一级预防
生活方式因素(肥胖、身体活动不足和压力)似乎是目前糖尿病流行的主要驱动因素。因而,所有年龄人群积极预防肥胖,可能有助于预防 2 型糖尿病。[29]Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019 May;42(5):731-54.
https://care.diabetesjournals.org/content/42/5/731.long
http://www.ncbi.nlm.nih.gov/pubmed/31000505?tool=bestpractice.com
[30]LeBlanc EL, Patnode CD, Webber EM, et al; Agency for Healthcare Research and Quality (US). Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: an updated systematic review for the U.S. Preventive Services Task Force. Sep 2018 [internet publication].
https://www.ncbi.nlm.nih.gov/books/NBK532379/
http://www.ncbi.nlm.nih.gov/pubmed/30354042?tool=bestpractice.com
一些临床试验显示,在高风险的成年人中,体重下降与延缓和降低糖尿病的发病有关。[14]Hemmingsen B, Gimenez-Perez G, Mauricio D, et al. Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database Syst Rev. 2017 Dec 4;(12):CD003054.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003054.pub4/full
http://www.ncbi.nlm.nih.gov/pubmed/29205264?tool=bestpractice.com
[23]Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.
https://www.nejm.org/doi/10.1056/NEJMoa012512
http://www.ncbi.nlm.nih.gov/pubmed/11832527?tool=bestpractice.com
[24]Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. Diabetes Care. 1997 Apr;20(4):537-44.
http://www.ncbi.nlm.nih.gov/pubmed/9096977?tool=bestpractice.com
[25]Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001 May 3;344(18):1343-50.
https://www.nejm.org/doi/full/10.1056/NEJM200105033441801
http://www.ncbi.nlm.nih.gov/pubmed/11333990?tool=bestpractice.com
[31]Knowler WC, Fowler SE, Hamman RF, et al; Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86.
http://www.ncbi.nlm.nih.gov/pubmed/19878986?tool=bestpractice.com
[32]Balk EM, Earley A, Raman G, et al. Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force. Ann Intern Med. 2015 Sep 15;163(6):437-51.
https://annals.org/aim/fullarticle/2395729/combined-diet-physical-activity-promotion-programs-prevent-type-2-diabetes
http://www.ncbi.nlm.nih.gov/pubmed/26167912?tool=bestpractice.com
通过限制饮食和定期参加体育活动的方式适度减轻体重(7% 的体重),能够使 3-4 年期间从糖尿病前期进展至糖尿病的患者数量降低 50%。[23]Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.
https://www.nejm.org/doi/10.1056/NEJMoa012512
http://www.ncbi.nlm.nih.gov/pubmed/11832527?tool=bestpractice.com
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What are the effects of diet, physical activity, or both in people at increased risk of developing type 2 diabetes mellitus?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1974/full展示答案 此外,已经证明多种药物均可限制糖尿病前期向糖尿病的进展,包括二甲双胍、α-葡萄糖苷酶抑制剂、奥利司他、胰高血糖素样肽-1 (GLP-1) 受体激动剂和噻唑烷二酮类药物。[2]American Diabetes Association. Standards of medical care in diabetes - 2019. Diabetes Care. 2019;42(Suppl 1):S1-193.
https://care.diabetesjournals.org/content/42/Supplement_1
[26]Gerstein HC, Yusuf S, Bosch J, et al; DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet. 2006 Sep 23;368(9541):1096-105.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69420-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/16997664?tool=bestpractice.com
[33]Apolzan JW, Venditti EM, Edelstein SL, et al. Long-term weight loss with metformin or lifestyle intervention in the Diabetes Prevention Program Outcomes Study. Ann Intern Med. 2019 May 21;170(10):682-90.
http://www.ncbi.nlm.nih.gov/pubmed/31009939?tool=bestpractice.com
[34]Moelands SV, Lucassen PL, Akkermans RP, et al. Alpha-glucosidase inhibitors for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database Syst Rev. 2018 Dec 28;(12):CD005061.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005061.pub3/full
http://www.ncbi.nlm.nih.gov/pubmed/30592787?tool=bestpractice.com
[35]Hemmingsen B, Sonne DP, Metzendorf MI, et al. Dipeptidyl-peptidase (DPP)-4 inhibitors and glucagon-like peptide (GLP)-1 analogues for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk for the development of type 2 diabetes mellitus. Cochrane Database Syst Rev. 2017;(5):CD012204.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012204.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/28489279?tool=bestpractice.com
生活方式改变和/或服用二甲双胍推荐用于大多数患者。[36]Roberts S, Barry E, Craig D, et al. Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes. BMJ Open. 2017 Nov 15;7(11):e017184.
