中国糖尿病防治指南（2024版）

J$%,

J7%,IJ

J /($'

$%, I

注：LEAD为下肢动脉病变；ABI为踝肱指数；TBI为趾肱指数

图8 糖尿病患者筛查LEAD的流程图

数字减影血管造影都是检查患者下肢动脉狭窄或闭塞病变的方法，且应该进行整条受累肢体的影像学检查；（6）如果患者有慢性下肢灌注不足导致的缺血性静息痛、不愈合性溃疡或坏疽（通常发生在远端节段）等表现，结合静息 ABI<0.40 或踝动脉压<50 mmHg、趾动脉压<30 mmHg 以及经皮氧分压<30 mmHg，应该诊断严重肢体缺血（CLTI）［591］。

值得注意的是，诊断 PAD 的最佳方式都并非是单一模式，例如ABI为 0.9~1.3、TBI≥0.7且有三相或双相波形时，存在 PAD的可能性较小，但临床尚缺乏排除PAD的确切阈值［592］。2.Fontaine 分期：LEAD 一经诊断，临床上应该进行Fontaine分期（表18）［592］。

3.预后评估：对糖尿病和足溃疡或坏疽患者的预后（如愈合和截肢）评估，除了踝压和ABI、趾压、经皮氧分压或皮肤灌注压测定，建议采用WIfI分类系统进行评估（表19）。

1.LEAD 的治疗目的：预防全身动脉粥样硬化疾病的进展，降低心血管事件及死亡的发生；预防

缺血导致的溃疡和肢端坏疽，预防截肢或降低截肢平面，改善间歇性跛行患者的功能状态［554， 590］。

2. 糖尿病性 LEAD 的预防：糖尿病性 LEAD 的规范化防治包括三个部分，即一级预防（防止或延缓LEAD的发生）、二级预防（缓解症状，延缓LEAD的进展）和三级预防（血运重建，降低截肢和心血管事件发生）。

（1）一级预防：筛查糖尿病 LEAD的高危因素，并给予 LEAD相关知识的教育，及早纠正不良生活方式，如戒烟、限酒、控制体重等。严格控制血糖（HbA1c<8%，但根据严重低血糖风险可适当放宽）、血压（<140/90 mmHg，但根据直立性低血压和其他不良反应风险可适当放宽）、血脂（LDL⁃C 目标值<1.8 mmol/L 并至少较基线降低 50%；能耐受高强度他汀类药物，无论是否加依折麦布时，建议目标水平 <1.4 mmol/L），有 适 应 证 者 给 予 抗 血 小 板治疗［590， 592］。

（2）二级预防：在一级预防的基础上，对于有症状的 LEAD 患者，建议单用抗血小板治疗，给予阿司匹林 75~160 mg/d或氯吡格雷 75 mg/d［591］，且后者更优［592］。对于足部皮肤完整的缺血型患者，指导患者进行运动康复锻炼，有效的运动为平板运动或走步，强度达到引发间歇性跛行后休息，每次 30~45 min，每 周 至 少 3 次 ，时 间 至 少 持 续 3~6 个月［593⁃595］。给予相应的抗血小板药物［596⁃598］、血管紧张素转化酶抑制剂（ACEI）［574， 599］、他汀类药物［600］、血管扩张药物［554， 590， 601⁃604］治疗，可以改善患者的下肢运动功能。

表19 伤口、缺血和足感染分类（WIfI）标准

W（伤口）

I（缺血）

fI（足感染）

得分

0

1

2

3

ABI

≥0.80

0.60~0.79

0.40~0.59<0.40

0 1 2 3

描述

无溃疡（缺血性静息痛）

小腿或足部小、浅溃疡，无坏疽

较深溃疡伴有骨、关节或肌腱暴露和（或）局限性足趾坏疽性变化广泛深部溃疡，足跟全层溃疡和（或）跟骨受累和（或）广泛坏疽踝关节压力（mmHg）

≥100

70~99

50~69

无感染症状和体征

局部感染，仅累及皮肤和皮下组织

局部感染，累及比皮肤及皮下组织更深的组织

全身炎症反应综合征

趾压或经皮氧分压（mmHg）≥60

40~59

30~39

<30

注：ABI为踝肱指数。1 mmHg=0.133 kPa

表18 下肢动脉病变的Fontaine分期

分期Ⅰ期Ⅱa期Ⅱb期Ⅲ期Ⅳ期

临床评估

无症状

轻度间歇性跛行

中度至重度间歇性跛行缺血性静息痛

缺血性溃疡或坏疽

对于间歇性跛行患者，除上述治疗外，尚需使用血管扩张药物［554， 590］。目前所用的血管扩张药物主要有脂微球包裹前列地尔、贝前列腺素钠、西洛他唑、盐酸沙格雷酯、萘呋胺、丙酰左卡尼汀、丁咯地尔和己酮可可碱等。由于多数有 LEAD 的糖尿病患者合并周围神经病变，这些患者常缺乏 LEAD的临床症状，因此，对糖尿病患者常规进行 LEAD筛查至关重要。对于已经发生 LEAD的患者，结构化教育可以改善患者的下肢运动功能，改善患者的身体状况［605］；心理干预可以改善患者的步行行为，增加无痛性行走距离，提高患者的生活质量［594， 606］。

对于症状性 LEAD 患者，在上述治疗基础上，联合小剂量抗凝治疗可以取得较好的效果［607⁃608］。

目前的研究证据表明，双通道抗栓（DPI）治疗较阿司匹林降低症状性 LEAD 患者主要不良心血管事件（MACE）风险 26%，包括重大截肢的主要不良肢体事件（MALE）风险 45%，并显著提高临床净获益［609］。对于行血运重建的 LEAD患者，DPI较阿司匹林有MACE与MALE复合终点获益，而不增加出血等不良事件［610］。因此，推荐症状性LEAD患者采用单一抗血小板治疗，也可采用 DPI治疗［611］；如为高缺血风险且非高出血风险，应考虑首选DPI。对于行血运重建（手术或血管内介入）的LEAD患者，如无高出血风险，应考虑 DPI 治疗；如伴高出血风险，推荐单一抗血小板治疗。

（3）三级预防：主要针对慢性 CLTI 患者，CLTI患者往往表现为静息痛、坏疽、溃疡不愈合，且具有极高的截肢和心血管死亡风险，血管病变主要是股腘动脉闭塞。根据缺血持续时间分为急性（≤2周）和慢性（>2周），以慢性更为常见。由于 CLTI患者血管重建术后 3 年累积截肢或死亡率高达 48.8%，远高于间歇性跛行患者（12.9%）［612］，因此，其临床治疗目标包括降低心血管事件发生及死亡率、缓解肢 体 疼 痛 、促 进 溃 疡 愈 合 、保 肢 及 改 善 生 活质量［554， 590］。

在内科保守治疗无效时，需行各种血管重建手术，可大幅降低截肢率，改善生活质量［554， 590］。血管重建手术应在具有血管腔内治疗和手术旁路血运重建专业技能或快速获得该技能的中心接受治疗，并由多学科团队进行。血管重建手术的目标应定为恢复至少一条足动脉的血流；且在可能或可行的情况下，考虑在血管造影术中靶向开通溃疡解剖区域的动脉；并在术后使用非侵入性床边方法评估灌注的充分性。血管重建手术的方式包括外科手术

治疗［包括动脉内膜剥脱术、人造血管和（或）自体

血管旁路术］、血管腔内治疗和杂交手术，迄今尚无

证据证明哪种手术方式更优。血管腔内治疗具有

微创、高效、可同时治疗多平面病变、可重复性强等优点，是目前 LEAD 的首选治疗方法，特别适用于高龄、一般情况差、没有合适的可供移植的自体血管以及流出道条件不好的 LEAD患者（但当患者腔内治疗风险和收益不成比例时，还是应该避免手术［592］）。血管腔内治疗的方法有很多，目前认为药

物涂层球囊和药物洗脱支架的应用可显著提高远期通畅率［458， 613⁃617］，但存在发生对比剂相关性肾病

的风险，尤其是有潜在或存在肾功能不全的患者，发生率较高且预后较差［590］。但对于需要做腹股沟

下血运重建术且对于两种手术方式（腔内血管成形

术和手术旁路血运重建）都适合的患者，在其有足

够长的单段隐静脉情况下，应优先考虑手术旁路血运重建而非血管内治疗［592］。当出现不能耐受的疼痛、肢体坏死或感染播散，则考虑行截肢手术［590］。

LEAD的三级预防要求临床上做到多学科协作（MDT），甚至在有条件的医疗机构建立多学科融合团队［618］，以应对日益增多的难治性足溃疡。首先由

糖尿病专科医师评估患者全身状况，完善内科诊疗，

尽可能地降低心血管并发症的发生，创造手术时机；

同时评估患者血管条件，创造经皮血管腔内介入治

疗或外科手术治疗条件；血管外科与血管腔内介入

治疗医师一起讨论手术方式，做出术中和术后发生

心血管事件的抢救预案，并且在手术成功后给予随访及药物调整［614， 619］。只有这样，才能最大限度地改善糖尿病性 LEAD患者的血运重建，减少截肢和死亡［620］，而MDT诊所的建设有利于CLTI患者面临的社会经济障碍，缩小这些患者与社会支持丰富、经济基础好的患者之间的治疗效果差异［621⁃622］。

在 CLTI 且无高出血风险的患者，应用低分子肝素联合阿司匹林能显著降低患者血管腔内治疗引起的血管闭塞或再狭窄；或考虑阿司匹林（75~100 mg/d）联合低剂量利伐沙班（2.5 mg，2 次/d）治疗［593］。应该对其中某些技术的风险、并发症和收益进行权衡，例如脊髓刺激虽然能在 1年内缓解疼痛、降低截肢率，但其未见对溃疡愈合的效果、成本高且有并发症可能［591］。

CLTI的治疗流程见图9［590］。五、糖尿病足病

糖尿病足病（DF）是糖尿病患者常见慢性并发症之一，而 DFU 是其最常见的表现形式。DFU 常

合并感染、缺血，治疗难度大、费用高，是导致患者截肢和（或）死亡的独立危险因素之一［579， 623⁃625］。我国 14省市 17家三甲医院的调查结果显示，2018年住院慢性创面的常见原因为糖尿病与感染（均在 25% 左右，前者略多）［626］，2007至 2008年为糖尿病与创伤（分别为 32.6%与 23.8%）［627］，而 1996年糖尿病仅占慢性创面病因的 4.9%［628］，提示目前我国慢性皮肤创面的病因与发达国家相似。我国DFU感染以金黄色葡萄球菌、大肠埃希菌和铜绿假单胞菌常见，其中多重耐药菌约占 20%［629⁃630］。此外，通过队列研究发现，我国 50岁以上糖尿病患者 1年内新发 DFU 的发生率为 8.1%，治愈后的 DFU 患者 1 年内新发DFU的发生率为 31.6%［631］。2010年在 19家三甲医院的截肢人群中，糖尿病足截肢率为

27.3%，占 非 创 伤 和 非 癌 症 截 肢 的 56.5%［632］；2012至 2013年DF总截肢率降至 19.03%（大截肢率

2.14%、小截肢率 16.88%）［633］，年死亡率为14.4%［631］，截肢（包括大截肢和小截肢）后的 5 年死亡率高达 40%［634］。因此，预防和治疗 DFU 可以明显降低糖尿病患者的截

肢率和死亡率以及医疗费用。

I&7$I05$I（一）诊断和分级

DF是指初诊糖尿病或已有糖尿病病史的患者，足部出现感染、溃疡或组织的破坏，通常伴有下肢神经病变和（或）PAD［635］。因此，在所有的糖尿病慢性并发症中，DF是一种相对容易识别、预防比较有效的并

发症。

1. 分类和病因诊断：DFU 可以分为神经性（即压力性）足溃疡、缺血性足溃疡和神经缺血性（即混合性）足溃疡［636］。神经性溃疡常见于足部承重部位（如跖骨头的跖面、胼胝区），伴有感觉缺失或异常而局部血供良好；缺血性溃疡常见于足部非承重部位（如足背外侧、趾尖）而局部感觉正常，但皮肤温度低、足背动脉和（或）胫后动脉搏动减弱或消失；神经缺血性足溃疡在临床上最为常见，兼有神经性与缺血性溃疡特征。由于不同类型DFU的治疗方案明显不同，因此明确DFU的类型非常重要。当溃疡出现在不常见分布部位、有不典型外观或对常规治疗反应不佳时，需要进行鉴别诊断［637］。

2.分级：DF一旦诊断，临床上应该进行分级评估，目前临床上广为接受的分级方法主要是Wagner分级（表 20）和 Texas 分类（表 21）［638］。Wagner分级方法是目前临床及科研中应用最为广泛的分级方法。Texas分类方法从病变程度和病因两个方面对DFU及坏疽进行评估，更好地体现了创面感染和缺血的情况，相对于Wagner分级在评价创面的严重性和预测肢体预后方面更好。近年，国际糖尿病足工作组特别推荐用于医务人员之间沟通的SINBAD系统（表22）［639］。（二）预防 DF 的治疗困难，但预防比较有效，因此，应强

表20 不同Wagner分级糖尿病足的临床特征

Wagner分级 0级

1级

2级

3级

4级

5级

有发生足溃疡的危险因素，目前无溃疡

足部表浅溃疡，无感染征象

较深溃疡，常合并软组织感染，无骨髓炎或深部脓肿深部溃疡，有脓肿伴骨质受累（X线下可见）

局限性坏疽（如趾、足跟等）

全足坏疽

注：CTA为CT血管成像；MRA为磁共振血管成像

图9 严重肢体缺血患者的治疗流程图

1. 糖尿病患者每年应进行全面的足部检查，详细询问既往大血管及微血管病变的病史，评估目前周围神经病变（疼痛、烧灼、麻木感）和下肢血管疾病（下肢疲劳、跛行）的症状及体征，以确定足部溃疡发生和下肢截肢的危险因素（B）

2. 足部检查应包括足部皮肤视诊、评估足部畸形、神经评估（10 g 尼龙丝试验、针刺、温度觉、振动觉试验及踝反射）、血管评估（下肢和足部血管搏动）（B）

3. 糖尿病患者都应该进行综合的足部自我管理教育（B）4. 糖尿病足溃疡（DFU）的治疗不但要强调多学科协作（MDT）诊治，还需要强调分级诊疗、及时转诊，提高保肢率和节省医疗费用（B）

调“预防重于治疗”［640］。糖尿病患者足部病变的预防应包括识别有风险的足、定期检查有风险的足、对患者及家属和医务人员的教育、日常穿合适的鞋、治疗溃疡前兆病变这几个方面［636， 641］。

1. 定期检查糖尿病患者的足并识别有风险的足：对所有糖尿病患者每年进行 1次全面的足部检查，以确定溃疡发生的风险等级。检查内容包括：（1）详细询问病史，包括既往疾病史（心脑血管病变、终末期肾病、小截肢或大截肢）、周围神经病变和周围血管的症状；（2）体格检查，包括皮肤视诊（如是否有畸形、胼胝、溃疡、皮肤颜色变化）、神经评估（10 g尼龙丝试验和针刺或振动觉试验或踝反

射）、血管评估（下肢和足部血管搏动）［640］。根据病史、保护性感觉丧失（LOPS）、PAD、足畸形的症状和体征以及相应的检查，根据国际糖尿病足工作组 2023年指南，明确糖尿病患者的DFU风险等级（0~3级），并制定相应的随访频率（表23）［642］。2.系统的DF相关知识的教育：系统的DF相关知识教育及采取足保护措施，不仅能减少 DF高危患者 DFU 的发生［643］，还能降低 DFU 的截肢率和复发率，提高无溃疡事件的存活率，并能降低医疗费用和提高患者生活质量［636］。

DF患者及其家属的教育内容包括：（1）加强高危患者的日常自我足部保护，例如无论是在室内还是室外，不要赤脚走路、不穿袜子、不穿鞋子和穿薄底拖鞋；每天洗脚，洗脚时的水温要合适，低于 37 ℃（仔细擦干，特别是趾间）；不宜用热水袋、电热器等物品直接保暖足部；避免赤足行走；避免自行修剪胼胝或用化学制剂来处理胼胝或趾甲；涂抹润肤剂；每天换袜子；不穿高过膝盖的袜子；平剪趾甲，两侧不要有过深弧度；每日自我监测 1 次足皮肤温度，能识别早期炎症迹象，如果连续 2 d足相应区域的温差都比温度阈值高 2.2 ℃，应指导患者减少走动并咨询专业医疗人员［644］。（2）向患者提供足部自我保健的结构化教育（例如何时联系医护人员、心理干预的作用等［645］），这些健康教育措施可以使患者早期发现 DFU 的前期病变，加强自我行为管理，并保持足部清洁，是预防DFU发生和复发的重要手段［641， 646］。

3.指导糖尿病患者穿着合适的鞋具：给有DFU风险（足畸形或溃疡前兆）的糖尿病患者穿适合他们足型的鞋，必要时考虑处方超深鞋具、定制鞋和鞋垫和（或）足趾矫形器［647］。给足底溃疡已愈合但仍处于再发 DFU 高风险的患者处方治疗鞋，有助于降低足底的压力；鼓励患者在室内和室外都坚持穿戴；适当运动，逐步增加每日负重活动水平（步行增加 1 000 步/d 是安全的）［643］；定期观察足部状态及足底压力的变化［641］。

4. 危险因素或前兆病变的治疗：对于有 DF 危

表22 糖尿病足溃疡分类和评分的 SINBAD系统

分类

部位

缺血

细菌感染

溃疡面积

深度

总分

定义

前足

中足或后足

足部血流良好；至少可触及1支血管搏动有足部血流减少的临床证据

保护性感觉存在

保护性感觉缺失

<1 cm2

≥1 cm2

溃疡局限于皮肤和皮下组织

溃疡到达肌肉、肌腱或更深处

0 1 0 1 0 1 0 1 0 1 0 1 0~6

表23 DFU风险的评估和随访

等级 0级 1级 2级 3级

溃疡风险非常低低

中等高

无LOPS和PAD

LOPS或PAD

LOPS合并PAD，或LOPS合并足畸形，或PAD合并足畸形

LOPS合并PAD，和以下1个或多个表现：足溃疡史、小截肢或大截肢史、ESRD

检查频率

每年1次

每6~12个月1次

每3~6个月1次

每1~3个月1次（有变化时随时检查）

注：DFU为糖尿病足溃疡；LOPS为保护性感觉丧失；PAD为外周动脉病变；ESRD为终末期肾病

表21 不同Texas分类糖尿病足的临床特征

Texas分类

分级（病变程度）

0级

分期（病因）

A期

B期

C期

D期

完全上皮化的溃疡前病变或溃疡后病变表浅溃疡，未累及肌腱、关节囊或骨质溃疡累及肌腱或关节囊

溃疡累及骨或关节

无感染和缺血

合并感染

合并缺血

感染和缺血并存

险因素或前兆的糖尿病患者，基层医务人员和非 DF 相关专科的医务人员，需及时安排这些患者就诊于 DF及相关专科，及时处治（如减压鞋具、清除胼胝、修剪嵌甲等），必要时手术干预纠正严重的畸形［636， 641］。

