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1、84 ENDOCRINE PRACTICE Vol 22 No. 1 January 2016 AACE/ACE Consensus StatementCONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM 2016 EXECUTIVE SUMMARYAlan J. Garber, MD, PhD, FACE
2、1; Martin 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; Jeffre
3、y R. Garber, MD, FACP, FACE11; W. Timothy Garvey, 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, ECNU
4、19; Paul D. Rosenblit, MD, PhD, FNLA, FACE20; Guillermo E. Umpierrez, MD, FACP, FACE21From 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, Depart
5、ment of Medicine and Harvard Medical School, Boston, Massachusetts, 3Division of Endocrinology, Kaiser Permanente of Georgia and the Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, 4Director, Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Diab
6、etes and Metabolism, Ochsner Medical Center, New Orleans, Louisiana, 5Clinical Professor, Mount Sinai School of Medicine, Editor, Journal of Diabetes, New York, New York, 6Clinical Chief, Division of Endocrinology, Cedars-Sinai Medical Center, Associate Clinical Professor of Medicine, Geffen School
7、of Medicine, UCLA, Los Angeles, California, 7A.C. Mullins Professor AACE = American Association of Clinical Endocrinologists; ACCORD = Action to Control Cardiovascular Risk in Diabetes; ACCORD BP = Action to Control Cardiovascular Risk in Diabetes Blood Pressure; ACEI = angiotensin- converting enzym
8、e inhibitor; AGI = alpha-glucosidase inhibitor; apo B = apolipoprotein B; ARB = angiotensin II receptor blocker; ASCVD = atherosclerotic cardio- vascular disease; BAS = bile acid sequestrant; BMI = body mass index; BP = blood pressure; CHD = coro- nary heart disease; CKD = chronic kidney disease; CV
9、D = 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; HDL-C = high- density-lipoprotein cholesterol; LDL-C = low-density- lipoprotein cholesterol; LDL-P = low-dens
10、ity-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- toring of blood glucose; T2D = type 2 diabetes; TZD = thiazolidinedioneEXECUTIV
11、E SUMMARYThis 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- tions, and evidence-based approaches to treatment. It is now clear that th
12、e 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 microvascular complications, this document high- lights obesity and predia
13、betes 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 cardiovascular disease (CVD).Since originally drafted in 20
14、13, 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, lipid-lowering, and antihypertensive medications ap
15、proved 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 Diabetes Mellitus Comprehensive Care Plan
16、 (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 management of dyslipidemia. In the accompanying algorithm, a chart summarizing the attributes of each antihyperglycemic class and the principles of the algorithm app
