聚焦2013 AACE糖尿病管理路径,2,患病率 (%),中国糖尿病患病率呈急剧上升趋势,Diabetes Atlas, Fourth edition International Diabetes Federation, 2009; 糖尿病学分会. 中华内分泌代谢杂志 2008; 24: 2a:1-22. Yang WY, et al. N Engl J Med 2010; 362:1090-1101.; 2010中国2型糖尿病治疗指南:p12, downloaded from http:/www.cdschina.org/x_uploadfiles/dm201otaolungao.pdf,Percentage of U.S. Adults Who Were Obese or Had Diagnosed Diabetes,Centers for Disease Control and Prevention: National Diabetes Surveillance System. Available online at: http:/apps.nccd.cdc.gov/DDTSTRS/default.aspx. Accessed 10/3/2011.,Obesity (BMI 30 kg/m2),Diabetes,No Data 4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% 9.0%,5,AACE引领全球内分泌领域发展,AACE是美国临床内分泌科医师学会（American Association of Clinical Endocrinologist） 始于1991年，由全球一流的临床内分泌学领导者创建，现已覆86个国家和地区，吸引全世界最好的临床内分泌医师成为会员 自建立之初制定并发布了内分泌领域众多疾病指南，指导全球内分泌疾病的规范化治疗，引领全球内分泌领域最新潮的治疗理念 学会取得飞速发展，某种程度上使得美国内科学成果在世界上占有领先地位,6,AACE制定众多内分泌疾病的临床专科指南-1,Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Patient - 2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery 2013 Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. 2012 American Association of Clinical Endocrinologists Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis 2012 AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Menopause 2011 American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly - 2011,https:/www.aace.com/publications/guidelines,7,AACE制定众多内分泌疾病的临床专科指南-2,Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists - 2011 American Association of Clinical Endocrinologists Medical Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan - 2011 American Association of Clinical Endocrinologists Guidelines for Clinical Practice for the Diagnosis and Treatment of Postmenopausal Osteoporosis 2010 American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules 2010 American Association of Clinical Endocrinologists Protocol for Standardized Production of Clinical Practice Guidelines - 2010 Update,AACE制定众多内分泌疾病的临床专科指南-3,11. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Growth Hormone Use in Growth Hormone-deficient Adults and Transition Patients 2009 Update American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas 2009 American Association Of Clinical Endocrinologists, The Obesity Society, and American Society For Metabolic & Bariatric Surgery Medical Guidelines For Clinical Practice For The Perioperative Nutritional, Metabolic, And Non Surgical Support Of The Bariatric Surgery Patient 2008 AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Hypertension 2006 AACE Medical Guidelines for the Clinical Use of Dietary Supplements and Nutraceuticals 2003,AACE制定众多内分泌疾病的临床专科指南-4,16. AACE Medical Guidelines for the Clinical Practice for Evaluation and Treatment of Male Sexual Dysfunction: A Couples Problem- 2003 Update 17. AACE Medical Guidelines for Clinical Practice for Evaluation and Treatment of Hypogonadism in Adult Male Patients- 2002 Update 18. AACE Medical Guidelines for Clinical Practice for Evaluation and Treatment of Hyperthyroidism and Hypothyroidism 2002 19. AACE/AAES Medical/Surgical Guidelines for Clinical Practice for Management of Thyroid Carcinoma 2001 20. AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Hyperandrogenic Disorders 2001,AACE糖尿病管理路径更被专科医师所推崇,美国第22届AACE年会于2013年5月1日5日在凤凰城召开 备受瞩目的糖尿病管理路径在会议期间隆重颁布,Garber AJ, et al. Endocr Pract. 2013 Mar-Apr;19(2):327-36.,11,2013AACE指南,血糖调节,生活方式改变（包括医学辅助减肥）,AG-I：-糖苷酶抑制剂 SGLT-2：葡萄糖转运体2 TZD: 噻唑烷二酮类 SU/GLN:磺脲类/格列奈类,糖尿病药物安全性整体评价一览表,Garber AJ, et al. Endocr Pract. 2013 Mar-Apr;19(2):327-36.,14,AACE2013指南有什么特点？（一）,AACE2013版指南强调并发症综合治疗及低血糖与体重的管理。 在药物选择方面，主要从安全性的角度考虑，而其中低血糖和体重增加被作为最重要的两个衡量指标，而降糖疗效则不是的关注点。,AACE2013指南有什么特点？（二）,磺脲类、格列奈类和胰岛素由于存在低血糖和体重增加的风险，因此在该指南中被标为慎用。 二甲双胍、GLP-1受体激动剂、DPP-4抑制剂和糖苷酶抑制剂由于在低血糖和体重增加方面更加安全，被该指南推荐为优先选择。,是不是我们中国的糖尿病的治疗，应该遵循AACE2013指南，慎用磺脲类药物？,众多权威指南在制定时的 出发点和考虑因素不尽相同,ADA-EASD（2012）磺脲类为二线联合治疗之一； NICE（2009）推荐磺脲类为一线治疗之一以及二线治疗首选； IDF（2012）以及中国指南（CDS 2010）均推荐磺脲类作为一线治疗备选和二线治疗首选。,磺脲类药物优势,磺脲类本身来说，其起效迅速，降糖疗效强，价格经济， 磺脲和双胍仍然是糖尿病医生和患者选择最多的药物。 在以降糖达标为首要目的的治疗中，磺脲依然是重要的选择。 而且在低血糖和体重增加方面，新一代的磺脲格列美脲相较于传统磺脲类已经有了显著改善。,AACE指南中提到基础胰岛素