DF 的治疗是一个复杂的系统过程，不仅需要多种药物、手术和康复等技术，还需要根据疗效来

及时调整方案，多学科合作有助于改善患者的预后［640， 648］。

1. 在进行 DFU 治疗之前，首先要评估 DFU 性质［554］。神经性溃疡、轻中度缺血性溃疡患者以内

科治疗为主，同时需要制动减压，特别要注意患者的鞋袜是否合适［554］。缺血病变严重的患者应先接

受血管微创介入治疗或手术旁路血运重建手术，待足部血供改善后再进行溃疡局部处理［649⁃650］。

2. 加强患者的护理。对于 DF 患者，需要加强患者生命体征和血糖（必要时行中心静脉压、血气

分析和尿量）等监测。纠正水、电解质和酸碱平衡

紊乱，治疗水肿和营养不良，维持内环境和代谢稳

定。按照深静脉血栓、出血、压疮和麻醉风险分层

评估结果，加强围手术期风险的防范。卧床期间，注意足跟和外踝和对侧肢体的保护［651⁃652］。

3.合理降糖、降压、调脂和抗血小板治疗。4.积极治疗糖尿病性LEAD。5. 合理选择抗生素进行抗感染治疗。DFU 是临床诊断，以局部或全身体征或炎症症状为基础［653］。

（1）抗生素的选择需遵循规范的使用原则，如对于无感染症状、体征的DFU，不用抗生素；对于合并感染的 DFU，应综合考虑病原微生物学特征、患者情况（如既往用药史、机体状态和社会情况）和抗生素特性这 3 个方面，以抗菌谱最窄、使用时间最短、不良反应最少、成本最低和安全性最高为原则［654］。

（2）在选择抗生素控制感染之前，应进行溃疡创面细菌培养和药敏试验，细菌培养方法可选择严格清创后的棉拭子及病理组织培养［655⁃656］。在未得

到细菌培养和药敏试验结果前，可经验性地选择抗

生素。抗生素的替换根据治疗后的临床效果判断，

若临床效果明显，即使药敏试验结果对该抗生素耐

药，也应该持续使用该抗生素；若临床效果不明显

或者无效，且药敏试验结果对该抗生素耐药，则根

据药敏试验结果替换抗生素。对于未合并骨髓炎

的 DFU，抗生素治疗疗程 1~2 周；合并骨髓炎的DFU，抗生素治疗疗程至少 4~6周［653］。如同时合并严重缺血，抗生素使用时间还需要适当延长 1~2 周［639， 657］。但是，如果及时手术去除感染的骨组织，抗生素使用可以减少到 2周［653， 658］。6.合理进行 DFU 的局部处理。彻底清创有利于控制DFU感染和促进溃疡愈合［554］。目前临床上有生物蛆虫清创、超声清创、酶促清创、多聚糖滴剂和葡聚糖高聚体以及水凝胶等方法用于清创［659］。

当清创到一定程度后，可选择溃疡局部负压吸引治

疗（包括真空辅助闭合及真空封闭引流），有利于肉芽生长和DFU的愈合［660⁃662］。当溃疡创面有新鲜肉芽组织，感染基本控制，可以选择生长因子［663］和（或）自体富血小板凝胶治疗［664⁃666］，可加速肉芽生长和 DFU的愈合。当溃疡肉芽生长到一定程度且周边有上皮爬行时，可选择适当的含银敷料［667⁃668］和（或）脱细胞真皮基质［669⁃670］、皮肤替代物［671⁃672］以及脱细胞生物羊膜［673］治疗，促进愈合。

7. 重视足溃疡的减压治疗。全接触石膏是 DFU（尤其足底 DFU）减压的一线方法，甚至作为“金指标”被推荐［674⁃675］。当全接触石膏或其他不可

拆卸助行器使用条件与患者条件相矛盾或患者不

耐受时，考虑临时鞋类、个性化定制鞋垫和鞋、限制站立和行走或用拐杖等干预措施［676］，有助于避免 DFU加重和愈合后的DFU复发［677⁃678］。8. 辅助使用物理治疗。较多的循证医学证据支持了局部氧治疗或全身高压氧治疗能改善 DFU的炎症和微循环状况。例如，在合并 LEAD的缺血性DFU患者，高压氧治疗不能促进创面愈合，但能够降低大截肢率［679］；未合并LEAD的神经性溃疡患者，高压氧治疗既不能加速创面愈合，也不能降低 DFU患者的大或小截肢［680］。全身高压氧治疗能够促进创面愈合且降低截肢率，死亡率无显著差异，

但患者不良事件的发生率显著升高（分别为

17.37% 和 8.27%）［681⁃682］。新近研究发现，局部氧治疗可减少溃疡面积、促进创面愈合，改善愈合的持

久性和生活质量，且不会增加不良事件的发生［683⁃684］。因此，基于现有研究，氧疗对于DFU治疗有效，临床上可以根据患者情况具体考虑；基于不

良事件的发生情况，临床推荐优先考虑局部氧治疗

疗法。

9. 手术是治疗的重要组成部分。对于无溃疡存在的周围神经病变足畸形患者，手术干预对于患

者足的机械稳定、协调足溃疡长期减压和足部保护

具有重要的作用，可以预防 DFU 发生以及促进溃疡愈合［685］。对于部分需要进行截趾或小截肢的 DFU 患者，部分足截肢术仍然是主要的手术方式，它结合解剖功能重建手术能很好地保留残余足的功能［686］。但研究发现，与非手术干预（包括减压、

伤口敷料和药物治疗等）相比，手术治疗（如外科清

创、血管再通和皮肤移植等）虽然能够显著促进创面愈合（分别为 84%和 60%）及缩短愈合时间（分别为 6 周和 12 周），但伴随的不良事件发生率高（如19%的患者发生截肢），因此，临床上是否选择手术干预治疗，需要根据患者的特定因素，充分考虑两者的优、劣势来做出合适的选择［687］。但是，对于合

并严重肢体感染和（或）缺血的患者而言，及早的专业手术治疗是确保其 DFU 愈合、保肢或降低截肢水平的关键性措施，“时间就是组织、就是肢体，甚至就是生命”［688］。

10.及时会诊与转诊。非DF专业的医务人员，应掌握 DF患者会诊或转诊的指征，糖尿病患者一旦出现以下情况，应该立即请血管外科、骨科、创面

外科等相关专科医师会诊，并及时转诊至高级别 DF 诊治中心或有能力救治的医院，包括但不限于［639］：（1）肢体皮肤颜色急剧变化（变红或变白）、皮肤温度急剧变化（变冷或变热）、疼痛加剧、不明

原因进行性加重的肿胀、脓毒血症（甚至休克、意识

丧失）、播散性蜂窝组织炎、坏死性筋膜炎、气性坏疽，以上这些情况需要在 24 h内将患者转诊。（2）新发深大溃疡、原有浅表溃疡恶化并累及骨质或关

节、慢性骨髓炎逐渐加重、部分反复发作的有严重足畸形的足溃疡等。及时会诊与转诊，MDT 诊治有助于提高 DF患者的溃疡愈合率，降低其截肢率和死亡率，并减少医疗费用［640， 648］。

第十五章 儿童和青少年糖尿病

一、儿童和青少年2型糖尿病随着儿童肥胖的增多，2型糖尿病（T2DM）表现出明显的上升趋势。我国一项多中心研究及浙江地区的调查结果均显示，T2DM呈明显上升趋势［689⁃690］。2004 年北京地区 6~18 岁人群 T2DM 患病率为0.6/1 000［691］，浙江地区2007至2013年，5~19岁人群T2DM 平均年龄标化发病率为 1.96/10万［690］。全国14个中心的调查数据显示，2005至 2010年间，儿童T2DM患病率为10.0/10万［689］。因肥胖在1型糖尿病（T1DM）患儿中不少见，有时儿童和青少年 T1DM

和 T2DM难以鉴别，另外还有可能与青少年起病的成人型糖尿病（MODY）等其他特殊类型糖尿病混淆。

低体重（<18.5）

正常体重（18.5~24.9）超重（25.0~29.9）

肥胖（≥30.0）

孕期体重增加总量（kg）

12.5~18.0

11.5~16.0

7.0~11.5

5.0~9.0

妊娠中晚期体重增加平均速率［kg/周，均值（范围）］

0.51（0.44~0.58）

0.42（0.35~0.50）

0.28（0.23~0.33）

0.22（0.17~0.27）

注：BMI为体重指数

素抵抗，导致的餐后血糖升高更为显著的特点，预混胰岛素应用存在局限性，不作为常规推荐。

（2）二甲双胍：除二甲双胍外，其他口服降糖药均不推荐应用于孕期。多项二甲双胍与胰岛素在妊娠期应用的头对头研究提示，使用二甲双胍在控制餐后血糖、减少孕妇体重增加及新生儿严重低血糖发生方面均有益处［823⁃824］；孕早期二甲双胍暴露并不增加任何先天畸形的风险［825⁃828］。应用二甲双胍治疗的育龄期 T2DM 患者以及严重胰岛素抵抗使用二甲双胍治疗的 PCOS患者，可在服用二甲双胍的基础上妊娠，孕后是否停用二甲双胍，需视血糖及患者意愿综合判断。我国尚无妊娠期使用二甲双胍的适应证，但可在充分知情同意基础上，酌情使用。二甲双胍的起始剂量是 500 mg/d，最大剂量 2 000 mg/d［809］。二甲双胍不应该用于伴有高血压、先兆子痫、胎儿生长受限的孕妇［829］。

7.HIP 的产后管理：（1）鼓励母乳喂养，哺乳期如果需要药物控制血糖，首选胰岛素，知情同意后可考虑口服二甲双胍［830⁃831］。（2）由于导致胰岛素抵抗的胎盘娩出，建议产后 GDM 停用胰岛素，PGDM和ODM胰岛素剂量至少减少 1/3，之后再依据产后的血糖水平决定下一步降糖方案。（3）PGDM 产后管理同普通糖尿病人群，ODM 产后需要重新评估糖尿病类型及糖代谢状态。（4）HIP 对母儿两代人的影响不因妊娠终止而结束［832］，GDM 患者需产后4~12周行 75 g OGTT 评估糖代谢状态，产后 1年再次行 75 g OGTT评估糖代谢状态，无高危因素者每1~3年筛查1次OGTT。四、老年糖尿病

老年糖尿病是指年龄≥60 岁［世界卫生组织（WHO）标准≥65 岁）］，包括 60 岁及以前和 60 岁以后诊断的糖尿病患者，具有患病率高、起病隐匿、异质性大、危害大等特点。根据 2022 年国家统计局发布的数字，截至 2021 年末，我国≥60 岁老年人口达 2.67 亿（总人口的 18.9%）［833］。老年人群糖尿病的患病率高。2021年国际糖尿病联盟糖尿病地图（第10版）显示，全球75~79岁年龄段人群糖尿病患病率达 24.4%［834］。2015至 2017年我国流行病学调查数据显示，60~69岁糖尿病患病率为 28.8%，糖尿病前期患病率为 47.8%；≥70 岁的人群糖尿病患病率为 31.8%，糖尿病前期的患病率为 47.6%；与其他年龄段相比，60 岁以上年龄段的糖尿病患病率及糖尿病前期患病率均最高，老年女性糖尿病患病率

高于男性［7］。老年人群是糖尿病防治的重点对象，老年糖尿病的治疗目标是减少急、慢性并发症导致的伤残和死亡，改善生存质量，提高预期寿命。

（二）老年糖尿病的特点

1.T2DM是老年糖尿病的主要类型。2.老年糖尿病患者异质性大，其患病年龄、病程、身体基础健康状况、各脏器和系统功能、并发症与合并症、合并用药情况、经济状况及医疗支持、治疗意愿、预期寿命等差异较大［835］。

3.60 岁以前诊断的老年糖尿病患者糖尿病病程较长，合并糖尿病慢性并发症及合并症的比例高。60 岁以后的新发糖尿病患者症状多不典型，血糖相对易于控制，糖尿病并发症的比例相对较低，但合并多代谢异常及脏器功能受损的情况多见［836］。因此，应重视对老年糖尿病患者的全面综合评估以及并发症、合并症的筛查。

4.随着年龄的增长，老年糖尿病患者的日常生活能力下降，听力、视力、认知能力、自我管理能力降低，运动能力及耐力下降，加之肌少症、骨量丢失及平衡能力下降，更容易出现运动伤、跌倒及骨折［837］。

5.老年糖尿病患者急性并发症症状不典型，易于误诊或漏诊。

6. 老年糖尿病患者发生低血糖的风险增加且对低血糖的耐受性差，更容易发生无意识低血糖、夜间低血糖和严重低血糖，出现严重不良后果［838］。

7. 老年糖尿病患者常伴有动脉粥样硬化性心血管疾病（ASCVD）危险因素的聚集，如肥胖、血脂 要点提示：

1. 对老年糖尿病患者应该进行包括基本健康状态、心理、功能等在内的综合评估，根据健康状态分层以及是否应用有低血糖风险的药物制定个体化的综合治疗、护理及康复策略（A）

2. 对老年糖尿病患者应该进行老年综合征的筛查（B）3.对 65岁以上的老年糖尿病患者在初诊时及以后每年的随访中，应进行轻度认知功能减退或痴呆的早期筛查（B）

4. 老年糖尿病患者动脉粥样硬化性心血管疾病（ASCVD）风险更高，易伴多种并发症、合并症、多脏器功能减退及老年综合征，应重视包括全身健康状态在内的综合评估及管理（A）

异常、高血压、高尿酸血症、高凝状态、高同型半胱氨酸血症等，心、脑、下肢血管等大血管病变的患病率高［839］。

8.老年糖尿病患者易合并肿瘤、呼吸系统疾病和消化系统疾病等。

9.老年糖尿病患者常多病共存，需要服用多种治疗药物，需要关注和了解药物间的相互作用和影响，避免不合理用药［840］。

（三）老年糖尿病的并发症

1.急性并发症：包括HHS、DKA及乳酸酸中毒。

部分老年糖尿病患者以HHS为首发症状。DKA多因停用胰岛素或感染、外伤等应激情况诱发。乳酸酸中毒常见于严重缺氧及肾功能不全的患者。血糖、渗透压、酮体、血气分析及乳酸检测有助于鉴别诊断。老年糖尿病急性并发症死亡率较高，需要及时启动胰岛素治疗。

2.慢性并发症：糖尿病大血管病变以动脉粥样硬化为病理基础，主要包括心、脑及下肢血管病变。

其主要特点为：虽然症状相对较轻或缺如，但病变范围广泛且严重，治疗困难、预后差，是老年糖尿病伤残和死亡的主要原因。随着增龄及糖尿病病程增加，微血管病变患病率逐渐增高。DR常见，但因多伴有白内障使DR的实际诊断率下降。老年糖尿病肾损害是多种危险因素共同作用的结果，血肌酐水平不能准确反映肾功能状态，需要计算估算的肾小球滤过率（eGFR）。老年糖尿病患者神经系统损害常见，包括中枢神经系统病变和周围神经病变。

3.低血糖：老龄是发生严重低血糖的独立危险因素。老年糖尿病患者发生低血糖的风险增加，加之感知低血糖的能力和低血糖后的自我调节和应对能力减弱，更容易发生无意识低血糖、夜间低血糖和严重低血糖，出现临床不良后果（如诱发心脑血管事件、加重认知障碍），甚至死亡［841］。伴有认知功能障碍、自主神经病变（DAN）、服用β受体阻滞剂或有反复低血糖发作史的患者，尤其需要警惕严重低血糖的发生，应适当放宽血糖的控制目标，尽量选用低血糖风险低的降糖药物，并严密监测血糖变化。

4.老年综合征：老年糖尿病患者易出现包括跌倒、痴呆、尿失禁、谵妄、晕厥、抑郁症、疼痛、睡眠障碍、药物滥用、帕金森综合征、压疮、便秘、营养不良、听力障碍和衰弱综合征等在内的老年综合征，严重影响患者的生活质量和预期寿命，增加了糖尿病管理的难度［842］。对此类患者，更需要全面评估后慎重考虑治疗获益与风险的平衡，确定以改善生

活质量为主的安全治疗策略。

5.老年糖尿病患者骨折风险增加［843］。6.老年糖尿病患者抑郁症的发生率明显增加，建议对 65岁以上的糖尿病患者每年进行 1次筛查，并予以相应处理［839， 844］。

7.老年糖尿病患者痴呆的发生率明显增加，建议对 65 岁以上的糖尿病患者，初诊时及以后的随诊中，每年进行1次认知功能的筛查［839， 845］。（四）老年糖尿病的治疗

老年糖尿病患者的健康综合评估是确定个体化血糖控制目标和治疗策略的基础，并根据评估结果以及是否应用有低血糖风险的药物决定糖尿病管理的治疗目标和路径，若老年糖尿病患者使用低血糖风险较高药物，HbA1c控制目标不应过低，并应设立明确的血糖控制目标下限，降低患者低血糖发生风险，血脂、血压的管理也应设置下限［839， 846⁃847］。

患者的健康状态及患者和照护者的意愿也是制定个体化治疗方案的重要考虑因素。

老年糖尿病患者的综合控制目标见表 30。健康教育、合理饮食、安全有效的运动应该贯穿老年糖尿病治疗的全程。生活方式干预是老年糖尿病患者的基础治疗，所有的老年糖尿病患者均应接受个体化的生活方式指导及治疗。根据患者的降糖目标、目前血糖情况、重要脏器功能、并发症与合并症、低血糖风险、衰弱状态、体重、治疗意愿和经济承受能力等因素制定合理、便利、安全可行的降糖方案。可以优先考虑不易出现低血糖的口服降糖药物，如二甲双胍、α⁃糖苷酶抑制剂、二肽基肽酶Ⅳ抑制剂（DPP⁃4i）等［835］。对没有禁忌证的老年糖尿病患者，合理使用 GLP⁃1RA 和 SGLT2i 在降糖的同时可能具有改善心、肾结局的作用。合并 ASCVD 及高危因素的老年 T2DM 患者，应首选有ASCVD 获益证据的 SGLT2i 或 GLP⁃1RA；合并 HF或 CKD 的老年 T2DM 患者，应首选 SGLT2i；合并CKD 的老年 T2DM 患者，若无法耐受 SGLT2i，也可选择有CKD获益证据的GLP⁃1RA［846］。年龄不是使用二甲双胍的禁忌证［848⁃849］。对使用上述药物血糖难以达标、患者自我管理能力较强及低血糖风险可控的患者，酌情使用胰岛素促泌剂，如磺脲类药物和格列奈类药物。但应尽量避免使用降糖效果很强、作用时间很长、低血糖纠正困难、可能给患者带来严重不良后果的药物，如格列本脲。要根据患者特定的身体状况避免使用可能对患者造成潜在不良影响的药物。肾功能不全的患者要慎用主要经

