2011年ADA糖尿病诊疗标准执行纲要中英文对照

2011年ADA糖尿病诊疗标准执行纲要美国糖尿病协会王新军于文译滨州医学院附属滨州市人民医院内分泌科，滨州，256610目前糖尿病的诊断标准●A1C≥6.5%。

试验应该用美国糖化血红蛋白标准化计划组织（National GlycohemoglobinStandardization Program，NGSP）认证的方法进行。

并与（Diabetes Control and Complications Trial，DCCT）的检测进行标化●空腹血糖（FPG）≥7.0 mmol/L。

空腹的定义是至少8小时未摄入热量，或●OGTT 2h血糖≥11.1 mmol/L。

试验应按照世界卫生组织（WHO）的标准进行，用75 g无水葡萄糖溶于水作为糖负荷●有高血糖的典型症状或高血糖危象，随机血糖≥11.1 mmol/L●如无明确的高血糖症状，结果应重复检测确认。

Current criteria for the diagnosis ofdiabetes●A1C6.5%. The test should be per-formed in a laboratory using a methodthatisNationalGlycohemoglobinStan-dardization Program (NGSP)-certifiedand standardized to the Diabetes Con-trol and Complications T rial (DCCT)assay●fasting plasma glucose (FPG)126mg/dl (7.0 mmol/l). Fasting is definedas no caloric intake for at least 8 h, or●2-h plasma glucose200 mg/dl (11.1mmol/l) during an oral glucose toler-ance test (OGTT). The test should beperformed as described by the WorldHealth Organization, using a glucoseload containing the equivalent of 75 ganhydrous glucose dissolved in water●in a patient with classic symptoms ofhyperglycemiaorhyperglycemiccrisis,a random plasma glucose200 mg/dl(11.1 mmol/l)●intheabsenceofunequivocalhypergly-cemia, result should be confirmed byrepeat testing.在无症状患者中进行糖尿病筛查2）并有一个以上其他糖尿病危险因素（见●在无症状的成人，如超重或肥胖（BMI≥25kg/m“2011年糖尿病诊疗标准”中的表4），应该从任何年龄开始筛查糖尿病并评估将来糖尿病的风险。

对没有这些危险因素的人群，应从45岁开始筛查。

（B）●如果检查结果正常，至少每3年复查一次。

（E）●为筛查糖尿病或评估未来糖尿病的风险，A1C、 FPG或2h 75g OGTT均是适用的。

（B）●对于那些已经确定未来糖尿病风险增加的人群，应该进一步评估并治疗其他心血管疾病（CVD）危险因素。

（B）Testing for diabetes in asymptomaticpatients●Testing to detect type 2 diabetes andassess risk for future diabetes in asymptomaticpeople should be considered inadults of any age who are overweight orobese (BMI _25 kg/m2) and who haveone or more additional risk factors fordiab etes (see Table 4 of the ―Standardsof Medical Care in Diabetes—2011‖).In those without these risk factors, testingshould begin at age 45 years. (B)●If tests are normal, repeat testing carriedout at least at 3-year intervals isreasonable. (E)●To test for diabetes or to assess risk offuture diabetes, A1C, FPG, or 2-h 75-gOGTT are appropriate. (B)●In those identified with increased riskfor future diabetes, identify and, if appropriateappropriate,treat other cardiovasculardisease (CVD) risk factors. (B)妊娠期糖尿病的筛查和诊断●在有危险因素的个体中，产前首次就诊时用标准的诊断标准筛查未诊断的2型糖尿病。

（B）●在未知是否具有糖尿病的怀孕妇女中，在妊娠24~28周用75g 2h OGTT筛查妊娠糖尿病，诊断切点见“2011年糖尿病诊疗标准”表6。

（B）Detection and diagnosis ofgestational diabetes mellitus (GDM)● Screen for undiagnosed type 2 diabetesat the first prenatal visit in those withrisk factors, using standard diagnosticcriteria. (B)● In pregnant women not known to havediabetes, screen for GDM at 24–28weeks of gestation, using a 75-g 2-hOGTT and the diagnostic cut points inTable 6 of the “Standards o f MedicalCare in Diabetes—2011”. (B)●妊娠糖尿病的妇女在产后6~12周筛查永久性糖尿病。

（E）●有妊娠糖尿病病史的妇女应至少每3年筛查是否发展为糖尿病或糖尿病前期。

（E）● Screen women with GDM for persistentdiabetes 6–12 weeks postpartum. (E)● Women with a history of GDM shouldHave life long screening for the develop-Ment of diabetes or prediabetes at leastevery 3 years. (E)预防/延缓2型糖尿病●对于糖耐量异常（IGT）（A）、空腹血糖受损（IFG）（E）或A1C 在5.7～6.4%之间（E）的患者，应该制定长期计划，以减轻体重7%，增加体力活动，每周进行至少150分钟中等强度（如步行）的体力活动。

（B）●定期随访咨询对成功非常重要。

（B）Prevention/delay of type 2 diabetes●Patients with impaired glucose toler-ance (IGT) (A), impaired fasting glu-cose(IFG)(E),oranA1Cof5.7–6.4%(E) should be referred to an effectiveongoing support program targetingweight loss of 7% of body weight andincreasing physical activity to at least150 min/week of moderate activitysuch as walking.●Follow-up counseling appears to be im-portant for success. (B)●基于节约糖尿病预防的潜在医疗费用，这种咨询的费用应由第三方支付。

（E）●对于那些可能发展为糖尿病的高危人群，如具有多种危险因素，尤其是尽管进行了生活方式的干预后血糖仍进展（如A1C＞6%），可以考虑使用二甲双胍治疗以预防2型糖尿病。

（B）●糖尿病前期患者应该每年进行检测以观察是否进展为糖尿病。

（E）●Based on potential cost-savings of dia-betes prevention, such programsshould be covered by third-party pay-ors. (E)●Metformin therapy for prevention oftype 2 diabetes may be considered inthose at highest risk for developing di-abetes,such as those with multiple riskfactors, especially if they demonstrateprogression of hyperglycemia(e.g.A1C6%) despite lifestyle interventions.(B)●Monitoring for the development of di-Abetes in those with prediabetes shouldbe performed every year. (E)血糖监测●每日多次胰岛素注射或采用胰岛素泵治疗的患者，应该进行自我检测血糖（SMBG）每天3次或以上。

（A）●对于胰岛素注射次数少或仅采用口服药物或医学营养治疗（MNT）的患者，SMBG或许有助于治疗成功。

（E）●餐后SMBG或许有助于餐后血糖控制达标。

（E）●SMBG医嘱后，应确保患者获得SMBG的初始指导和定期随访评估，并用SMBG数据指导和调整治疗。

（E）●对于年龄25岁以上的1型糖尿病患者进行动态血糖监测（CGM）并联合胰岛素强化治疗，是降低A1C水平的有效方法。