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1、84 ENDOCRINE PRACTICE Vol 22 No 1 January 2016 AACE ACE Consensus Statement CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM 2016 EXECUTIVE SUMMARY Alan J Garber MD PhD FACE1 M
2、artin J Abrahamson MD2 Joshua I Barzilay MD FACE3 Lawrence Blonde MD FACP FACE4 Zachary T Bloomgarden MD MACE5 Michael A Bush MD6 Samuel Dagogo Jack MD DM FRCP FACE7 Ralph A DeFronzo MD BMS MS BS8 Daniel Einhorn MD FACP FACE9 Vivian A Fonseca MD FACE10 Jeffrey R Garber MD FACP FACE11 W Timothy Garve
3、y MD FACE12 George Grunberger MD FACP FACE13 Yehuda Handelsman MD FACP FNLA FACE14 Robert R Henry MD FACE15 Irl B Hirsch MD16 Paul S Jellinger MD MACE17 Janet B McGill MD FACE18 Jeffrey I Mechanick MD FACN FACP FACE ECNU19 Paul D Rosenblit MD PhD FNLA FACE20 Guillermo E Umpierrez MD FACP FACE21 From
4、 the 1Chair Professor Departments of Medicine Biochemistry and Molecular Biology and Molecular and Cellular Biology Baylor College of Medicine Houston Texas 2Beth Israel Deaconess Medical Center Department of Medicine and Harvard Medical School Boston Massachusetts 3Division of Endocrinology Kaiser
5、Permanente of Georgia and the Division of Endocrinology Emory University School of Medicine Atlanta Georgia 4Director Ochsner Diabetes Clinical Research Unit Department of Endocrinology Diabetes and Metabolism Ochsner Medical Center New Orleans Louisiana 5Clinical Professor Mount Sinai School of Med
6、icine Editor Journal of Diabetes New York New York 6Clinical Chief Division of Endocrinology Cedars Sinai Medical Center Associate Clinical Professor of Medicine Geffen School of Medicine UCLA Los Angeles California 7A C Mullins Professor AACE American Association of Clinical Endocrinologists ACCORD
7、 Action to Control Cardiovascular Risk in Diabetes ACCORD BP Action to Control Cardiovascular Risk in Diabetes Blood Pressure ACEI angiotensin converting enzyme inhibitor AGI alpha glucosidase inhibitor apo B apolipoprotein B ARB angiotensin II receptor blocker ASCVD atherosclerotic cardio vascular
8、disease BAS bile acid sequestrant BMI body mass index BP blood pressure CHD coro nary heart disease CKD chronic kidney disease CVD cardiovascular disease DKA diabetic ketoac idosis DPP 4 dipeptidyl peptidase 4 EPA eicosa pentaenoic acid FDA Food and Drug Administration GLP 1 glucagon like peptide 1
9、HDL C high density lipoprotein cholesterol LDL C low density lipoprotein cholesterol LDL P low density lipopro tein particle Look AHEAD Look Action for Health in Diabetes NPH neutral protamine Hagedorn OSA obstructive sleep apnea SFU sulfonylurea SGLT 2 sodium glucose cotransporter 2 SMBG self moni
10、toring of blood glucose T2D type 2 diabetes TZD thiazolidinedione EXECUTIVE SUMMARY This algorithm for the comprehensive management of persons with type 2 diabetes T2D was developed to provide clinicians with a practical guide that considers the whole patient their spectrum of risks and complica tio
11、ns and evidence based approaches to treatment It is now clear that the progressive pancreatic beta cell defect that drives the deterioration of metabolic control over time begins early and may be present before the diagnosis of diabetes 1 In addition to advocating glycemic control to reduce microvas
12、cular complications this document high lights obesity and prediabetes as underlying risk factors for the development of T2D and associated macrovascular complications In addition the algorithm provides recom mendations for blood pressure BP and lipid control the two most important risk factors for c
13、ardiovascular disease CVD Since originally drafted in 2013 the algorithm has been updated as new therapies management approach es and important clinical data have emerged The 2016 edition includes a new section on lifestyle therapy as well as discussion of all classes of obesity antihyperglycemic li
14、pid lowering and antihypertensive medications approved by the U S Food and Drug Administration FDA through December 2015 This algorithm supplements the American Association of Clinical Endocrinologists AACE and American College of Endocrinology ACE 2015 Clinical Practice Guidelines for Developing a
15、Diabetes Mellitus Comprehensive Care Plan 2 and is organized into discrete sections that address the following topics the founding principles of the algo rithm lifestyle therapy obesity prediabetes glucose control with noninsulin antihyperglycemic agents and insulin management of hypertension and ma
16、nagement of dyslipidemia In the accompanying algorithm a chart summarizing the attributes of each antihyperglycemic class and the principles of the algorithm appear at the end Endocr Pract 2016 22 84 113 Principles The founding principles of the Comprehensive Type 2 Diabetes Management Algorithm are as follows see Comprehensive Type 2 Diabetes Management Algorithm Principles 1 Lifestyle optimization is essential for all patients with diabetes Lifestyle optimization is multifac eted ongoing and s