由肾脏排泄的药物；HF 的患者要慎用加重心脏负荷的药物；骨质疏松的患者要慎用影响骨代谢的药物；严重缺氧状态下要慎用可能导致乳酸增加的药物等［840］。此外，如必须使用对比剂，要鼓励患者在用药前后多饮水，并短期停用二甲双胍［849］。使用胰岛素时，要充分考虑患者胰岛素治疗的获益、使用的便利性和可能出现的问题，还需要斟酌患者的视力、双手配合精细操作的能力、出现低血糖时的自我应对能力等因素。对空腹血糖升高为主的患者，应首选基础胰岛素治疗；如空腹及餐后血糖均升高，可选择预混胰岛素及其类似物或基础胰岛素联合餐时胰岛素治疗［850］。应及时评估患者的健康状态并调整降糖治疗目标和用药方案，根据需要将复杂的治疗方案进行简化，对获益不明确的患者应考虑去强化治疗。

对患者的人文关怀意味着必须从患者的角度思考医疗行为。老年糖尿病患者的评估和治疗复杂，涉及多方面的因素，需要全面慎重考虑治疗获益与风险，既要避免因过度强调治疗安全性问题而放松对老年糖尿病的血糖管理，又要避免过度治疗可能出现的问题及带给患者的负担。

五、阻塞性睡眠呼吸暂停与高血糖

阻塞性睡眠呼吸暂停（OSA）是指在睡眠中因上气道阻塞而反复出现呼吸暂停，表现为口鼻腔气流停止而胸腹呼吸存在，从而导致血氧饱和度降低，并反复出现睡眠中短暂觉醒的睡眠呼吸疾病。OSA是 T2DM常见的共病之一，可累及多系统并造成多器官损害，近年来发病呈上升及年轻化趋势。

表30　根据健康状况分层的老年糖尿病患者的血糖、血压、血脂综合控制目标

健康状况分层

健康 a

复杂或中等程度的健康 b

非常复杂或健康状况较差 c

评估

较长的预期寿命

中等长度的预期寿命，高治疗负担，低血糖风险较高，跌倒风险高

有限的预期寿命，治疗获益不确定

<130/80

<140/90

<150/90

使用他汀类药物，除非有禁忌证或不能耐受使用他汀类药物，除非有禁忌证或不能耐受

评估使用他汀类药物的获益（二级预防为主）

血糖

治疗分层

未使用低血糖风险较高药物使用低血糖风险较高药物未使用低血糖风险较高药物使用低血糖风险较高药物未使用低血糖风险较高药物使用低血糖风险较高药物

HbA1c目标 d（%）<7.5

7.0~7.5

<8.0

7.5~8.5

<8.5

8.0~8.5

空腹或餐前血糖（mmol/L）

5.0~7.2

5.0~8.3

5.6~8.3

5.6~10.0

睡前血糖（mmol/L）

8.3~10.0

6.1~11.1

8.3~13.9

注：HbA1c为糖化血红蛋白；1 mmHg=0.133 kPaa健康：合并较少的慢性疾病，完整的认知和功能状态

b复杂或中等程度的健康：多种（≥3种）并存的慢性疾病，或 2项以上工具日常生活活动能力受损，或轻度认知功能障碍或早期痴呆，其中并存的慢性疾病需要达到药物或生活方式干预的程度，包括关节炎、肿瘤、充血性心力衰竭、抑郁症、肺气肿、跌倒、高血压、失禁、3期以上慢性肾脏病、心肌梗死、卒中

c非常复杂或健康状况较差：需要长期护理，慢性疾病终末期，或 2项以上日常生活活动不能独立完成，或中度至重度的认知功能障碍或痴呆，其中慢性疾病终末期是单一的终末期慢性疾病，3~4期充血性心力衰竭、氧依赖性肺疾病、需要透析的慢性肾脏病、不能控制的转移癌，可导致明显的症状或功能受损，明显减少预期寿命

d更低的HbA1c治疗目标仅适用于没有反复或严重低血糖或没有治疗负担的个体；HbA1c为 8.5%相当于平均血糖水平11.1 mmol/L，不推荐更宽松的超过 8.5%的HbA1c控制目标，因为患者会更频繁地暴露于高血糖，导致急性并发症（如尿糖、脱水、高渗性高血糖状态、伤口不愈合等）发生风险增加

1. 阻塞性睡眠呼吸暂停（OSA）与 2 型糖尿病（T2DM）风险增加相关，也是糖尿病进展的独立危险因素（B）2. T2DM 患者合并 OSA 发生率高、知晓率低，建议对T2DM患者进行OSA的筛查（B）3. 对 T2DM 合并 OSA 患者应制定个体化的治疗方案，除无创正压通气（NPPV）以外，也可以选择胰高糖素样肽⁃1 受体激动剂（GLP⁃1RA）等药物，在改善 OSA 的同时有助于减轻体重和提高胰岛素敏感性（B）

（一）病理生理改变

一方面，OSA 可导致间歇性缺氧和睡眠碎片化，进而增加交感神经兴奋性、诱发氧化应激、激活炎症通路、造成下丘脑⁃垂体⁃肾上腺轴改变，生物钟节律紊乱，是胰岛β细胞功能受损、胰岛素抵抗、糖耐量减低（IGT）和 T2DM 的独立危险因素［851⁃853］。T2DM合并OSA会导致并发症风险增加，如心血管疾病（CVD）、DKD 和 DR 等［854⁃857］。另一方面，高血糖可抑制颈动脉感受器敏感性，糖尿病自主神经病变可影响上气道神经反射和呼吸中枢，从而增加 T2DM患者OSA风险。T2DM与OSA互为独立危险因素，并与病情严重程度呈正相关［858］。此外，作为 T2DM和OSA共同的危险因素，肥胖可通过氧化应激和解剖结构对两者造成多方面影响，是疾病管理中的重点［859⁃860］。

（二）糖尿病合并OSA的患病率糖尿病患者中 OSA 的患病率显著高于一般人群。国外资料显示，T2DM患者合并OSA的发病风险约比非 T2DM 患者高约 50%［861⁃864］。国内研究结果显示，住院 T2DM 患者 OSA 的患病率在 60% 以上，且中重度OSA患者占比超过 30%［865⁃866］，肥胖的T2DM 患 者 OSA 的 患 病 率 明 显 升 高 ，可 达86%［867⁃868］。（三）OSA的筛查T2DM 患者合并 OSA 发生率高、知晓率低，推荐对有以下症状的糖尿病人群进行OSA筛查，包括打鼾、白日嗜睡、肥胖（尤其腹型肥胖）、严重胰岛素抵抗、血糖变异度大、顽固难治性高血压（以晨起高血压为突出表现）、夜间心绞痛、难以纠正的心律失常、顽固性充血性心力衰竭、反复发生脑血管疾病、癫痫、认知功能障碍、夜尿增多、胃食管反流、不明原因的慢性咳嗽、红细胞增多症和 OSA家族史等。同时需要关注患者是否使用相关精神药品（如苯二氮䓬类），是否有吸烟饮酒史。在查体时除 BMI之外，应考虑脂肪分布（如腹型肥胖）的影响，应测量腰围、臀围及颈围［869⁃870］。睡眠筛查问卷所能提供的诊断价值有限，如果高度怀疑 T2DM患者合并严重 OSA，必要时可考虑直接进行多导睡眠监测（PSG）［871］。（四）OSA的诊断1.OSA诊断标准［872］：OSA的诊断主要依赖相关症状及睡眠监测。对于成人 T2DM患者，睡眠期间或记录时间内，每小时出现 5次以上以阻塞为主的“呼吸事件”，即呼吸暂停低通气指数（AHI）或呼吸

紊乱指数≥5次/h，即可诊断OSA。典型症状包括日间嗜睡、疲劳、失眠、鼾声响亮、呼吸暂停、苏醒时喘憋感、睡眠后无法恢复活力等。“呼吸事件”包括阻塞或混合性呼吸暂停、低通气和呼吸努力相关性觉醒。“睡眠呼吸暂停事件”定义为睡眠过程中口鼻呼吸气流信号幅度值下降≥90% 基础值，持续时间≥10 s。“低通气”定义为睡眠过程中口鼻气流较基线水平降低≥30% 并伴动脉血氧饱和度较基线下降≥4%，持续时间≥10 s；或口鼻气流较基线水平降低≥50%并伴动脉血氧饱和度下降≥3%或伴有微觉醒，持续时间≥10 s。呼吸努力相关性觉醒指未达到呼吸暂停或低通气标准，但有时间≥10 s 的异常呼吸努力并伴有相关微觉醒。AHI 指平均每小时呼吸暂停与低通气的次数之和。呼吸紊乱指数是平均每小时呼吸暂停、低通气和呼吸努力相关性觉醒事件的次数之和。OSA 按照严重程度分为 3 级，包括：轻度 OSA：5 次/h<AHI≤15 次/h；中度：15 次/h<AHI≤30次/h；重度：AHI>30次/h。2.OSA 的诊断方法：（1）PSG：整夜 PSG 是确诊OSA 的“金标准”，可进行严重程度分级，定量评估睡眠结构、睡眠中呼吸紊乱及低氧情况、心电图及血压的变化，识别同时存在的其他睡眠呼吸障碍。

（2）家庭睡眠呼吸暂停监测［873］：便携式睡眠监测设备操作简单易行，允许患者在多种场景下进行睡眠监测，可由内分泌科医技人员在门诊或病房进行检查和初步判读。选择设备时应包括鼻压力、胸腹部呼吸感应体积描记及血氧测定等传感器。如家庭睡眠呼吸暂停监测阴性、但临床仍怀疑 OSA，应行PSG检查以明确诊断。（3）新型诊断技术：一些可穿戴和非可穿戴设备可用于持续记录患者在睡眠期间的生理信号，如呼吸、心电信号、下颌肌电等信息，并且可以进行多个夜晚连续监测。新型诊断技术基于这些数据开发的深度学习算法在预测 AHI方面具有一定价值［874］，未来将有助于内分泌科医技人员的OSA诊疗工作。（五）糖尿病合并OSA的治疗1.生活方式干预：优化生活方式是OSA管理的关键部分［875］。鼓励患者戒烟、戒酒，戒辛辣刺激食物以免气道水肿、通气不畅加剧。综合患者的代谢目标制定合理膳食有助于改善 OSA［876］。慎用镇静催眠药物以免加重上气道的塌陷和降低呼吸中枢敏感性。有些OSA是体位依赖性的，侧卧位睡眠和适当抬高床头可在一定程度上缓解 AHI［877］。有研究表明，运动可改善OSA严重程度和相关症状，联

合进行抗阻运动和有氧运动的效果优于单纯有氧运动［878］。

2. 减重：体重下降与 AHI 降低有密切关系，减重对于OSA以及糖尿病的治疗都有积极作用，同时能够使其他治疗方式发挥更好的效果［879］。肥胖 T2DM合并OSA患者减重手术效果显著，术后大部分患者OSA症状和AHI均得到缓解［880］。3.药物治疗：肠促胰素类降糖药对于OSA改善有显著作用。GLP⁃1RA 类药物（如利拉鲁肽）在减轻 体 重 的 同 时 可 使 AHI 显 著 下 降［881］。 其 他GLP⁃1RA 类 药 物 也 可 能 有 类 似 的 获 益［882］。SURMOUNT⁃OSA 研究结果显示，在肥胖合并中重度OSA患者中，葡萄糖依赖性促胰岛素多肽（GIP）/GLP⁃1 双受体激动剂替尔泊肽（Tirzepatide）治疗52周时，与安慰剂相比，平均减少AHI达62.8%［883］。GLP⁃1RA 或 GIP/GLP⁃1 双受体激动剂类降糖药物不仅能改善OSA的症状，还有调节其他代谢风险因素的潜在获益，对有适应证的T2DM合并OSA患者可作为优先选择。选择常用降糖药物时应尽可能使用不增加体重的药物，对于低氧血症严重者慎用或禁用双胍类药物。此外，SGLT2i 类降糖药可降低OSA在T2DM人群中的相对风险［884］。4. 改善 OSA 的治疗：无创正压通气（NPPV）是OSA患者的一线治疗，无绝对禁忌证。国内外多项研究结果均显示，NPPV 中的持续气道正压通气（CPAP）模式治疗可以部分改善OSA合并 T2DM患者的胰岛素抵抗，降低 HbA1c、空腹及餐后血糖、改善血糖波动。但 CPAP不耐受的情况较为常见，对于压力过高或有其他特殊情况者，可考虑双水平气道正压通气或自动 CPAP［885］。同时，对患者在NPPV治疗中出现的依从性和不良反应等问题应需寻找原因积极处理［886］。

5. 积极治疗其他导致 OSA 的疾病：如对甲状腺功能减退症所致 OSA 进行甲状腺激素补充治疗。需要解除上气道梗阻的患者必要时可考虑气道手术治疗，上颌骨前移、鼻咽各平面手术以及多级分期手术等。舌下神经刺激治疗可减少吸气时气道塌陷，对特定患者有一定效果。口腔矫治器相对经济，可用于不能耐受 CPAP治疗的轻度至中度患者［877］。

糖尿病与OSA均为复杂异质性疾病且互相影响，应加强医务人员对两病共存的认识，充分考虑患者的主诉与感受、疾病的病理生理特点及严重程度，从多方面进行干预和治疗，实现精准治疗。治疗OSA有利

于改善糖尿病患者的血糖控制，而治疗糖尿病及其并发症（如DAN）也有利于改善OSA的病情。六、糖尿病与感染

糖尿病容易并发各种感染，细菌感染最为常见，真菌及病毒感染也易发生于血糖控制不佳的糖尿病患者。糖尿病并发感染可形成一个恶性循环，即感染导致难以控制的高血糖，而高血糖进一步加重感染。糖尿病患者手术部位的感染概率大。感染可诱发糖尿病急性并发症，也是糖尿病的重要死因之一。

（一）糖尿病患者常见的感染类型

1.呼吸道感染：肺炎常见的致病菌包括葡萄球菌、链球菌及革兰阴性菌。糖尿病患者是肺炎球菌感染的菌血症的高风险人群。流感病毒、呼吸道合胞病毒和新型冠状病毒是重症社区获得性肺炎的常见病原［887⁃890］。毛霉菌病及曲霉病等呼吸道真菌感染亦多见于糖尿病患者。糖尿病患者发生院内菌血症的风险很高，病死率高达 50%。2.泌尿生殖系统感染：糖尿病患者无症状菌尿及其他尿路感染的风险增加［891⁃892］。有时可导致严重并发症，如肾盂肾炎、肾及肾周脓肿、肾乳头坏死和败血症。常见的致病菌是大肠杆菌及克雷伯杆菌，其次为革兰阳性球菌和真菌。糖尿病与霉菌性生殖器感染（女性多数为阴道炎，男性多数为龟头炎）的风险增加相关［893⁃894］。

3.结核：糖尿病患者结核的发生率显著高于非糖尿病患者，其影像学表现常不典型。

4. 消化系统感染：糖尿病患者感染幽门螺杆菌［895］、肝炎病毒（包括乙型肝炎病毒和丙型肝炎病毒）的风险更高［896⁃897］。糖尿病也是肝脓肿发生的重要危险因素。

5.其他感染：皮肤葡萄球菌感染是糖尿病患者的常见感染之一，多见于下肢。足部溃疡的常见致病菌包括葡萄球菌、链球菌、革兰阴性菌及厌氧菌。

糖尿病患者牙周炎的发病风险增加，易导致牙齿松动，糖尿病合并颌面部感染亦不少见。外耳炎常见，但常被忽略。糖尿病也增加了慢性骨髓炎的感染风险。

（二）糖尿病合并感染的防治

1.预防：良好的血糖控制，加强自身卫生及必要的免疫接种，在一定程度上可有效预防严重感染的发生。根据情况必要时进行流感、肺炎球菌等疫苗接种，以减少住院和死亡风险，但注意避免接种减毒活疫苗［898］。

2.治疗：严格控制血糖为首要措施，胰岛素治疗为首选；进行有效的抗感染治疗，并根据药物敏感试验结果，及时调整抗生素的种类，并进行早期、足量、联合、足疗程抗感染治疗以彻底控制感染；必要时行外科手术治疗。

七、糖尿病与口腔疾病

糖尿病与口腔疾病呈相互影响的双向关系［899⁃906］。一方面，糖尿病是口腔疾病发生的危险因素，糖尿病患者的唾液量减少、流率减慢，唾液内葡萄糖浓度升高，唾液 pH值下降，使口腔的自洁力下降，口腔内环境改变，易引起各种病原微生物的滋生和繁殖，导致口腔发生多种疾病（如舌炎、口腔黏膜炎、龋病等）。另外，糖尿病患者有着特异性的血管病变，血糖升高，血小板黏附、聚集增强，抗凝血因子减少，红细胞脆性增加，造成牙龈等口腔组织缺血缺氧，血管内皮损伤，容易受到细菌及其产物（如内毒素）的侵袭。同时，糖尿病患者伤口愈合障碍，导致口腔病变迁延难愈。急性感染（如颌面部间隙感染）若不及时治疗可能危及生命。另一方面，口腔疾病是T2DM及GDM发病的重要危险因素，对糖尿病患者的血糖控制有负面影响［904， 907⁃910］，当这些问题控制后，糖尿病病情可以得到改善［899， 901， 911⁃913］。

（一）糖尿病口腔疾病的种类

1. 牙龈炎和牙周炎：糖尿病患者易患牙周疾病，表现为牙龈肿胀充血、水肿、疼痛，牙周部位可发生牙周脓肿、牙周袋形成，并有脓性渗出。T2DM（尤其是血糖控制不佳）是牙周病的危险因素。同时，牙周病亦会影响血糖控制。T1DM和GDM也增加牙周病患病风险［914］。

2.口腔黏膜病变：糖尿病患者唾液减少，表现为口腔黏膜干燥，失去透明度，有触痛和烧灼痛，味觉障碍。由于口腔黏膜干燥，自洁能力下降，易受到微生物侵入，临床多见感染性口炎、口腔白色念珠菌病、口腔扁平苔藓［915］、口腔白斑病［916］。部分糖尿病患者因口干首诊于口腔黏膜病科。

