverse populations: a transethnic genome-wide meta-analysis.PLoS Med,14,e1002383.
40. Whitmer, RA,Karter, AJ,Yaffe, K(2009).Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus.JAMA,301,1565-1572.
41. Wilson, DM,Kollman,Diabetes Research in Children Network(DirecNet) Study Group(2008).Relationship of A1C to glucose concentrations in children with type 1 diabetes: assessments by high-frequency glucose determinations by sensors.Diabetes Care,31,381-385.
42. Zoungas, S,Chalmers, J,Neal, B,ADVANCEON Collaborative Group(2014).Follow-up of bloodpressure lowering and glucose control in type 2 diabetes.N Engl J Med,371,1392-1406.