冠心病合并2型糖尿病患者的血糖管理专家共识  

Consensus on Glycemic Management for Patients With Coronary Heart Disease and Type 2 Diabetes

作　　者：中国医疗保健国际交流促进会心血管病学分会 陈韵岱 纪立农[2] 刘靖[3] 周翔海[3] Cardiovascular Subcommittee of Chinese International Exchange and Promotion Association for Medical and Healthcare;CHEN Yundai;JI Linong

机构地区：[1]不详 [2]中国人民解放军总医院 [3]北京大学人民医院

出　　处：《中国循环杂志》2024年第4期342-352,共11页Chinese Circulation Journal

摘　　要：我国冠心病合并糖尿病患者的比例较高,即使接受降压、降脂、抗栓等常规治疗仍存在残余心血管风险。近年的研究证明,一些降糖药物对2型糖尿病患者具有明确的心血管获益。但调研显示,目前心内科医师对2型糖尿病筛查时机、指标和诊断标准仍不熟悉,对具有明确心血管获益的新型降糖药物如胰高糖素样肽-1受体激动剂/钠-葡萄糖共转运蛋白2抑制剂的认知程度不够、规范应用率低。在此背景下,根据国内外指南/共识和最新的循证医学证据,本共识旨在规范急性冠状动脉综合征、慢性冠状动脉综合征以及经皮冠状动脉介入治疗围术期冠心病患者的血糖管理方案,不涉及糖尿病急性并发症,对冠心病患者中2型糖尿病的筛查和诊断、心血管风险综合管理等内容总结了要点,明确具有心血管获益的降糖药物的临床应用实践,促进上述药物在心血管及其他相关专业领域规范应用,同时也关注患者的非降糖治疗,以全面降低其心血管风险。The prevalence of patients with coronary heart disease and diabetes mellitus is notably high,posing significant residual cardiovascular risks even after routine medication interventions such as antihypertensive,lipid-lowering,and antithrombotic treatments.Recent studies have demonstrated that some glucose-lowering medications have cardiovascular benefits for patients with type 2 diabetes.However,a survey indicates that cardiologists may not be fully acquainted with the optimal screening timing,indicators and diagnostic criteria of type 2 diabetes,and their knowledge and prescription of novel glucose-lowering medications with cardiovascular benefits demonstrated in dedicated cardiovascular outcomes trials,such as glucagon like peptide-1 receptor agonists and sodium–glucose cotransporter 2 inhibitors,are generally less.In this context,based on domestic and international guidelines as well as consensus and the latest evidence-based evidence,this consensus aims to standardize the glycemic management for patients with acute coronary syndrome,chronic coronary syndrome,and perioperative management for percutaneous coronary intervention.It highlights the key points in type 2 diabetes screening and diagnostic,and comprehensive management of cardiovascular risk for patients with coronary heart disease.The consensus elaborates on the principles and algorithms of glycemic management for coronary heart disease patients,without involving acute complications of diabetes,clarifies the clinical practice of glucose-lowering medications with cardiovascular benefits,and promotes the standardized use of the above medications in cardiovascular and other related specialty fields.Additionally,it addresses the non-glucose-lowering treatment to comprehensively reduce cardiovascular risks.

关 键 词：冠心病 2型糖尿病 新型降糖药物 血糖管理 共识 

分 类 号：R54[医药卫生—心血管疾病]