3.龋齿：龋齿在糖尿病患者中普遍存在。糖尿

病患者唾液质和量发生改变，自洁能力下降，助长

菌斑形成和黏附在牙齿表面上。

4.牙槽骨吸收和牙齿松动脱落：糖尿病患者龋缘出现肉芽肿及牙周袋形成，牙周袋内可有积脓，

随之牙齿周围齿槽骨吸收，导致牙齿松动、脱落。

随患者年龄增大，牙槽骨吸收和牙齿松动脱落现象

更为普遍。

5.颌骨及颌周感染：口腔颌面部有互相连通的筋膜间隙，上至颅底，下达纵隔，内含疏松结缔组

织，抗感染能力弱，在发生化脓性炎症时可以迅速

蔓延。进展的龋齿根尖炎及齿龈炎极易波及颌骨

及颌周软组织。糖尿病患者免疫机能下降致炎症

扩展更加严重，出现皮肤红肿、局部剧烈疼痛、张口受限、高热、白细胞计数升高，可诱发DKA。（二）糖尿病口腔疾病的防治

1.一般治疗：保持口腔环境清洁，去除局部刺激因素，如牙石、不良修复体、用口呼吸、食物嵌塞

等。保持口腔卫生有助于减少感染。提倡患者养

成良好的卫生习惯，定期进行口腔检查。

2.控制血糖：加强血糖控制有助于口腔病变的治疗。糖尿病患者在进行外科手术或种植牙前，控制好血糖至关重要［900］。

3.控制感染：因口腔颌面部感染极易扩散，对牙龈炎、颌面部感染等应积极控制，防止炎症进一

步蔓延导致病情恶化，可在病原微生物检查的基础

上选择合适的抗生素。

4.手术治疗：存在牙周脓肿、急性牙髓炎、口腔颌面部蜂窝织炎的患者，需要切开引流，避免病情

加重。其他手术治疗包括拔牙、根管治疗术、牙结扎固定术等［917］。

5.对症、支持治疗：中药外敷缓解症状，维持水电解质平衡等。

八、糖皮质激素与糖尿病

（一）糖皮质激素与糖尿病风险

糖皮质激素通过增加中心型肥胖和胰岛素抵抗导致类固醇糖尿病［918］。类固醇糖尿病的发生、

发展与糖皮质激素使用剂量和时间密切相关。外

源性糖皮质激素应用与内源性皮质醇分泌过多均可引起血糖增高［919］。一项荟萃分析显示，在既往无糖尿病的患者中，糖皮质激素治疗超过 1个月后高血糖发病率约为 32%，糖尿病发病率为 19%［920］；长期局部外用糖皮质激素也可增加糖尿病发生风险［921］；尤其是血管并发症风险增加，包括CVD发病率和死亡率的增加［922⁃923］。

1. 糖尿病可引起或加重牙周病、口腔黏膜病变、龋齿、牙槽骨吸收、牙齿松动脱落、颌骨及颌周感染等多种口腔疾病（A）

2.口腔疾病的有效处理有利于血糖控制（B）

（二）类固醇糖尿病的临床特点

类固醇糖尿病的典型临床特点为：（1）发病较快，既往无糖尿病史者在糖皮质激素治疗后平均约 6 周可出现 IGT；（2）肾糖阈降低，血糖值与尿糖值不成比例；（3）起病隐匿，多在血糖筛查时发现，病情较轻者不易并发酮症；（4）对胰岛素治疗的反应不一，部分患者需要更大剂量的胰岛素方可有效控制血糖［924］；（5）停药反应，停用糖皮质激素后高血糖多能缓解，仅部分无法恢复；（6）具有时间性，类固醇糖尿病常以午餐后至睡前血糖升高为主，空腹血糖受影响较少［925］。研究显示，既往无糖尿病史人群长期使用中等剂量的糖皮质激素会导致机体增加胰岛素分泌来代偿，而长期使用超剂量糖皮质激素患者，75%~80%会出现 IGT，10%~15%最终会进展为糖尿病［919］。

（三）糖皮质激素导致血糖升高的机制

糖皮质激素可通过多种病理生理学机制导致高血糖，包括：（1）糖皮质激素促进肝脏糖异生增加［926］；（2）糖皮质激素促进蛋白质分解致骨骼肌量丢失，导致胰岛素抵抗［927］；（3）促进脂肪重新分布，循环游离脂肪酸增高，细胞内脂质沉积，加重胰岛素抵抗［928］。

（四）类固醇糖尿病的临床筛查策略

类固醇糖尿病属于特殊类型糖尿病，其诊断标准与 T2DM 相同，在开始糖皮质激素治疗前，应评估患者易患类固醇糖尿病的相关危险因素，包括年龄、BMI和家族史，并应筛查血糖情况，包括空腹血

糖和HbA1c［929］。既往无糖尿病史者，在起始中等剂量糖皮质激素治疗前 3 d，建议监测餐前和餐后血糖；若患者在住院期间或既往有糖尿病病史，应增加血糖监测频率［930］。与空腹血糖相比，糖皮质激素对餐后血糖的影响更为显著。临床上最常采用的清晨一次激素疗法常引起午餐后至睡前血糖升高，夜间血糖逐渐下降，空腹血糖可以正常。使用糖皮质激素或相关疾病患者，推荐在午、晚餐前或午、晚餐后 1~2 h筛查血糖，如发现血糖异常则开始每日 4次以上（三餐前、睡前）的血糖监测。随着疾病进展或糖皮质激素持续使用，患者空腹血糖也会逐渐增高。短期应用糖皮质激素的患者，停药后血糖可逐渐恢复。而对于长期接受外源性糖皮质激素治疗或内源性糖皮质激素增多疾病（如库欣综合征）患者，在停药或原发病治疗后仍然有持续高血糖风险。停用糖皮质激素 6 周后检测空腹血糖或OGTT，即可判断是否演变为持续性糖尿病，而HbA1c会因近期产生的高血糖影响结果准确性，可于 停 用 糖 皮 质 激 素 3 个 月 后 检 测 HbA1c 进 行评估［931］。

（五）类固醇糖尿病的治疗方案与控制目标

类固醇糖尿病确诊后应首先进行糖尿病教育。

生活方式干预包括饮食和运动治疗，应根据患者的具体情况制定个体化方案。对于所有应用外源性糖皮质激素者，应在病情控制的前提下尽量采用最小有效剂量。对于由原发疾病导致内源性糖皮质激素分泌过多者，控制血糖的同时应尽可能根除原发疾病（如治疗库欣综合征），以纠正皮质醇增多的病理生理改变。不论采取何种治疗方案，其血糖控制目标均推荐为餐前血糖 <7.0 mmol/L，2hPG<10.0 mmol/L，HbA1c<7.0%。重症患者可放宽为随机血糖<15 mmol/L［931］。1.非胰岛素类药物治疗：对于血糖轻度或中度升高（随机血糖在 11.1 mmol/L 以下）的患者，可使用非胰岛素降糖药。对于短期应用糖皮质激素引起血糖轻度升高者，其口服降糖药物宜选择起效迅速和降低餐后血糖为主的药物，如阿卡波糖、格列奈类药物等。

2.胰岛素治疗：胰岛素为类固醇糖尿病的首选降糖药物［918⁃919， 925］。接受糖皮质激素治疗的非糖尿病患者如血糖水平持续≥10 mmol/L，则应开始胰岛素治疗［932］。口服药治疗的糖尿病患者接受糖皮质激素治疗后血糖不能充分控制也应使用胰岛素。

在给予激素治疗的糖尿病患者中，需考虑根据激素

1. 类固醇糖尿病诊断标准同糖尿病诊断标准，清晨一次糖皮质激素疗法常引起午餐后至睡前血糖升高（A）

2. 既往无糖尿病史者，建议在起始中等剂量糖皮质激素治疗前 3 d 监测餐前和餐后血糖；既往有糖尿病或糖尿病前期病史者，即使应用低剂量糖皮质激素也应密切监测血糖（C）

3. 胰岛素是治疗类固醇糖尿病的重要且常用药物之一，需根据糖皮质激素的效应时间合理选择胰岛素（C）

4. 长期应用糖皮质激素的糖尿病患者，一般血糖控制目标为：餐前血糖<7.0 mmol/L，餐后血糖 <10.0 mmol/L，糖 化 血 红 蛋 白（HbA1c）<7.0%（A）

的效应时间合理选择胰岛素。如使用泼尼松或氢化可的松等中短效激素，可考虑选择中效或预混胰岛素；而使用地塞米松或持续性激素给药时，则选用长效胰岛素，使胰岛素的持续时间尽量覆盖糖皮质激素的效应时间，减少糖皮质激素失效后的低血糖风险。以早上 1次顿服糖皮质激素为例，可考虑的初始给药方案为：（1）早上 1 次按体重给予起始中效胰岛素，每 10 mg 泼尼松给予中效胰岛素0.1 U/kg，直到最大剂量 0.4 U/kg［933］。（2）早上 1次中效胰岛素按 10 U 起始，日增剂量 10%~20%。如果高血糖持续至夜间，可考虑给予基础胰岛素，如甘精胰岛素、德谷胰岛素、德谷门冬双胰岛素等。如果一日多次使用糖皮质激素，在每日 1次胰岛素不足以控制高血糖的情况下，可考虑每日 2次预混胰岛素或每日多次短效胰岛素加基础胰岛素的方案［934］。

九、糖尿病伴抑郁焦虑障碍

（一）临床特点

与普通人群相比，T2DM 人群中出现抑郁焦虑障碍更为常见，糖尿病患者发生抑郁焦虑障碍的风险是非糖尿病人群的 2 倍。约 1/4 的 T2DM 或T1DM患者存在不同程度的抑郁状况［935］，而其中只有 25%~50%的患者得到诊断和治疗［936］。据统计，14%~35.8% 的糖尿病患者合并抑郁症［937］。T2DM和抑郁焦虑之间存在一种双向关系，即 T2DM会增加抑郁焦虑的发生率，而抑郁焦虑则会增加 T2DM的患病风险，此外，抑郁症和 T2DM 患者并发症和

死亡率升高存在关联［938⁃939］。流行病学资料显示，

糖尿病患者中女性抑郁焦虑的发生率显著高于男性，GDM 患者或产后糖尿病患者是抑郁焦虑发生的高危人群［940］，与未患 GDM 的妇女相比，GDM 妇女患产前抑郁症的风险增加［941］。抑郁症对 T2DM的影响中有 36.5%是由BMI介导的［942］。此外，糖尿病发病年龄、并发症、病程、血糖控制情况、社会经

济地位均与抑郁焦虑的发生相关。

研究表明，糖尿病患者中焦虑相关障碍的患病率呈逐年上升趋势［943］。年龄≥45 岁的糖尿病患者具有较高的焦虑发病率，而年龄≥45岁的女性发病率更高［943］。在另一项研究中，与未患糖尿病的女

性相比，女性糖尿病患者的一生中焦虑症的发病率更高，该群体中50%的患者在一生中的某个时候会出现焦虑症［944］。此外，男性和女性都显示了 T2DM、肥胖和焦虑之间的相关性，超过 1/3的女性和 1/5 的男性表现出焦虑迹象［945］。糖尿病患者合并常见的焦虑相关障碍包括广泛性焦虑障碍、躯体

变形障碍、强迫障碍、特定恐惧症和创伤后应激障碍［946］。引起糖尿病患者焦虑的常见因素有对高血糖［947⁃948］、未达降糖目标［946］、胰岛素注射或输液（针

头恐惧症、血液恐惧症、低血糖）以及对发生并发症的担忧［949］。

除抑郁焦虑外，一些其他心理行为障碍（如认知障碍［950⁃953］、人格改变、饮食习惯改变［935， 954⁃955］、睡眠障碍［956⁃958］、性功能障碍等）也常见于糖尿病患者［959］。很多患者存在超过一种精神心理问题。

对于 GDM 患者，当其意识到糖尿病控制不佳会导致妊娠相关并发症和不良新生儿结局时，更容易出现产前抑郁和焦虑。患者对GDM的认知与心理问题的发生密切相关，由于缺乏糖尿病及治疗的

相关知识和护理常识，患者对疾病更加担心并容易

产生焦虑和抑郁情绪。其他原因来自自我监测血

糖、饮食限制和胰岛素治疗的需要。患者担心用药对胎儿生长发育的不良影响，也会产生焦虑［960］。

（二）危害

有证据表明，抑郁焦虑等负性情绪可加重糖尿病的病情［961⁃963］。糖尿病患者合并抑郁可使生活质

量降低，自我护理能力降低，血糖水平控制不佳，大

血管及微血管并发症增加，可以导致更多的认知能力下降［937］，甚至使患者死亡率增加3倍。同时，糖尿病合并抑郁焦虑的患者，医疗保健支出显著增加。

焦虑会增加糖尿病患者自我管理的复杂程度，主要原因有：（1）严重的焦虑表现与低血糖症状有

1. 建议对糖尿病患者进行定期抑郁和焦虑筛查，特别是血糖控制不佳或存在并发症的患者，以便早期发现和干预心理问题。在糖尿病管理的多学科团队中引入专业的心理健康服务，确保患者获得全面的心理支持，尤其是在抑郁和焦虑症状严重或需要专业治疗时，应及时转诊至精神科

2. 强调心理健康和糖尿病管理应结合认知行为疗法等心理干预方法，帮助患者缓解负面情绪，以提升治疗依从性

3. 选择能缓解抑郁症状并可能改善血糖控制的抗抑郁药物，但需个性化用药，并密切监测药物的效果和可能出现的代谢影响

很大重叠，使糖尿病患者难以区分焦虑症状和需要即刻治疗的低血糖症状；（2）确诊糖尿病后对于注射和抽血的焦虑，可能会进一步加重或达到特定的焦虑障碍诊断标准；（3）对低血糖的恐惧，可能是糖尿病患者焦虑障碍的来源，会导致患者刻意将血糖水平维持在目标值以上的水平。

（三）治疗及管理

鉴于糖尿病患者中抑郁症的高患病率，强烈建议对其共病性抑郁症及其相关危险因素进行筛查。

建议由训练有素的卫生保健专业人员对糖尿病患者进行抑郁症的常规筛查［964⁃965］。抑郁焦虑障碍和糖尿病共病管理的两个主要目标是抑郁焦虑缓解和血糖控制［937］。心理健康是糖尿病管理中的一部分，尽早发现和缓解糖尿病患者的抑郁焦虑情绪［940］，帮助患者及早摆脱不良心理、恢复自信，不但有助于提高患者的生活质量，也有助于糖尿病的控制［961， 966］，降低糖尿病并发症的风险。但是在接受治疗的糖尿病患者中，有高达45%的心理健康状况和严重的心理困扰没有被发现［967］。据估计，仅有约 1/3的糖尿病合并精神心理问题的患者得到诊断和治疗。因此，糖尿病管理团队中应加入精神科医师或心理治疗师共同参与。

抑郁症和糖尿病都可以根据症状的严重程度和实验室评估分为不同亚组，各亚组之间的治疗策略应有所不同［937］。例如，严重抑郁症患者的首要事项是排除需要特定紧急干预的自杀倾向或急性危象，抑郁症患者的心理症状可以通过认知行为疗法达到有效缓解。区分糖尿病和抑郁症的不同亚型以及相关症状的严重程度，可以根据准确的疾病状态分层制定精确的治疗计划。

在排除自杀倾向和急性危象后，抑郁短期内有效缓解对增加用药依从性和改善生活质量至关重要。从长远来看，对预防微血管和大血管病变、残疾和认知障碍至关重要。药物治疗、心理治疗和多样化的协同管理可以缓解抑郁症状，增加治疗依从性和改善血糖控制。糖尿病和抑郁症患者应采用协作护理的综合模式进行管理［937］。

对糖尿病伴抑郁焦虑障碍患者的管理内容包括：（1）心理状态的评估应始终贯穿糖尿病的治疗：抑郁焦虑评估是一种快速、简单的方法，可以帮助患者判断自身的感受是否存在精神心理问题。早期筛查、评估及监测心理状况，尤其是对有抑郁焦虑病史的糖尿病患者，在病情变化（如出现并发症）或存在其他心理社会因素时，应特别注意

情绪评估［966］。世界卫生组织五项身心健康指标（WHO⁃5）［968］、贝克抑郁量表Ⅱ（BDI⁃Ⅱ）［968］、健康问卷抑郁量表（PHQ⁃9）［969］、流行病学研究中心抑郁量表（CES⁃D）［970］是广泛使用的抑郁症评估方法。健康问卷抑郁量表是一种经过充分验证的方法，具有良好的敏感性和特异性［937］。

（2）心理治疗方法主要包括认知行为疗法，认知部分推动对生活有益的信念，行为方面帮助患者学习采取更为健康的行动。认知行为疗法是一种有效且有前途的干预抑郁症状、糖尿病困扰和健康焦虑的方法，也有助于患者提高生活质量、治疗依从性和身体活动［971］。心理治疗尤其是认知行为疗法和协作护理对抑郁焦虑等情绪障碍有效。糖尿病管理团队成员最好有专业的心理治疗师或有经验的精神科医师加盟，以便提供更为专业的心理治疗服务［966， 972⁃973］。多种行为策略（认知行为疗法、社区运动或联合治疗）可以有效地治疗成人 T2DM患者的抑郁症。这些以社区为基础的干预措施是对医疗保健的补充［974］。在糖尿病合并抑郁的初级护理中，协作护理模式证实能显著改善抑郁和血糖控制，节省医疗费用。基于网络的心理干预，结合认知行为治疗工具、糖尿病自我护理促进有益信念，有效地减轻了 T2DM患者的抑郁症状，增强了血糖控制，并显示了一定经济效益［975］。

（3）当患者有抑郁症、焦虑症、人格障碍、药物成瘾、认知功能障碍等表现时，应将其转诊至具备糖尿病知识的精神科就诊［976］。伴有抑郁焦虑的糖尿病患者血糖不易得到满意控制，微血管和大血管并发症发生的风险可能高于普通糖尿病患者。

（4）抗抑郁药物治疗：药物治疗可以通过缓解抑郁症状和改善血糖控制来帮助抑郁症和糖尿病共病患者［937］。五羟色胺再摄取抑制剂、五羟色胺和去甲肾上腺素再摄取抑制剂常作为糖尿病合并抑郁焦虑患者的一线选择药物，同时可能改善患者血糖控制。有研究显示，服用抗抑郁药可使糖尿病患者血糖控制率提高 95%。但并非所有足以减轻抑郁症状的治疗都能控制血糖水平，例如舍曲林已被证明可以缓解抑郁，但不影响血糖。五羟色胺再摄取抑制剂能改善糖尿病患者的抑郁样行为，而不会影响葡萄糖稳态，但却是糖尿病某些并发症的危险因素。研究表明，胰岛素敏感性的改善可以缓解抑郁。此外，与未服用药物的老年糖尿病患者相比，服用二甲双胍的患者发生抑郁

风险较低，表明二甲双胍可能是这些患者抑郁的保护因素［977］。

十、重性精神障碍、人类免疫缺陷病毒/获得性免疫缺陷综合征与糖尿病

（一）重性精神障碍与糖尿病

研究表明，重性精神障碍患者罹患 T2DM的概率是普通人的 2~3倍，女性高于男性［978⁃979］。约 10%的重性精神障碍患者（包括精神分裂症、分裂情感性障碍、双相情感障碍等）同时患有糖尿病，即共病糖尿病［978］，特别是在晚发型精神分裂症患者中，糖尿病比例可高达 25.3%［980］。共病糖尿病的患者结局更差，且与年龄相关。