https://bmjopen.bmj.com/content/7/11/e017184.long
http://www.ncbi.nlm.nih.gov/pubmed/29146638?tool=bestpractice.com
[37]Haw JS, Galaviz KI, Straus AN, et al. Long-term sustainability of diabetes prevention approaches: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med. 2017 Dec 1;177(12):1808-17.
http://www.ncbi.nlm.nih.gov/pubmed/29114778?tool=bestpractice.com
[38]Herman WH, Pan Q, Edelstein SL, et al; Diabetes Prevention Program Research Group. Impact of lifestyle and metformin interventions on the risk of progression to diabetes and regression to normal glucose regulation in overweight or obese people with impaired glucose regulation. Diabetes Care. 2017 Dec;40(12):1668-77.
https://care.diabetesjournals.org/content/40/12/1668.long
http://www.ncbi.nlm.nih.gov/pubmed/29021207?tool=bestpractice.com
[39]Galaviz KI, Weber MB, Straus A, et al. Global diabetes prevention interventions: a systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose. Diabetes Care. 2018 Jul;41(7):1526-34.
https://care.diabetesjournals.org/content/41/7/1526.long
http://www.ncbi.nlm.nih.gov/pubmed/29934481?tool=bestpractice.com
更激进的多药联合用药法尚存争议。[40]Armato JP, DeFronzo RA, Abdul-Ghani M, et al. Successful treatment of prediabetes in clinical practice using physiological assessment (STOP DIABETES). Lancet Diabetes Endocrinol. 2018 Oct;6(10):781-9.
http://www.ncbi.nlm.nih.gov/pubmed/30224284?tool=bestpractice.com
糖尿病前期筛查以及根据个体需求降低心血管风险,也十分重要。[27]Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Circulation. 2019 Sep 10;140(11):e596-e646.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678
http://www.ncbi.nlm.nih.gov/pubmed/30879355?tool=bestpractice.com
[41]Cosentino F, Grant PJ, Aboyans V, et al; Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2019 Aug 31 [Epub ahead of print].
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz486/5556890
http://www.ncbi.nlm.nih.gov/pubmed/31497854?tool=bestpractice.com
[42]Rosenzweig JL, Bakris GL, Berglund LF, et al. Primary prevention of ASCVD and T2DM in patients at metabolic risk: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019 Sep;104(9):3939-85.
https://academic.oup.com/jcem/article/104/9/3939/5540926
http://www.ncbi.nlm.nih.gov/pubmed/31365087?tool=bestpractice.com
二级预防
虽然通过有效的多因素干预措施可使大血管并发症的风险降低 50% 以上,[199]Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003 Jan 30;348(5):383-93. https://www.nejm.org/doi/full/10.1056/NEJMoa021778 http://www.ncbi.nlm.nih.gov/pubmed/12556541?tool=bestpractice.com 美国一项全国调查发现,超过一半的 50 岁以上糖尿病伴发高血压的门诊患者未接受过抗血小板剂、他汀类药物治疗,或血管紧张素转换酶抑制剂/血管紧张素 II 受体拮抗剂治疗。[200]Newman JD, Berger JS, Ladapo JA. Underuse of medications and lifestyle counseling to prevent cardiovascular disease in patients with diabetes. Diabetes Care. 2019 May;42(5):e75-e76. https://care.diabetesjournals.org/content/42/5/e75.long http://www.ncbi.nlm.nih.gov/pubmed/30862654?tool=bestpractice.com
其他预防措施包括:[2]American Diabetes Association. Standards of medical care in diabetes - 2019. Diabetes Care. 2019;42(Suppl 1):S1-193. https://care.diabetesjournals.org/content/42/Supplement_1
每年的流感免疫接种
预防肺炎球菌病的疫苗接种
对年龄在 19 岁至 59 岁的成年糖尿病患者接种乙型肝炎疫苗;对于年龄在 60 岁级以上的非糖尿病成人考虑进行免疫接种
常规牙齿护理
针对性糖尿病教育。
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