规范与指南
ENGLISH ABSTRACT
糖尿病患者体重管理专家共识(2024版)
杨雁
陈颖
张惠杰
时立新
洪天配
单忠艳
余学锋
刘铭
薛耀明
秦贵军
姬秋和
纪立农
李小英
内分泌代谢科肥胖诊疗联盟
作者及单位信息
·
DOI: 10.3760/cma.j.cn115791-20240731-00396
Expert consensus on weight management in patients with diabetes mellitus (2024 edition)
Yang Yan
Chen Ying
Zhang Huijie
Shi Lixin
Hong Tianpei
Shan Zhongyan
Yu Xuefeng
Liu Ming
Xue Yaoming
Qin Guijun
Ji Qiuhe
Ji Linong
Li Xiaoying
Endocrine Metabolism Medical Alliance for Obesity
Authors Info & Affiliations
Yang Yan
Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Chen Ying
Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Zhang Huijie
Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Shi Lixin
Department of Endocrinology and Metabolism, Guiqian International General Hospital, Guiyang 550018, China
Hong Tianpei
Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing 100191, China
Shan Zhongyan
Department of Endocrinology and Metabolism, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
Yu Xuefeng
Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Liu Ming
Department of Endocrinology and Metabolism, General Hospital of Tianjin Medical University, Tianjin 300052, China
Xue Yaoming
Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
Qin Guijun
Department of Endocrinology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Ji Qiuhe
Department of Endocrinology, Xi'an International Medical Center Hospital, Xi'an 710100, China
Ji Linong
Department of Endocrinology, Peking University, People′s Hospital, Beijing 100044, China
Li Xiaoying
Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Endocrine Metabolism Medical Alliance for Obesity
·
DOI: 10.3760/cma.j.cn115791-20240731-00396
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摘要

体重管理已成为糖尿病患者综合管理的重要组成内容和基础。糖尿病患者需及早进行体重评估并进行积极管理,以期实现体重管理的广泛获益。生活方式干预、药物和代谢手术,是目前超重或肥胖糖尿病患者体重管理的主要手段。具有体重获益的降糖药物,尤其是新一代肠促胰素类药物的问世,为糖尿病患者的体重管理带来新希望。为进一步规范糖尿病患者的体重管理,内分泌代谢科肥胖诊疗联盟邀请国内相关领域的专家,依据体重管理的最新理念与循证证据共同撰写了《糖尿病患者体重管理专家共识(2024版)》,从对超重肥胖的全面评估、个性化减重目标的设定以及分层管理策略等多个层面分别给出推荐意见,以期为临床诊疗中糖尿病患者的体重管理提供全面指导,帮助糖尿病患者实现体重管理的持续获益。

糖尿病;体重管理;评估;管理策略;专家共识
引用本文

杨雁,陈颖,张惠杰,等. 糖尿病患者体重管理专家共识(2024版)[J]. 中华糖尿病杂志,2024,16(09):959-971.

DOI:10.3760/cma.j.cn115791-20240731-00396

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肥胖是糖尿病最为重要的危险因素,糖尿病患者合并超重或肥胖的比例高,超重和肥胖严重影响糖尿病患者的血糖、血脂、血压等代谢指标的控制。大量研究结果表明,糖尿病患者不同程度的体重减轻可以带来血糖改善、降糖药使用减少,甚至糖尿病缓解。生活方式、药物和代谢手术是目前体重管理的主要手段,在超重和肥胖的糖尿病患者中广泛使用。由于肠促胰素类降糖药物具有显著的减重作用,越来越多的糖尿病患者接受这类药物治疗。为进一步规范糖尿病患者的体重管理,内分泌代谢科肥胖诊疗联盟邀请国内相关领域的专家,依据已发表的相关国内外指南或专家共识及最新研究进展,共同撰写了《糖尿病患者体重管理专家共识(2024版)》,以期为临床诊疗中从事糖尿病患者体重管理工作的临床医师提供指导。
本共识制定过程中,工作组对糖尿病患者体重管理的相关问题进行文献检索,检索数据库包括PubMed、万方、中国知网等数据库,检索时间为2000年1月1日至2024年3月31日。基于检索结果,执笔专家汇总循证医学证据,综合我国诊疗现状和临床实践经验,对糖尿病患者的体重管理给出推荐意见,后经专家讨论商议,确定推荐意见及共识具体内容。本共识中的证据质量和推荐意见参考GRADE(grading of recommendations assessment,development and evaluation)系统分级标准 1,证据质量分级分为A、B、C、D共4级,推荐强度分为强、弱两级( 表1 )。采用德尔菲法对推荐意见及推荐强度进行调查,以70%以上专家意见作为推荐意见强度达成的标准,最终所有推荐意见均达成共识。
证据质量和推荐意见 符号 具体描述
证据分级
A 非常确信真实的效应值接近效应估计值
B 对效应估计值有中等程度的信心:真实值有可能接近估计值,但仍存在二者大不相同的可能性
C 对效应估计值确信程度有限:真实值可能与效应估计值大不相同
极低 D 对效应估计值几乎没有信心:真实值很可能与效应估计值大不相同
推荐强度
强推荐 1 明确显示干预措施利大于弊或弊大于利
弱推荐 2 利弊不确定或无论质量高低的证据均显示利弊相当
证据质量和推荐意见分级标准 1
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