抗精神病药物（尤其是第二代药物）可增加肥胖、T2DM 和血脂异常的风险［981］，至少 12% 接受药物治疗的重性精神障碍患者罹患 T2DM。抗精神病药物中，除阿立哌唑和氨磺必利外，大多数药物都有诱发或加剧T2DM的可能［978］。研究表明，情绪稳定剂锂盐和拉莫三嗪在双相情感障碍患者中，并不增加T2DM的风险［982］。

（二）人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）与糖尿病

研究表明，与未感染者相比，HIV 感染者发生糖尿病的风险增加约 40%［983］。一项回顾性研究显示，分别有 20.2% 和 20.7% 的 HIV感染者罹患糖尿病前期或 T2DM，糖尿病前期个体中又有 31.8% 进展为 T2DM［984］。治疗HIV/AIDS的高活性抗逆转录酶病毒药物也可导致血脂异常和胰岛素抵抗，并可导致或加重糖尿病，尤其当使用蛋白酶抑制剂时［985⁃986］。值得注意的是，核苷逆转录酶抑制剂可

降低 HIV 感染者从糖尿病前期发展为 T2DM 的风险［984］。此外，基于整合酶链转移抑制剂或蛋白酶

抑制剂的治疗方案相比于非核苷类逆转录酶抑制

剂为基础的方案，具有较低的糖尿病发病率；整合

酶链转移抑制剂中，雷替拉韦相较于艾维特韦有较低的糖尿病发生率［987⁃988］。

一项纳入 4 376例HIV/AIDS患者的研究显示，该人群中糖尿病患病率为 11.4%，抗病毒治疗的HIV/AIDS 患糖尿病的相关危险因素包括年龄≥40 岁、男性、丙型肝炎病毒感染、基线体重指数（BMI）≥24 kg/m2、最 近 一 次 甘 油 三 酯（TG）≥1.7 mmol/L 以及初始抗病毒药物为依非韦伦［989］。一项多中心前瞻性队列研究显示，基线体重、年龄、未治疗的高血压、基线空腹血糖>100 mg/dl，以及虽经治疗但仍可检测到 HIV⁃RNA 的 HIV 感染者，是HIV感染者发生糖尿病的危险因素［990］。（三）筛查

建议所有接受精神类药物治疗的重性精神障碍患者及接受抗逆转录病毒治疗的HIV/AIDS患者定期进行糖尿病风险筛查。对于高风险人群（如年龄≥40岁、有家族史、肥胖、高血压等），每 12~16周监测体重、血糖、血脂，并进行多学科团队管理［164］。

建议 HIV 感染者使用血浆葡萄糖测定筛查和诊断糖尿病，而不建议使用HbA1c。（四）治疗与管理策略

除要注意药物交互作用和治疗不良反应等情

况外，共病糖尿病的治疗或管理与普通糖尿病相似，包括药物治疗和生活方式干预等［981， 985⁃986， 989， 991］。

共病的糖尿病漏诊率达 70%，建议在制定抗精神病和抗 HIV 感染治疗计划时要考虑这种情况发生的可能，并加强患者或照护者教育，以预防和控制糖

尿病。开始上述药物治疗前，应检查患者的血糖和

血脂，询问是否存在其他危险因素，如高血压、肥

胖、吸烟史和特殊疾病家族史。使用抗精神病药物的患者每月检测 1次血糖和体重，治疗过程中体重增加者应进行相关检查。针对HIV感染者，建议在接受抗逆转录病毒治疗后的 3~6 个月内以及更换治疗方案时进行糖尿病筛查［992］。

第十九章 代谢综合征

代谢综合征是一组以肥胖、高血糖（糖尿病或糖调节受损）、血脂异常［高甘油三酯血症和（或）低高密度脂蛋白胆固醇（HDL⁃C）血症］及血压增高等

1. 建议重性精神障碍和人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）感染患者定期进行糖尿病风险筛查。高风险患者应每 12~16 周进行综合监测并及时调整治疗策略

2. 使用抗精神病药物的患者应每月监测 1 次血糖和体重；HIV/AIDS 患者接受抗逆转录病毒治疗后的 3~6 个月内，以及更换治疗方案时应进行糖尿病筛查

3. 重性精神障碍、HIV/AIDS 患者建议选择对血糖影响较小的治疗药物

聚集为特点，在代谢上相互关联的临床综合征。代谢综合征直接促进了动脉粥样硬化性心血管疾病（ASCVD）的发生，也增加了 2 型糖尿病（T2DM）的风险，是心血管疾病（CVD）的高危人群［993⁃994］。一、诊断标准

具 备 以 下 至 少 3 项 即 可 诊 断 代 谢 综 合征［428， 995⁃996］：（1）腹型肥胖（即中心型肥胖）：腰围男性 ≥90 cm，女性 ≥85 cm；（2）高血糖：空腹血糖 ≥6.1 mmol/L 或口服葡萄糖耐量试验（OGTT）2 h 血糖≥7.8 mmol/L 和（或）已确诊为糖尿病并治疗者；（3）血 压 增 高 ：血 压 ≥130/85 mmHg（1 mmHg=0.133 kPa）和（或）已确诊为高血压并治疗者；（4）空腹甘油三酯（TG）≥1.70 mmol/L；（5）空腹 HDL⁃C<1.04 mmol/L。二、代谢综合征的防治

代谢综合征防治的主要目标是提高患病人群的疾病防控意识及自我管理能力，综合控制各个代谢综合征的异常组分，最终降低代谢综合征相关疾病的发生率和心血管事件导致的病死率。积极且持久的生活方式干预是达到上述目标的重要措施。原则上应先启动生活方式干预，如果不能达到目标，则应针对各个组分采取相应的药物治疗。

1.生活方式干预：根据代谢综合征患者的治疗目标，推荐终止高血压膳食、中国心脏健康饮食和辣膳食［428， 996］，规律进餐［997］，减少热量摄入、限盐、减少含糖或代糖饮料摄入、戒烟、避免过量饮酒。

根据代谢综合征患者年龄和身体状况，以心率计算法为指导，确定运动形式、强度与时长，例如每周至少 150 min 中等强度或 75 min 高强度运动，有氧运动与抗阻运动结合。这样不仅能减轻胰岛素抵抗和高胰岛素血症，也能改善糖耐量和其他 CVD 危险因素［998］。

2.针对各个组分的药物治疗：针对糖尿病或糖尿病前期、高血压、血脂紊乱以及肥胖等各组分进行药物治疗。降压药物优先推荐血管紧张素转化酶抑制剂（ACEI）和血管紧张素Ⅱ受体拮抗剂（ARB），尤其适用于糖尿病或者腹型肥胖患者。钠⁃葡萄糖共转运蛋白 2抑制剂（SGLT2i）和胰高糖素样肽⁃1 受体激动剂（GLP⁃1RA）有助于合并糖尿病者的多个组分综合达标。严重患者（如重度肥胖合并糖尿病等其他代谢并发症时）可推荐代谢手术治疗。治疗目标如下：（1）体重在 1 年内减轻 7%~10%，争取达到正常体重指数（BMI）和腰围；（2）血压 ：<130/80 mmHg；（3）低 密 度 脂 蛋 白 胆 固 醇

（LDL⁃C）<2.60 mmol/L，TG<1.70 mmol/L，HDL⁃C>1.04 mmol/L［999］；（4）空腹血糖 <6.1 mmol/L，OGTT 2 h 血糖 <7.8 mmol/L 及糖化血红蛋白（HbA1c）<6.5%。

第二十章 中医药防治糖尿病

中医药防治糖尿病，应遵循整体观和辨证论治

原则，运用八纲辨证、脏腑辨证、三消辨证及三型辨证、态靶辨证等方法［1000⁃1001］。

糖尿病的中医药治疗主要包括中药内服与外

治、针灸、推拿、传统锻炼功法、食疗药膳及代茶饮等治疗措施［1002］。可开展糖尿病“三师共管”诊疗模式。

历代用于治疗消渴病的方剂，如肾气丸［1003］、六味地黄丸［1004］、消渴方［1005］、白虎加人参汤［1003］等仍沿用至今。近年来，中药单体（如黄连素［1006⁃1009］）、少数民族药（如苗药糖宁通络［1010⁃1014］等）研究受到国

内外关注。

2型糖尿病（T2DM）患者的临床辨证具体可参考《糖尿病中医药临床循证实践指南》［1015］、《2型糖尿病中西医结合诊疗指南》［1016］及《糖尿病“三师共管”诊疗模式应用指南（2024版）》［1017］等。二、糖尿病前期

津力达颗粒可增强胰岛素敏感性，降低 T2DM发生相对风险 41%，适用于伴多代谢紊乱的糖尿病前期患者［1018］。天芪降糖胶囊、金芪降糖片也具有预防T2DM发生的作用［1019⁃1021］。三、2型糖尿病中药复方葛根芩连汤［1022⁃1023］、大柴胡汤［1024］、肾气丸［1003］、六味地黄丸［1004］、消渴方［1005］、白虎加人参汤［1003］等经典名方均具有一定降糖作用。

津力达颗粒通过减轻胰岛素抵抗及促进胰岛素分泌，降低T2DM患者血糖和血糖变异性［1025⁃1028］，而且能缓解口干、自汗和便秘等症状［1029］。

天麦消渴片可降低 T2DM（证属气阴两虚、阴虚内热）患者的血糖，并减轻口干、多饮及烦躁等临床症状［1030］。

中医药可在降低糖尿病发生风险、单独及协同控糖、防治并发症、改善症状和体征、提高生活质量等方面发挥作用（B）

参芪降糖颗粒可降低 T2DM（气阴两虚证）患者的空腹及餐后血糖［1031⁃1032］。

消渴丸（每粒含 0.25 mg格列本脲）适用于气阴两虚型 T2DM，除有降糖效果外，在改善口干多饮、多食易饥和倦怠乏力等症状上均有疗效［1033］。注意避免低血糖风险。

中药提取物桑枝总生物碱片可单药降低糖化血红蛋白（HbA1c）水平 0.93%，改善血糖波动，其作用机制为选择性抑制小肠黏膜中的 α⁃葡萄糖苷酶活性，且胃肠道不良反应较少［1034⁃1035］。

四、糖尿病并发症

1. 糖尿病肾脏病（DKD）：渴络欣胶囊可改善 DKD（气阴两虚兼血瘀证）患者的临床症状及肾功能，降低尿微量白蛋白［1036⁃1037］。黄葵胶囊能降低 DKD患者的尿白蛋白水平［1038⁃1040］。2. 糖尿病视网膜病变（DR）：复方丹参滴丸可减轻 T2DM 非增殖型视网膜病变（气滞血瘀证）患者的视网膜微血管病变及黄斑水肿［1041］。芪明颗粒增加视网膜血流及改善血液循环，减轻缺血缺氧损伤及黄斑水肿［1042⁃1043］。

3.糖尿病周围神经病变：木丹颗粒可改善糖尿病周围神经病变（气虚络阻证）患者的四肢麻木、疼痛等感觉异常，提高神经传导速度［1044］。

五、糖尿病相关生活质量

T2DM患者常合并失眠、腹泻、便秘、焦虑及抑郁 等 症 状 ，影 响 患 者 的 血 糖 控 制 和 生 活 质量［1045⁃1047］。中医经典名方改善临床症状疗效确切［1048⁃1051］。如合并失眠，可选用黄连温胆汤或酸枣仁汤等；合并腹泻，可选用参苓白术散或升阳益胃汤等；合并便秘，可选用桃核承气汤或麻子仁丸等；

合并情绪异常，可选用柴胡疏肝散或逍遥散等。应

用经典名方有助于提高生活质量，进而达到协同控糖的作用［1002］。

六、针灸、中药外治等

针刺疗法可降低 T2DM 患者的血糖水平和体重，减轻胰岛素抵抗［1052⁃1053］。在糖尿病周围神经病

变治疗上，针刺疗法具有一定优势，尤其是改善疼痛、麻木、感觉迟钝等临床症状［1054⁃1055］。电针不仅

能缓解痛性糖尿病周围神经病变患者的疼痛，改善

患者的睡眠障碍和生活质量，而且具有良好的耐受性和安全性［1056］。中药足部熏洗联合穴位按摩，可提高 T2DM 周围神经病变患者感觉神经和运动神经的传导速度，降低疼痛程度［1057］。

七、中国传统锻炼功法

太极拳、八段锦和心身桩等中国传统锻炼功法

是适合糖尿病患者的运动方式。太极拳可有效改善T2DM患者的血糖控制与生活质量［1058⁃1059］。对于伴有轻度认知功能障碍的老年 T2DM患者，相比于健步走，太极拳更能改善其整体认知功能［1060］。除了降低血糖水平外，八段锦亦可提升 T2DM患者的心理幸福感，改善焦虑、抑郁等心理状况［1061⁃1062］。

志谢 赵家军（山东第一医科大学附属省立医院）、母义明（解放军总医院第一医学中心）、洪天配（北京大学第三医院）、陈伟（北京协和医院）、杨叔禹（厦门大学附属第一医院）、王正珍（北京体育大学）、刘铭（天津医科大学总医院）、杨涛（南京医科大学第一附属医院）、潘琦（北京医院）、王爱萍（东部战区空军医院）、陆灏（上海中医药大学附属曙光医院）、周健（上海交通大学医学院附属第六人民医院）、袁宁（中南大学湘雅三医院）、顾天伟（南京大学医学院附属鼓楼医院）、王维敏（南京大学医学院附属鼓楼医院）在指南撰写和修改中所作的贡献

附录1　主要常用名词术语英文缩略语释义

2hPG ABI

ACEI ADA

AGP

AHI

AI

AIDS ARB

ASCVD BMI

CAN

餐后2 h血糖

踝肱指数

血管紧张素转化酶抑制剂美国糖尿病学会

动态葡萄糖图谱

呼吸暂停低通气指数

人工智能

获得性免疫缺陷综合征

血管紧张素Ⅱ受体拮抗剂动脉粥样硬化性心血管疾病体重指数

心血管自主神经病变

2 h⁃postprandial plasma glucose

ankle⁃brachial index

angiotensin converting enzyme inhibitor American Diabetes Association

ambulatory glucose profile

apnea⁃hypopnea index

artificial intelligence

acquired immunodeficiency syndrome angiotensin Ⅱ receptor antagonist

atherosclerotic cardiovascular disease body mass index

cardiovascular autonomic neuropathy

英文缩写

中文全称

英文全称

CGM

CKD

CLTI

CPAP

CSII

CVD

CVOT

DAN

DF

DFU

DKA

DKD

DME

DPI

DPP⁃4i

DR

DSMES DSPN

ESRD

euDKA

FDA

FDC

FRC

GA

GADA

GDM

GIP

GKA

GLP⁃1

GLP⁃1RA GMI

HDL⁃C

HF

HHS

HIP

HIV

IA⁃2A

IAA

ICA

IFG

IGT

LADA

LDL⁃C

LEAD

持续葡萄糖监测

慢性肾脏病

严重肢体缺血

持续气道正压通气

持续皮下胰岛素输注

心血管疾病

心血管结局试验

自主神经病变

糖尿病足病

糖尿病足溃疡

糖尿病酮症酸中毒

糖尿病肾脏病

糖尿病性黄斑水肿

双通道抗栓

二肽基肽酶Ⅳ抑制剂

糖尿病视网膜病变

糖尿病自我管理教育与支持远端对称性多发性神经病变估算的肾小球滤过率

终末期肾病

血糖正常的糖尿病酮症酸中毒美国食品药品监督管理局

固定剂量复方

固定比例复方

糖化白蛋白

谷氨酸脱羧酶抗体

妊娠期糖尿病

葡萄糖依赖性促胰岛素多肽葡萄糖激酶激活剂

胰高糖素样肽⁃1

胰高糖素样肽⁃1受体激动剂葡萄糖管理指标

糖化血红蛋白

高密度脂蛋白胆固醇

心力衰竭

高渗性高血糖状态

妊娠期高血糖

人类免疫缺陷病毒

蛋白酪氨酸磷酸酶抗体

胰岛素自身抗体

胰岛细胞抗体

空腹血糖受损

糖耐量减低

成人隐匿性自身免疫糖尿病低密度脂蛋白胆固醇

下肢动脉病变

continuous glucose monitoring

chronic kidney disease

chronic limb⁃threatening ischemia

continuous positive airway pressure

continuous subcutaneous insulin infusion

cardiovascular disease

cardiovascular outcome trial

diabetic autonomic neuropathy

diabetic foot

diabetic foot ulcer

diabetic ketoacidosis

diabetic kidney disease

diabetic macular edema

dual⁃pathway inhibition

dipeptidyl peptidase Ⅳ inhibitor

diabetic retinopathy

diabetes self⁃management education and support distal symmetric polyneuropathy

estimated glomerular filtration rate

end⁃stage renal disease

euglycemic diabetic ketoacidosis

Food and Drug Administration

fix⁃dose combination

fixed⁃ratio combination

glycosylated albumin

glutamic acid decarboxylase antibody

gestational diabetes mellitus

glucose dependent insulinotropic polypeptide

glucokinase activator

glucagon⁃like peptide⁃1

glucagon⁃like peptide⁃1 receptor agonist

glucose management indicator

glycated hemoglobin A1c

high⁃density lipoprotein⁃cholesterol

heart failure

hyperosmolar hyperglycemic state

hyperglycemia in pregnancy

human immunodeficiency virus

insulinoma⁃associated 2 malecule autoantibody insulin autoantibody

islet cell antibody

impaired fasting glucose

impaired glucose tolerance

latent autoimmune diabetes in adult

low⁃density lipoprotein⁃cholesterol

lower extremity arterial disease

续附录1

LOPS MACE MALE MASLD MDT

MIDD MODY NDM

NPDR NPPV ODM

OGTT OSA

PAD

PCOS PDR

PGDM PNDM PPAR PSG

RCT

SAP

SFN

SGLT2i SMBG T1DM T2DM TAR

TBI

TG

TZD

UACR WHO ZnT8A

保护性感觉丧失

主要不良心血管事件

主要不良肢体事件

代谢相关脂肪性肝病

多学科协作

母系遗传糖尿病伴耳聋

青少年起病的成人型糖尿病新生儿糖尿病

非增殖型糖尿病视网膜病变无创正压通气

妊娠期显性糖尿病

口服葡萄糖耐量试验

阻塞性睡眠呼吸暂停

外周动脉疾病

多囊卵巢综合征

增殖型糖尿病视网膜病变

孕前糖尿病

永久性新生儿糖尿病

过氧化物酶体增殖物激活受体多导睡眠监测

随机对照试验

传感器增强型胰岛素泵

小纤维神经病变

钠⁃葡萄糖共转运蛋白 2抑制剂自我血糖监测

1型糖尿病

2型糖尿病

葡萄糖高于目标范围时间

趾肱指数

葡萄糖低于目标范围时间

甘油三酯

葡萄糖在目标范围内时间

噻唑烷二酮

尿白蛋白/肌酐比值

世界卫生组织

锌转运体8自身抗体

loss of protective sensation

major adverse cardiovascular event

major adverse limb event

metabolic dysfunction⁃associated steatotic liver disease multiple disciplinary team

maternally inherited diabetes and deafness syndrome maturity onset diabetes of the young

neonatal diabetes mellitus

non⁃proliferative diabetic retinopathy

non⁃invasive positive pressure ventilation

overt diabetes mellitus

oral glucose tolerance test

obstructive sleep apnea

peripheral arterial disease

polycystic ovary syndrome

proliferative diabetic retinopathy

pregestational diabetes mellitus

persistent neonatal diabetes mellitus

peroxisome proliferator⁃activated receptor

polysomnography

randomized controlled trial

sensor augmented pump

small fiber neuropathy

sodium⁃glucose co⁃transporter 2 inhibitor

self⁃monitoring of blood glucose

type 1 diabetes mellitus

type 2 diabetes mellitus

time above range

toe⁃brachial index

time below range

triglyceride

time in range

thiazolidinedione

urinary albumin⁃to⁃creatinine ratio

World Health Organization

zinc transporter 8 autoantibody

附录2　常用口服降糖药物

口服单药

双胍类

二甲双胍

二甲双胍缓释片

250、500、850 500

500~2 000 500~2 000

5~6 8

1.5~1.8

6.2

药物类别及通用名

每片剂量（mg）

剂量范围（mg/d）

作用时间（h）

半衰期（h）

磺脲类

格列本脲

格列吡嗪

格列吡嗪控释片

格列齐特

格列齐特缓释片

格列喹酮

格列美脲

格列奈类

瑞格列奈

那格列奈

米格列奈钙片

TZD类

吡格列酮

罗格列酮

α⁃糖苷酶抑制剂

阿卡波糖

伏格列波糖

米格列醇

西格列汀

沙格列汀

维格列汀

利格列汀

阿格列汀

瑞格列汀

考格列汀

SGLT2i

达格列净

恩格列净

卡格列净

艾托格列净

恒格列净

加格列净

多格列艾汀

PPAR泛激动剂

西格列他钠

口服GLP⁃1RA

口服司美格鲁肽片固定剂量复方制剂

吡格列酮+二甲双胍

罗格列酮+二甲双胍

西格列汀+二甲双胍

沙格列汀+二甲双胍缓释片维格列汀+二甲双胍

2.5

5

80

30

1、2

0.5、1、2

120

15

4

50、100

0.2

50

100

25

100、300

5/10

75

16

3、7、14

15/500

2/500

50/500、50/850

5/500、5/1 000、2.5/1 000 50/850、50/1 000

2.5~20.0

2.5~30.0

5.0~20.0

80~320

30~120

30~180

1.0~8.0

1~16

120~360

30~60

15~45

4~8

100~300

0.2~0.9

10 mg/两周

10~25

5~10

25~50

150

32~48

3~14

15/500~30/1 000 2/500~8/2 000 50/500~100/1 700 5/500~5/2 000 50/850~100/2 000

16~24

8~12

6~12

10~20

2~6（达峰时间）

24

4~6

1.3

0.23~0.28

2（达峰时间）

1（达峰时间）

2~4

0.5~2

1.5（达峰时间）

1~2（达峰时间）

0.5~1.75（达峰时间）

1.2~1.8（达峰时间）24

1.3~3.0（达峰时间）

1~2（达峰时间）无数据

1.5~2.0（达峰时间）无数据

4~5

0.5~2.3

10~16

2~5

6~12 12~20

1.5

1.25

1.2

3~7

3~4

3.7~9.6

6~8

2~3

12.4

21

12.5

131.5

12.9

5.6~13.1

10.6~13.1

16.6

9.1~14.0 21~23

6.6~8.6

9.0~11.9

168

无数据无数据无数据无数据无数据

续附录2

利格列汀+二甲双胍

恩格列净+二甲双胍

达格列净+二甲双胍缓释片恒格列净+二甲双胍缓释片

2.5/500、2.5/850、2.5/1 000 5/500

5/500、10/1 000

5/1 000

2.5/500~5.0/2 000 10/1 000~20/2 000

5/500~10/1 000 5/1 000~10/2 000

无数据无数据无数据无数据

注：TZD为噻唑烷二酮；DPP⁃4i为二肽基肽酶Ⅳ抑制剂；SGLT2i为钠⁃葡萄糖共转运蛋白 2抑制剂；GKA为葡萄糖激酶激活剂；PPAR为过氧化物酶体增殖物激活受体；GLP⁃1RA为胰高糖素样肽⁃1受体激动剂

附录3 国内上市的肠促胰素类降糖药物

通用名

短效GLP⁃1RA

贝那鲁肽

艾塞那肽

利司那肽

长效GLP⁃1RA

利拉鲁肽

艾塞那肽周制剂

度拉糖肽

洛塞那肽

司美格鲁肽注射液

司美格鲁肽片

GIP/GLP⁃1RA

替尔泊肽

达峰时间

19 min

2.1 h

1.0~3.5 h

8~12 h 2个高峰 a

48 h

67~118 h

1~3 d

1 h

8~72 h

半衰期

11 min

2.4 h

3 h

13 h

2.4 h每次释放

108~112 h

104~121 h 1周

1周

5 d

规格

4.2 mg 笔芯配合谊生泰注射笔 5、10 mg/次预填充笔（60次）10、20 μg/次预填充笔（14次）

18 mg 预填充笔（可调剂量 ，分别为 0.6、1.2、1.8 mg）2 mg 单 次 注 射 预 填充笔

0.75、1.50 mg 单 次 注射笔

0.1、0.2 mg卡氏瓶配合笔式注射器

1.34 mg/ml，1.5 ml 或3.0 ml 预填充注射笔（可调剂量，分别为0.25、0.5、1.0 mg）3、7、14 mg片剂

2.5、 5.0、 7.5、 10.0、12.5、15.0 mg预填充注射笔或其他注射装置

用法

三餐前 5 min；皮下注射早晚餐前 60 min，2 次注射至少间隔 60 min 以上；皮下注射每日 1 次，每日任何 一 餐 前 1 h内；皮下注射

一 天 中 任 何 时间；皮下注射

一 天 中 任 何 时间 ，每 周 同 一天；皮下注射

晨起空腹少量水（≤120 ml）送服

用量

0.1~0.2 mg，每日3次5~10 μg， 每日2次 10~20 μg，每日1次

0.6~1.8 mg，每日1次 2 mg，每 周1次

0.75~1.50 mg，每周1次0.1~0.2 mg，每周1次

0.25~1.0 mg，每周1次 3~14 mg， 每日1次

2.5~15.0 mg，每周1次

肾功能不全时用药

不适用

eGFR<30 ml·min⁻¹·（1.73 m²）⁻¹不推荐

ESRD不推荐

eGFR<30 ml·min⁻¹·（1.73 m²）⁻¹不推荐 eGFR<15 ml·min⁻¹·（1.73 m²）⁻¹不推荐 eGFR<30 ml·min⁻¹·（1.73 m²）⁻¹不推荐

重度肾功能不全患者使用经验有限，ESRD 患者不推荐

重度肾功能不全患者使用经验有限，ESRD不推荐重度肾功能不全和 ESRD 患者使用经验有限，使用应谨慎

注：GLP⁃1RA 为胰高糖素样肽⁃1受体激动剂；GIP为葡萄糖依赖性促胰岛素分泌多肽；eGFR 为估算的肾小球滤过率；ESRD 为终末期肾病。a2周微球表面结合的艾塞那肽释放，6~7周微球内的艾塞那肽释放

附录4　治疗糖尿病神经病变的常用药物

甲钴胺

α⁃硫辛酸

500~1 000 μg，每日 1 次，肌内注射或静脉滴注 2~4 周；之后改为500 μg，每日3次，口服3个月 600 mg，每日 1 次，口服 3 个月；症状明显者：600 mg，每日1次，静脉滴注2~4周；之后改为600 mg，每日1次，口服

无明显不良反应

安全性良好。过敏者禁用，不与葡萄糖溶液或林格液及所有可能与硫基或二硫键起反应的溶液配伍；避光保存

药物名称

用法用量

不良反应与注意事项

参 考 文 献

[1] 全国糖尿病研究协作组调查研究组 . 全国 14省市 30万人口中糖尿病调查报告 [J]. 中华内科杂志 , 1981, 20(11):678‑683.

[2] Pan XR, Yang WY, Li GW, et al. Prevalence of diabetes and its risk factors in China, 1994[J]. Diabetes Care, 1997, 20(11):1664‑1669. DOI: 10.2337/diacare.20.11.1664.

[3] 李立明, 饶克勤, 孔灵芝, 等 . 中国居民 2002年营养与健康状况调查 [J]. 中华流行病学杂志 , 2005, 26(7): 478‑484. DOI: 10.3760/j.issn:0254‑6450.2005.07.004.

[4] Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China[J]. N Engl J Med, 2010, 362(12):1090‑1101. DOI: 10.1056/NEJMoa0908292.

[5] Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults[J]. JAMA, 2013, 310(9):

948‑959. DOI: 10.1001/jama.2013.168118.

[6] Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J]. JAMA, 2017, 317(24): 2515‑2523. DOI: 10.1001/jama.2017.7596.

[7] Li Y, Teng D, Shi X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J]. BMJ, 2020, 369:m997. DOI: 10.1136/bmj.m997.

[8] Wang L, Peng W, Zhao Z, et al. Prevalence and treatment of diabetes in China, 2013‑2018[J]. JAMA, 2021, 326(24):2498‑2506. DOI: 10.1001/jama.2021.22208.

[9] Weng J, Zhou Z, Guo L, et al. Incidence of type 1 diabetes in China, 2010‑13: population based study[J]. BMJ, 2018, 360:j5295. DOI: 10.1136/bmj.j5295.

[10] Tang X, Yan X, Zhou H, et al. Prevalence and identification

依帕司他

前列腺素E1己酮可可碱

胰激肽原酶

巴曲酶

乙酰左卡尼汀木丹颗粒

50 mg，每日3次，餐前口服3个月

前列腺素E1脂微球载体制剂 10 μg/d，静脉滴注 2周；之后改为贝前列腺素钠 20~40 μg，每日2~3次，口服8周

0.1~0.2 g，每日 1~2 次，静脉滴注 8 周（每日最大剂量不超过0.4 g；口服缓释片0.4 g，每日1~2次，8周 40 U，每日 1 次，肌内注射 10 d；之后改为 40 U，隔日 1 次，肌内注射20 d；口服120~240 U，每日3次3个月首剂10 BU；之后5 BU，隔日1次（30 BU为1个疗程）

口服250~500 mg，每日2~3次6个月

口服7 g，每日3次4周

长期应用耐受性较好，不良反应较少，服用本品后尿液可能出现褐红色：过敏体质者慎用

不良反应发生率低。心功能衰竭、青光眼、眼压升高、胃溃疡、间质性肺炎患者慎用

偶有过敏反应

偶见注射部位止血延迟

不良反应少

续附录4

附录5 治疗痛性远端对称性多发性神经病变的常用药物

药物名称普瑞巴林

克利加巴林

美洛加巴林

加巴喷丁

度洛西汀

50 mg 每日 3 次起始，至 100 mg 每日 3 次，若维持300 mg/d 剂量 2~4 周后疼痛未充分缓解，可增至600 mg/d，分次服用

推荐剂量为每次 20 mg，每日 2 次。对于疼痛未得到充分缓解同时安全性可耐受的患者，特别是年龄≥65岁或糖尿病性周围神经病理性疼痛病程>1年的患者，可考虑谨慎增加剂量至每次 40 mg，每日2次 5 mg 每日 2 次起始，间隔 1 周后每次用药剂量增加5 mg，直到增至 15 mg每日 2次，可根据患者年龄和症状，在10~15 mg每日2次的范围内调整 300 mg每日1次起始，增至300~600 mg每日3次

20 mg每日1次起始，增至60 mg每日1次

不良反应

头晕、嗜睡、共济失调、意识模糊、乏力、思维异常、视物模糊、运动失调、外周水肿

头晕、嗜睡、外周水肿、乏力、体重增加

头晕、嗜睡、肝酶升高和药物诱导的肝损伤、体重增加、意识丧失

眩晕、嗜睡、共济失调、震颤、胃肠道反应

恶心、口干、便秘、食欲下降、疲乏、嗜睡、出汗增多

注意事项

同时服用 ACEI 类药物时，血管性水肿发生可能性增加；存在超敏反应患者禁用

中度和重度肾功能不全患者每日使用剂量分别调整为肾功能正常者临床治疗剂量的1/2和1/4

对于肾功能损害患者，应参考肌酐清除率水平调整剂量和给药间隔

存在血糖波动、出血性胰腺炎等风险

因可能出现危及生命的中枢 5⁃羟色胺综合征，禁止与单胺氧化酶抑制剂和选择性 5⁃羟色胺再摄取抑制剂联用；禁止用于未经治疗的窄角型青光眼

注：ACEI为血管紧张素转化酶抑制剂

附录6 本指南证据等级说明

本指南在每章开头尽量加上要点说明和证据级别，根据证据质量、一致性、临床意义、普遍性和适用性等，将推荐意见分为A（优秀）、B（良好）和C（满意）三级。其中A级推

荐意见应来自Ⅰ级水平的证据，所有研究结论一致，临床意义大，证据研究的样本人群与目标人群吻合，因此，该推荐意见可直接应用于各医疗行为中；而 B、C级推荐意见则在上述各方面存在一定问题，其适用性受到不同限制。

of type 1 diabetes in Chinese adults with newly diagnosed diabetes[J]. Diabetes Metab Syndr Obes, 2019, 12:1527‑1541. DOI: 10.2147/DMSO.S202193.

[11] 国家统计局 . 第五次全国人口普查公报(第 1 号)[EB/OL]. (2001‑05‑15) [2024‑05‑16]. http://www. stats. gov. cn/tjsj/tjgb/rkpcgb/qgrkpcgb/200203/t20020331_30314.html.

[12] 国家统计局 . 中华人民共和国 2008 年国民经济和社会发展统计公报[EB/OL]. (2009‑02‑26) [2024‑05‑16]. http://www. stats. gov. cn/tjsj/tjgb/ndtjgb/qgndtjgb/200902/t20090226_30023.html.

[13] 国家统计局 . 中华人民共和国2017年国民经济和社会发展统计公报[EB/OL]. (2018‑02‑28) [2024‑05‑16]. http://www.

stats.gov.cn/tjsj/zxfb/201802/t20180228_1585631.html.

[14] 国家统计局 . 中华人民共和国 2023 年国民经济和社会发展统计公报[EB/OL]. (2024‑02‑29) [2024‑05‑16]. https://www. gov. cn/lianbo/bumen/202402/content_6934935.

htm.

[15] 国家卫生健康委 . 中国居民营养与慢性病状况报告(2020年)[M]. 北京:人民卫生出版社, 2020.

[16] Li M, Xu Y, Wan Q, et al. Individual and combined associations of modifiable lifestyle and metabolic health status with new‑onset diabetes and major cardiovascular events: the China cardiometabolic disease and cancer cohort (4C) study[J]. Diabetes Care, 2020, 43(8):1929‑1936. DOI: 10.2337/dc20‑0256.

[17] Du H, Guo Y, Bennett DA, et al. Red meat, poultry and fish consumption and risk of diabetes: a 9 year prospective cohort study of the China Kadoorie biobank[J]. Diabetologia, 2020, 63(4): 767‑779. DOI: 10.1007/s00125‑020‑05091‑x.

[18] Li S, Guo B, Jiang Y, et al. Long‑term exposure to ambient PM2.5 and its components associated with diabetes: evidence from a large population‑based cohort from China[J]. Diabetes Care, 2023, 46(1): 111‑119. DOI:

10.2337/dc22‑1585.

[19] Cho YS, Chen CH, Hu C, et al. Meta‑analysis of genome‑wide association studies identifies eight new loci for type 2 diabetes in East Asians[J]. Nat Genet, 2011, 44(1):67‑72. DOI: 10.1038/ng.1019.

[20] Ma RC, Hu C, Tam CH, et al. Genome‑wide association study in a Chinese population identifies a susceptibility locus for type 2 diabetes at 7q32 near PAX4[J]. Diabetologia, 2013, 56(6): 1291‑1305. DOI: 10.1007/s00125‑013‑2874‑4.

[21] Li H, Gan W, Lu L, et al. A genome‑wide association study identifies GRK5 and RASGRP1 as type 2 diabetes loci in Chinese Hans[J]. Diabetes, 2013, 62(1): 291‑298. DOI:

10.2337/db12‑0454.

[22] Hu C, Wang C, Zhang R, et al. Association of genetic variants of NOS1AP with type 2 diabetes in a Chinese population[J]. Diabetologia, 2010, 53(2): 290‑298. DOI:

10.1007/s00125‑009‑1594‑2.

[23] Hu C, Jia W. Diabetes in China: epidemiology and genetic risk factors and their clinical utility in personalized medication[J]. Diabetes, 2018, 67(1):3‑11. DOI: 10.2337/dbi17‑0013.

[24] Yan J, Peng D, Jiang F, et al. Impaired pancreatic beta cell compensatory function is the main cause of type 2 diabetes in individuals with high genetic risk: a 9 year prospective cohort study in the Chinese population[J]. Diabetologia, 2016, 59(7): 1458‑1462. DOI: 10.1007/

s00125‑016‑3939‑y.

[25] Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J]. Diabet Med, 1998, 15(7):539‑553. DOI: 10.1002/(SICI)1096‑9136(199807)15: 7<539::AID‑DIA668>3.0.CO;2‑S.

[26] World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation, 2006[M]. Geneva: WHO Document Production Services, 2006.

[27] World Health Organization. Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus. Abbreviated report of a WHO consultation, 2011[EB/OL]. (2013‑11‑12) [2024‑05‑16]. http://who. int/diabetes/publications/report‑hbalc‑2011.Pdf.

[28] American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S20‑S42. DOI: 10.2337/dc24‑S002.

[29] Bao Y, Ma X, Li H, et al. Glycated haemoglobin A1c for diagnosing diabetes in Chinese population: cross sectional epidemiological survey[J]. BMJ, 2010, 340:c2249. DOI: 10.1136/bmj.c2249.

[30] Wang S, Niu J, Zhao Z, et al. Detection of diabetes and prediabetes using glycosylated hemoglobin in Chinese adults living in Shanghai: a prospective analysis[J]. J Diabetes, 2020, 12(8):573‑582. DOI: 10.1111/1753‑0407.13028.

[31] Klein KR, Walker CP, McFerren AL, et al. Carbohydrate intake prior to oral glucose tolerance testing[J]. J Endocr Soc, 2021, 5(5):bvab049. DOI: 10.1210/jendso/bvab049.

[32] Conn JW. Interpretation of the glucose tolerance test. The necessity of a standard preparatory diet[J]. Am J Med Sci, 1940, 199:555‑564. DOI: 10.1097/00000441‑194004000‑00014.

[33] Wilkerson HL, Butler FK, Francis JO. The effect of prior carbohydrate intake on the oral glucose tolerance test[J]. Diabetes, 1960, 9:386‑391. DOI: 10.2337/diab.9.5.386.

[34] Gilmour JA. Response to the letter to the editor from Dr. Boudreau et al, “Validation of a stepwise approach using glycated hemoglobin levels to reduce the number of required oral glucose tolerance tests to screen for cystic fibrosis‑related diabetesin adults”[J]. Can J Diabetes, 2019, 43:163. DOI: 10.1016/j.jcjd.2019.02.002.

[35] Gilmour JA, Sykes J, Etchells E, et al. Cystic fibrosis‑related diabetes screening in adults: a gap analysis and evaluation of accuracy of glycated hemoglobin levels[J]. Can J Diabetes, 2019, 43(1): 13‑18. DOI: 10.1016/j.

jcjd.2018.04.008.

[36] 项坤三 . 特殊类型糖尿病[M]. 上海:上海科学技术出版社,

2011.

[37] 中华医学会糖尿病学分会, 中国医师协会内分泌代谢科医师分会, 中华医学会内分泌学分会, 等 . 中国1型糖尿病诊治指南(2021版)[J].中华糖尿病杂志, 2022, 14(11):1143‑1250. DOI: 10.3760/cma.j.cn115791‑20220916‑00474.

[38] 中国医师协会内分泌代谢科医师分会, 国家代谢性疾病临床医学研究中心 . 糖尿病分型诊断中国专家共识[J]. 中华糖尿病杂志 , 2022, 14(2): 120‑139. DOI: 10.3760/cma. j.

cn115791‑20211219‑00672.

[39] 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[J]. Diabetes Care, 1997, 20(4): 537‑544. DOI: 10.2337/

diacare.20.4.537.

[40] Li G, Zhang P, Wang J, et al. The long‑term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20‑year follow‑up study[J]. Lancet, 2008, 371(9626): 1783‑1789. DOI:

10.1016/S0140‑6736(08)60766‑7.

[41] Gong Q, Zhang P, Wang J, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30‑year results of the Da Qing Diabetes Prevention Outcome Study[J]. Lancet Diabetes Endocrinol, 2019, 7(6): 452‑461. DOI: 10.1016/S2213‑8587(19)30093‑2.

[42] Lindström J, Ilanne‑Parikka P, Peltonen M, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow‑up of the Finnish Diabetes Prevention Study[J]. Lancet, 2006, 368(9548):1673‑1679. DOI: 10.1016/S0140‑6736(06)69701‑8.

[43] Knowler WC, Barrett‑Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin[J]. N Engl J Med, 2002, 346(6):393‑403. DOI: 10.1056/NEJMoa012512.

[44] Knowler WC, Fowler SE, Hamman RF, et al. 10‑year follow‑up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study[J]. Lancet, 2009, 374(9702): 1677‑1686. DOI: 10.1016/S0140‑6736(09)61457‑4.

[45] Diabetes Prevention Program Research Group. Long‑term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15‑year follow‑up: the Diabetes Prevention Program Outcomes Study[J]. Lancet Diabetes Endocrinol, 2015, 3(11):866‑875. DOI: 10.1016/S2213‑8587(15)00291‑0.

[46] Zhang L, Zhang Y, Shen S, et al. Safety and effectiveness of metformin plus lifestyle intervention compared with lifestyle intervention alone in preventing progression to diabetes in a Chinese population with impaired glucose regulation: a multicentre, open‑label, randomised controlled trial[J]. Lancet Diabetes Endocrinol, 2023, 11(8):567‑577. DOI: 10.1016/S2213‑8587(23)00132‑8.

[47] 中华医学会内分泌学分会, 中华医学会糖尿病学分会, 中国医师协会内分泌代谢科医师分会, 等 . 中国成人糖尿病前期干预的专家共识 [J]. 中华内分泌代谢杂志 , 2020, 36(5):371‑380. DOI: 10.3760/cma.j.cn311282‑20200115‑00022.

[48] 中华人民共和国卫生部 . WS 397‑2012 糖尿病筛查和诊断[S]. 北京:中国标准出版社, 2012.

[49] Chung S, Azar KM, Baek M, et al. Reconsidering the age thresholds for type Ⅱ diabetes screening in the U.S[J]. Am J Prev Med, 2014, 47(4): 375‑381. DOI: 10.1016/j.

amepre.2014.05.012.

[50] Jia WP, Pang C, Chen L, et al. Epidemiological characteristics of diabetes mellitus and impaired glucose regulation in a Chinese adult population: the Shanghai Diabetes Studies, a cross‑sectional 3‑year follow‑up study in Shanghai urban communities[J]. Diabetologia, 2007, 50(2):286‑292. DOI: 10.1007/s00125‑006‑0503‑1.

[51] Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes[J]. N Engl J Med, 2005, 353(25):2643‑2653. DOI: 10.1056/NEJMoa052187.

[52] Holman RR, Paul SK, Bethel MA, et al. 10‑year follow‑up of intensive glucose control in type 2 diabetes[J]. N Engl J

Med, 2008, 359(15): 1577‑1589. DOI: 10.1056/NEJMoa0806470.

[53] UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38[J]. BMJ, 1998, 317(7160):703‑713.

[54] Snow V, Weiss KB, Mottur‑Pilson C. The evidence base for tight blood pressure control in the management of type 2 diabetes mellitus[J]. Ann Intern Med, 2003, 138(7):587‑592. DOI: 10.7326/0003‑4819‑138‑7‑200304010‑00017.

[55] Collins R, Armitage J, Parish S, et al. MRC/BHF Heart Protection Study of cholesterol‑lowering with simvastatin in 5963 people with diabetes: a randomised placebo‑controlled trial[J]. Lancet, 2003, 361(9374):2005‑2016. DOI: 10.1016/s0140‑6736(03)13636‑7.

[56] Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo‑controlled trial[J]. Lancet, 2004, 364(9435):685‑696. DOI: 10.1016/S0140‑6736(04)16895‑5.

[57] Sever PS, Poulter NR, Dahlöf B, et al. Reduction in cardiovascular events with atorvastatin in 2, 532 patients with type 2 diabetes: Anglo‑Scandinavian Cardiac Outcomes Trial‑‑lipid‑lowering arm (ASCOT‑LLA) [J]. Diabetes Care, 2005, 28(5): 1151‑1157. DOI: 10.2337/diacare.28.5.1151.

[58] ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes[J]. N Engl J Med, 2008, 358(24): 2560‑2572. DOI: 10.1056/NEJMoa0802987.

[59] Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes[J]. N Engl J Med, 2008, 358(24): 2545‑2559. DOI: 10.1056/NEJMoa0802743.

[60] Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes[J]. N Engl J Med, 2009, 360(2): 129‑139. DOI:

10.1056/NEJMoa0808431.

[61] Gaede P, Lund‑Andersen H, Parving HH, et al. Effect of a multifactorial intervention on mortality in type 2 diabetes[J]. N Engl J Med, 2008, 358(6): 580‑591. DOI: 10.1056/NEJMoa0706245.

[62] 中华医学会糖尿病学分会 . 中国 2 型糖尿病防治指南(2020 年版) [J]. 中华糖尿病杂志 , 2021, 13(4): 315‑409. DOI: 10.3760/cma.j.cn115791‑20210221‑00095.

[63] American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S52‑S76. DOI: 10.2337/dc24‑S004.

[64] Goldsborough E 3rd, Tasdighi E, Blaha MJ. Assessment of cardiovascular disease risk: a 2023 update[J]. Curr Opin Lipidol, 2023, 34(4): 162‑173. DOI: 10.1097/MOL.0000000000000887.

[65] Fang M, Wang D, Tang O, et al. Subclinical cardiovascular disease in US adults with and without diabetes[J]. J Am Heart Assoc, 2023, 12(11): e029083. DOI: 10.1161/JAHA.122.029083.

[66] American Diabetes Association. 5. Facilitating behavior

change and well‑being to improve health outcomes: standards of medical care in diabetes‑2020[J]. Diabetes Care, 43(Suppl 1):S48‑S65. DOI: 10.2337/dc20‑S005.

[67] Powers MA, Bardsley JK, Cypress M, et al. Diabetes self‑management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association[J]. Diabetes Care, 2020, 43(7): 1636‑1649. DOI: 10.2337/dci20‑0023.

[68] Marrero DG, Ard J, Delamater AM, et al. Twenty‑first century behavioral medicine: a context for empowering clinicians and patients with diabetes: a consensus report[J]. Diabetes Care, 2013, 36(2):463‑470. DOI: 10.2337/dc12‑2305.

[69] Gong E, Baptista S, Russell A, et al. My diabetes coach, a mobile App‑based interactive conversational agent to support type 2 diabetes self‑management: randomized effectiveness‑implementation trial[J]. J Med Internet Res, 2020, 22(11):e20322. DOI: 10.2196/20322.

[70] Chrvala CA, Sherr D, Lipman RD. Diabetes self‑management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control[J]. Patient Educ Couns, 2016, 99(6):926‑943. DOI: 10.1016/j.pec.2015.11.003.

[71] Wieland ML, Vickery KD, Hernandez V, et al. Digital storytelling intervention for hemoglobin A1c control among hispanic adults with type 2 diabetes: a randomized clinical trial[J]. JAMA Netw Open, 2024, 7(8):e2424781. DOI: 10.1001/jamanetworkopen.2024.24781.

[72] Cheng L, Sit J, Choi KC, et al. The effects of an empowerment‑based self‑management intervention on empowerment level, psychological distress, and quality of life in patients with poorly controlled type 2 diabetes: a randomized controlled trial[J]. Int J Nurs Stud, 2021, 116:

103407. DOI: 10.1016/j.ijnurstu.2019.103407.

[73] Nkhoma DE, Soko CJ, Bowrin P, et al. Digital interventions self‑management education for type 1 and 2 diabetes: a systematic review and meta‑analysis[J]. Comput Methods Programs Biomed, 2021, 210: 106370. DOI: 10.1016/j.

cmpb.2021.106370.

[74] Guo M, Meng F, Guo Q, et al. Effectiveness of mHealth management with an implantable glucose sensor and a mobile application among Chinese adults with type 2 diabetes[J]. J Telemed Telecare, 2023, 29(8): 632‑640. DOI: 10.1177/1357633X211020261.

[75] Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) [J]. Diabetologia, 2022, 65(12): 1925‑1966. DOI:

10.1007/s00125‑022‑05787‑2.

[76] Olson JL, White B, Mitchell H, et al. The design of an evaluation framework for diabetes self‑management education and support programs delivered nationally[J]. BMC Health Serv Res, 2022, 22(1): 46. DOI: 10.1186/s12913‑021‑07374‑4.

[77] Powers MA, Bardsley J, Cypress M, et al. Diabetes self‑management education and support in type 2

diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics[J]. Clin Diabetes, 2016, 34(2): 70‑80. DOI:

10.2337/diaclin.34.2.70.

[78] Bekele BB, Negash S, Bogale B, et al. Effect of diabetes self‑management education (DSME) on glycated hemoglobin (HbA1c) level among patients with T2DM: systematic review and meta‑analysis of randomized controlled trials[J]. Diabetes Metab Syndr, 2021, 15(1):177‑185. DOI: 10.1016/j.dsx.2020.12.030.

[79] Fisher V, Li WW, Malabu U. The effectiveness of mindfulness‑based stress reduction (MBSR) on the mental health, HbA1c, and mindfulness of diabetes patients: a systematic review and meta‑analysis of randomised controlled trials[J]. Appl Psychol Health Well Being, 2023, 15(4): 1733‑1749. DOI: 10.1111/aphw.12441.

[80] Jenkinson E, Knoop I, Hudson JL, et al. The effectiveness of cognitive behavioural therapy and third‑wave cognitive behavioural interventions on diabetes‑related distress: a systematic review and meta‑analysis[J]. Diabet Med, 2022, 39(11):e14948. DOI: 10.1111/dme.14948.

[81] Dennick K, Sturt J, Speight J. What is diabetes distress and how can we measure it? A narrative review and conceptual model[J]. J Diabetes Complications, 2017, 31(5):898‑911. DOI: 10.1016/j.jdiacomp.2016.12.018.

[82] Schmitt A, Reimer A, Kulzer B, et al. How to assess diabetes distress: comparison of the Problem Areas in Diabetes Scale (PAID) and the Diabetes Distress Scale (DDS) [J]. Diabet Med, 2016, 33(6): 835‑843. DOI:

10.1111/dme.12887.

[83] Khoo K, Man R, Rees G, et al. The relationship between diabetic retinopathy and psychosocial functioning: a systematic review[J]. Qual Life Res, 2019, 28(8):2017‑2039. DOI: 10.1007/s11136‑019‑02165‑1.

[84] McGowan JE, Murray K. Exploring resilience in nursing and midwifery students: a literature review[J]. J Adv Nurs, 2016, 72(10):2272‑2283. DOI: 10.1111/jan.12960.

[85] Polikandrioti M, Vasilopoulos G, Koutelekos I, et al. Depression in diabetic foot ulcer: associated factors and the impact of perceived social support and anxiety on depression[J]. Int Wound J, 2020, 17(4): 900‑909. DOI:

10.1111/iwj.13348.

[86] Ju C, Shi R, Yao L, et al. Effect of peer support on diabetes distress: a cluster randomized controlled trial[J]. Diabet Med, 2018, 35(6):770‑775. DOI: 10.1111/dme.13625.

[87] Young‑Hyman D, de Groot M, Hill‑Briggs F, et al. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association[J]. Diabetes Care, 2016, 39(12): 2126‑2140. DOI: 10.2337/dc16‑2053.

[88] Rollo ME, Aguiar EJ, Williams RL, et al. eHealth technologies to support nutrition and physical activity behaviors in diabetes self‑management[J]. Diabetes Metab Syndr Obes, 2016, 9:381‑390. DOI: 10.2147/DMSO.

S95247.

[89] Iyengar V, Wolf A, Brown A, et al. Challenges in diabetes care: can digital health help address them? [J]. Clin Diabetes, 2016, 34(3): 133‑141. DOI: 10.2337/diaclin.34.3.133.

[90] Gamble A, Pham Q, Goyal S, et al. The challenges of COVID‑19 for people living with diabetes: considerations for digital health[J]. JMIR Diabetes, 2020, 5(2): e19581. DOI: 10.2196/19581.

[91] Yu MG, Gordin D, Fu J, et al. Protective factors and the pathogenesis of complications in diabetes[J]. Endocr Rev, 2024, 45(2):227‑252. DOI: 10.1210/endrev/bnad030.

[92] Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular‑kidney‑metabolic health: a presidential advisory from the American Heart Association[J]. Circulation, 2023, 148(20): 1606‑1635. DOI: 10.1161/CIR.0000000000001184.

[93] Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular‑kidney‑metabolic (CKM) syndrome: a scientific statement from the American Heart Association[J]. Circulation, 2023, 148(20): 1636‑1664. DOI: 10.1161/CIR.0000000000001186.

[94] 中华医学会糖尿病学分会, 中华医学会内分泌学分会 . 中国成人 2 型糖尿病患者糖化血红蛋白控制目标及达标策略专家共识[J]. 中华糖尿病杂志 , 2020, 12(1):1‑12. DOI:

10.3760/cma.j.issn.1674‑5809.2020.01.001.

[95] 苏青 . 浅谈成人 2型糖尿病患者糖化血红蛋白控制目标及达标策略 [J]. 中华糖尿病杂志 , 2020, 12(1): 13‑16. DOI:

10.3760/cma.j.issn.1674‑5809.2020.01.002.

[96] 中华医学会糖尿病学分会, 中华医学会内分泌学分会 . 中国成人 2 型糖尿病合并心肾疾病患者降糖药物临床应用专家共识[J]. 中华糖尿病杂志 , 2020, 12(6):369‑381. DOI:

10.3760/cma.j.cn115791‑20200419‑00233.

[97] American Diabetes Association Professional Practice Committee. 6. Glycemic goals and hypoglycemia: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S111‑S125. DOI: 10.2337/dc24‑S006.

[98] American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes‑2025[J]. Diabetes Care, 2025, 48(Suppl 1): S181‑S206. DOI:

10.2337/dc25‑S009.

[99] Marx N, Federici M, Schütt K, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes[J]. Eur Heart J, 2023, 44(39): 4043‑4140. DOI: 10.1093/eurheartj/ehad192.

[100] Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study[J]. BMJ, 2000, 321(7258): 405‑412. DOI: 10.1136/bmj.321.7258.405.

[101] Adler AI, Coleman RL, Leal J, et al. Post‑trial monitoring of a randomised controlled trial of intensive glycaemic control in type 2 diabetes extended from 10 years to 24 years (UKPDS 91)[J]. Lancet, 2024, 404(10448):145‑155. DOI: 10.1016/S0140‑6736(24)00537‑3.

[102] Kunutsor SK, Balasubramanian VG, Zaccardi F, et al. Glycaemic control and macrovascular and microvascular outcomes: a systematic review and meta‑analysis of trials investigating intensive glucose‑lowering strategies in people with type 2 diabetes[J]. Diabetes Obes Metab, 2024, 26(6):2069‑2081. DOI: 10.1111/dom.15511.

[103] Sirtori CR, Castiglione S, Pavanello C. Metformin: from diabetes to cancer to prolongation of life[J]. Pharmacol Res, 2024, 208: 107367. DOI: 10.1016/j.

phrs.2024.107367.

[104] 《二甲双胍临床应用专家共识》更新专家组 . 二甲双胍临床应用专家共识 (2023 年版)[J]. 中华内科杂志 , 2023, 62(6):619‑630. DOI: 10.3760/cma.j.cn112138‑20230305‑00131.

[105] Kunutsor SK, Zaccardi F, Balasubramanian VG, et al. Glycaemic control and macrovascular and microvascular outcomes in type 2 diabetes: systematic review and meta‑analysis of cardiovascular outcome trials of novel glucose‑lowering agents[J]. Diabetes Obes Metab, 2024, 26(5):1837‑1849. DOI: 10.1111/dom.15500.

[106] Drake T, Landsteiner A, Langsetmo L, et al. Newer pharmacologic treatments in adults with type 2 diabetes: a systematic review and network Meta‑analysis for the American College of Physicians[J]. Ann Intern Med, 2024, 177(5):618‑632. DOI: 10.7326/M23‑1490.

[107] Banerjee M, Pal R, Maisnam I, et al. GLP‑1 receptor agonists, SGLT2 inhibitors and noncardiovascular mortality in type 2 diabetes: insights from a meta‑analysis[J]. Diabetes Metab Syndr, 2024, 18(1):102943. DOI: 10.1016/j.dsx.2024.102943.

[108] Edmonston D, Mulder H, Lydon E, et al. Kidney and cardiovascular effectiveness of SGLT2 inhibitors vs GLP‑1 receptor agonists in type 2 diabetes[J]. J Am Coll Cardiol, 2024, 84(8):696‑708. DOI: 10.1016/j.jacc.2024.06.016.

[109] Williams DM, Atkinson M, Evans M. Stroke prevention and treatment in people with type 2 diabetes: is there a role for GLP‑1 (glucagon‑like peptide‑1) analogues?[J]. Stroke, 2023,

54(5):

1441‑1451.

DOI:

10.1161/

STROKEAHA.122.042109.

[110] Lui DTW, Tang EHM, Wu T, et al. Risks of stroke, its subtypes and atrial fibrillation associated with glucagon‑like peptide 1 receptor agonists versus sodium‑glucose cotransporter 2 inhibitors: a real‑world population‑based cohort study in Hong Kong[J]. Cardiovasc Diabetol, 2023, 22(1): 40. DOI: 10.1186/s12933‑023‑01772‑0.

[111] Stefanou MI, Theodorou A, Malhotra K, et al. Risk of major adverse cardiovascular events and stroke associated with treatment with GLP‑1 or the dual GIP/GLP‑1 receptor agonist tirzepatide for type 2 diabetes: a systematic review and meta‑analysis[J]. Eur Stroke J, 2024, 9(3):530‑539. DOI: 10.1177/23969873241234238.

[112] Banerjee M, Pal R, Mukhopadhyay S, et al. GLP‑1 receptor agonists and risk of adverse cerebrovascular outcomes in type 2 diabetes: a systematic review and Meta‑analysis of randomized controlled trials[J]. J Clin Endocrinol Metab, 2023, 108(7):1806‑1812. DOI: 10.1210/clinem/dgad076.

[113] Adamou A, Barkas F, Milionis H, et al. Glucagon‑like peptide‑1 receptor agonists and stroke: a systematic review and meta‑analysis of cardiovascular outcome trials[J]. Int J Stroke,

2024,

19(8):

876‑887.

10.1177/17474930241253988.

[114] Albert SG, Shrestha E, Ahir V. Stroke prevention by antihyperglycemic drugs in type 2 diabetes mellitus[J]. Endocr Pract, 2024, 30(3): 246‑252. DOI: 10.1016/j.

eprac.2023.12.007.

[115] Sacco S, Foschi M, Ornello R, et al. Prevention and treatment of ischaemic and haemorrhagic stroke in people with diabetes mellitus: a focus on glucose control and comorbidities[J]. Diabetologia, 2024, 67(7):1192‑1205. DOI: 10.1007/s00125‑024‑06146‑z.

[116] Dormandy JA, Charbonnel B, Eckland DJ, et al. Secondary

prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial[J]. Lancet, 2005, 366(9493):1279‑1289. DOI: 10.1016/S0140‑6736(05)67528‑9.

[117] Kernan WN, Viscoli CM, Furie KL, et al. Pioglitazone after ischemic stroke or transient ischemic attack[J]. N Engl J Med, 2016, 374(14): 1321‑1331. DOI: 10.1056/NEJMoa1506930.

[118] Nguyen BN, Nguyen L, Mital S, et al. Comparative efficacy of sodium‑glucose co‑transporter‑2 inhibitors, glucagon‑like peptide‑1 receptor agonists and non‑steroidal mineralocorticoid receptor antagonists in chronic kidney disease and type 2 diabetes: a systematic review and network meta‑analysis[J]. Diabetes Obes Metab, 2023, 25(6): 1614‑1623. DOI: 10.1111/dom.15009.

[119] Rhee JJ, Han J, Montez‑Rath ME, et al. Comparative effectiveness of sodium‑glucose cotransporter‑2 inhibitors versus glucagon‑like peptide‑1 receptor agonists in patients with type 2 diabetes and mild/moderate chronic kidney disease[J]. Diabetes Obes Metab, 2024, 26(4): 1273‑1281. DOI: 10.1111/dom.15427.

[120] Perkovic V, Tuttle KR, Rossing P, et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes[J]. N Engl J Med, 2024, 391(2): 109‑121. DOI: 10.1056/NEJMoa2403347.

[121] Ferreira JP, Sharma A, Butler J, et al. Glucagon‑like peptide‑1 receptor agonists across the spectrum of heart failure[J]. J Clin Endocrinol Metab, 2023, 109(1):4‑9. DOI:

10.1210/clinem/dgad398.

[122] Abel ED, Gloyn AL, Evans‑Molina C, et al. Diabetes mellitus‑progress and opportunities in the evolving epidemic[J]. Cell, 2024, 187(15): 3789‑3820. DOI:

10.1016/j.cell.2024.06.029.

[123] Drucker DJ. Prevention of cardiorenal complications in people with type 2 diabetes and obesity[J]. Cell Metab, 2024, 36(2):338‑353. DOI: 10.1016/j.cmet.2023.12.018.

[124] Sattar N, Presslie C, Rutter MK, et al. Cardiovascular and kidney risks in individuals with type 2 diabetes: contemporary understanding with greater emphasis on excess adiposity[J]. Diabetes Care, 2024, 47(4): 531‑543. DOI: 10.2337/dci23‑0041.

[125] Koirala S, Sunnaa M, Bernier T, et al. The role of obesity as a cardiac disease risk factor in patients with type 2 diabetes[J]. Curr Cardiol Rep, 2024, 26(11): 1309‑1320. DOI: 10.1007/s11886‑024‑02129‑z.

[126] Brown KA, Scherer PE. Update on adipose tissue and cancer[J]. Endocr Rev, 2023, 44(6): 961‑974. DOI:

10.1210/endrev/bnad015.

[127] Harborg S, Kjærgaard KA, Thomsen RW, et al. New horizons: epidemiology of obesity, diabetes mellitus, and cancer prognosis[J]. J Clin Endocrinol Metab, 2024, 109(4):924‑935. DOI: 10.1210/clinem/dgad450.

[128] Avogaro A. Diabetes and obesity: the role of stress in the development of cancer[J]. Endocrine, 2024, 86(1): 48‑57. DOI: 10.1007/s12020‑024‑03886‑1.

[129] Kim J, Kim B, Kim MK, et al. Weight change in patients with new‑onset type 2 diabetes mellitus and its association with remission: comprehensive real‑world

data[J]. Diabetes Obes Metab, 2024, 26(2): 567‑575. DOI:

10.1111/dom.15345.

[130] Lingvay I, Sumithran P, Cohen RV, et al. Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation[J]. Lancet, 2022, 399(10322): 394‑405. DOI: 10.1016/S0140‑6736(21)01919‑X.

[131] American Diabetes Association Professional Practice Committee. 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S145‑S157. DOI: 10.2337/dc24‑S008.

[132] Rayner CK, Horowitz M. Twincretin therapy for type 2 diabetes: how do two do? [J]. Lancet, 2021, 398(10300):560‑561. DOI: 10.1016/S0140‑6736(21)01597‑X.

[133] Zhao L, Cheng Z, Lu Y, et al. Tirzepatide for weight reduction in Chinese adults with obesity: the SURMOUNT‑CN randomized clinical trial[J]. JAMA, 2024, 332(7):551‑560. DOI: 10.1001/jama.2024.9217.

[134] Karagiannis T, Malandris K, Avgerinos I, et al. Subcutaneously administered tirzepatide vs semaglutide for adults with type 2 diabetes: a systematic review and network meta‑analysis of randomised controlled trials[J]. Diabetologia, 2024, 67(7): 1206‑1222. DOI: 10.1007/s00125‑024‑06144‑1.

[135] Kim KS, Hong S, Han K, et al. Association of non‑alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: nationwide population based study[J]. BMJ, 2024, 384:e076388. DOI: 10.1136/bmj‑2023‑076388.

[136] Lawitz EJ, Fraessdorf M, Neff GW, et al. Efficacy, tolerability and pharmacokinetics of survodutide, a glucagon/glucagon‑like peptide‑1 receptor dual agonist, in cirrhosis[J]. J Hepatol, 2024, 81(5): 837‑846. DOI:

10.1016/j.jhep.2024.06.003.

[137] Loomba R, Hartman ML, Lawitz EJ, et al. Tirzepatide for metabolic dysfunction‑associated steatohepatitis with liver fibrosis[J]. N Engl J Med, 2024, 391(4):299‑310. DOI:

10.1056/NEJMoa2401943.

[138] Sanyal AJ, Bedossa P, Fraessdorf M, et al. A phase 2 randomized trial of survodutide in MASH and fibrosis[J]. N Engl J Med, 2024, 391(4): 311‑319. DOI: 10.1056/NEJMoa2401755.

[139] Engström A, Wintzell V, Melbye M, et al. Association of glucagon‑like peptide‑1 receptor agonists with serious liver events among patients with type 2 diabetes: a Scandinavian cohort study[J]. Hepatology, 2024, 79(6):1401‑1411. DOI: 10.1097/HEP.0000000000000712.

[140] Targher G, Mantovani A, Byrne CD. Mechanisms and possible hepatoprotective effects of glucagon‑like peptide‑1 receptor agonists and other incretin receptor agonists in non‑alcoholic fatty liver disease[J]. Lancet Gastroenterol Hepatol, 2023, 8(2): 179‑191. DOI:

10.1016/S2468‑1253(22)00338‑7.

[141] Krishnan A, Schneider CV, Hadi Y, et al. Cardiovascular and mortality outcomes with GLP‑1 receptor agonists vs other glucose‑lowering drugs in individuals with NAFLD and type 2 diabetes: a large population‑based matched cohort study[J]. Diabetologia, 2024, 67(3): 483‑493. DOI:

10.1007/s00125‑023‑06057‑5.

[142] Ahmad A, Sabbour H. Effectiveness and safety of the

combination of sodium‑glucose transport protein 2 inhibitors and glucagon‑like peptide‑1 receptor agonists in patients with type 2 diabetes mellitus: a systematic review and meta‑analysis of observational studies[J]. Cardiovasc Diabetol, 2024, 23(1): 99. DOI: 10.1186/s12933‑024‑02192‑4.

[143] Scheen AJ. GLP‑1 receptor agonists and SGLT2 inhibitors in type 2 diabetes: pleiotropic cardiometabolic effects and add‑on value of a combined therapy[J]. Drugs, 2024, 84(11):1347‑1364. DOI: 10.1007/s40265‑024‑02090‑9.

[144] Simms‑Williams N, Treves N, Yin H, et al. Effect of combination treatment with glucagon‑like peptide‑1 receptor agonists and sodium‑glucose cotransporter‑2 inhibitors on incidence of cardiovascular and serious renal events: population based cohort study[J]. BMJ, 2024, 385:e078242. DOI: 10.1136/bmj‑2023‑078242.

[145] Neuen BL, Fletcher RA, Heath L, et al. Cardiovascular, kidney, and safety outcomes with GLP‑1 receptor agonists alone and in combination with SGLT2 inhibitors in type 2 diabetes: a systematic review and Meta‑analysis[J]. Circulation, 2024, 150(22): 1781‑1790. DOI: 10.1161/CIRCULATIONAHA.124.071689.

[146] Schlosser R. Fixed‑dose and fixed‑ratio combination therapies in type 2 diabetes[J]. Can J Diabetes, 2019, 43(6):440‑444. DOI: 10.1016/j.jcjd.2019.05.005.

[147] Haluzik M, Taybani Z, Araszkiewicz A, et al. Expert opinion on optimising type 2 diabetes treatment using fixed‑ratio combination of basal insulin and GLP‑1 RA for treatment intensification and simplification[J]. Diabetes Ther, 2024, 15(8): 1673‑1685. DOI: 10.1007/s13300‑024‑01610‑w.

[148] TODAY Study Group. Effect of early glycemic control in youth‑onset type 2 diabetes on longer‑term glycemic control and β‑cell function: results from the TODAY study[J]. Diabetes Care, 2023, 46(8): 1507‑1514. DOI: 10.2337/dc23‑0560.

[149] Tsuchida K, Soda S, Rizzo M. The legacy effect in early‑stage diabetes: don′t stay by me, cardiovascular disease! [J]. J Diabetes Complications, 2023, 37(8):

108544. DOI: 10.1016/j.jdiacomp.2023.108544.

[150] Rodriguez‑Gutierrez R. Legacy effect of intensive glycaemic control in type 2 diabetes‑the UKPDS[J]. Lancet, 2024, 404(10448): 100‑102. DOI: 10.1016/S0140‑6736(24)01395‑3.

[151] Yang T, Qi F, Guo F, et al. An update on chronic complications of diabetes mellitus: from molecular mechanisms to therapeutic strategies with a focus on metabolic memory[J]. Mol Med, 2024, 30(1): 71. DOI:

10.1186/s10020‑024‑00824‑9.

[152] Laiteerapong N, Ham SA, Gao Y, et al. The legacy effect in type 2 diabetes: impact of early glycemic control on future complications (the diabetes & aging study) [J]. Diabetes Care, 2019, 42(3): 416‑426. DOI: 10.2337/dc17‑1144.

[153] Matthews DR, Paldánius PM, Proot P, et al. Glycaemic durability of an early combination therapy with vildagliptin and metformin versus sequential metformin monotherapy in newly diagnosed type 2 diabetes (VERIFY): a 5‑year, multicentre, randomised, double‑blind trial[J]. Lancet, 2019, 394(10208):1519‑1529. DOI: 10.1016/S0140‑6736(19)32131‑2.

[154] Ji L, Chan JCN, Yu M, et al. Early combination versus initial metformin monotherapy in the management of newly diagnosed type 2 diabetes: an East Asian perspective[J]. Diabetes Obes Metab, 2021, 23(1): 3‑17. DOI: 10.1111/dom.14205.

[155] Liu L, Ke W, Li H, et al. Intense simplified strategy for newly diagnosed type 2 diabetes in patients with severe hyperglycaemia: multicentre, open label, randomised trial[J]. BMJ, 2024, 387:e080122. DOI: 10.1136/bmj‑2024‑080122.

[156] Nakhleh A, Halfin E, Shehadeh N. Remission of type 2 diabetes mellitus[J]. World J Diabetes, 2024, 15(7):1384‑1389. DOI: 10.4239/wjd.v15.i7.1384.

[157] Magliano DJ, Sacre JW, Harding JL, et al. Young‑onset type 2 diabetes mellitus‑implications for morbidity and mortality[J]. Nat Rev Endocrinol, 2020, 16(6): 321‑331. DOI: 10.1038/s41574‑020‑0334‑z.

[158] The Lancet Diabetes Endocrinology. Alarming rise in young‑onset type 2 diabetes[J]. Lancet Diabetes Endocrinol, 2024, 12(7): 433. DOI: 10.1016/S2213‑8587(24)00161‑X.

[159] Strati M, Moustaki M, Psaltopoulou T, et al. Early onset type 2 diabetes mellitus: an update[J]. Endocrine, 2024, 85(3):965‑978. DOI: 10.1007/s12020‑024‑03772‑w.

[160] Misra S, Ke C, Srinivasan S, et al. Current insights and emerging trends in early‑onset type 2 diabetes[J]. Lancet Diabetes Endocrinol, 2023, 11(10): 768‑782. DOI:

10.1016/S2213‑8587(23)00225‑5.

[161] Bjornstad P, Chao LC, Cree‑Green M, et al. Youth‑onset type 2 diabetes mellitus: an urgent challenge[J]. Nat Rev Nephrol, 2023, 19(3): 168‑184. DOI: 10.1038/s41581‑022‑00645‑1.

[162] Emerging Risk Factors Collaboration. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high‑income countries: 23 million person‑years of observation[J]. Lancet Diabetes Endocrinol, 2023, 11(10): 731‑742. DOI: 10.1016/S2213‑8587(23)00223‑1.

[163] Lin B, Coleman RL, Bragg F, et al. Younger‑onset compared with later‑onset type 2 diabetes: an analysis of the UK Prospective Diabetes Study (UKPDS) with up to 30 years of follow‑up (UKPDS 92) [J]. Lancet Diabetes Endocrinol, 2024, 12(12): 904‑914. DOI: 10.1016/S2213‑8587(24)00242‑0.

[164] American Diabetes Association Professional Practice Committee. 5. Facilitating positive health behaviors and well‑being to improve health outcomes: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S77‑S110. DOI: 10.2337/dc24‑S005.

[165] 贺娟 . 甄别与还原——论《黄帝内经》两种不同的医学体系[J].

北京中医药大学学报, 2024, 47(1):30‑36. DOI: 10.3969/j.

issn.1006‑2157.2024.01.006.

[166] 中国医疗保健国际交流促进会营养与代谢管理分会, 中国营养学会临床营养分会, 中华医学会糖尿病学分会, 等 . 中国糖尿病医学营养治疗指南(2022 版)[J]. 中华糖尿病杂志 , 2022, 14(9): 881‑933. DOI: 10.3760/cma. j.

cn115791‑20220704‑00324.

[167] 中国营养学会 . 中国居民膳食营养素参考摄入量(2023版)[M]. 北京:人民卫生出版社, 2023.

[168] Dyson PA, Twenefour D, Breen C, et al. Diabetes UK evidence‑based nutrition guidelines for the prevention and management of diabetes[J]. Diabet Med, 2018, 35(5):

541‑547. DOI: 10.1111/dme.13603.

[169] Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report[J]. Diabetes Care, 2019, 42(5):731‑754. DOI: 10.2337/dci19‑0014.

[170] Seidelmann SB, Claggett B, Cheng S, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta‑analysis[J]. Lancet Public Health, 2018, 3(9):e419‑e428. DOI: 10.1016/S2468‑2667(18)30135‑X.

[171] Reynolds A, Mann J, Cummings J, et al. Carbohydrate quality and human health: a series of systematic reviews and meta‑analyses[J]. Lancet, 2019, 393(10170):434‑445. DOI: 10.1016/S0140‑6736(18)31809‑9.

[172] Huo R, Du T, Xu Y, et al. Effects of Mediterranean‑style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta‑analysis[J]. Eur J Clin Nutr, 2015, 69(11): 1200‑1208. DOI: 10.1038/ejcn.2014.243.

[173] Chiavaroli L, Viguiliouk E, Nishi SK, et al. DASH dietary pattern and cardiometabolic outcomes: an umbrella review of systematic reviews and Meta‑analyses[J]. Nutrients, 2019, 11(2):338. DOI: 10.3390/nu11020338.

[174] Silverii GA, Botarelli L, Dicembrini I, et al. Low‑carbohydrate diets and type 2 diabetes treatment: a meta‑analysis of randomized controlled trials[J]. Acta Diabetol, 2020, 57(11): 1375‑1382. DOI: 10.1007/s00592‑020‑01568‑8.

[175] Luo Y, Wang J, Sun L, et al. Isocaloric‑restricted Mediterranean diet and Chinese diets high or low in plants in adults with prediabetes[J]. J Clin Endocrinol Metab, 2022, 107(8): 2216‑2227. DOI: 10.1210/clinem/dgac303.

[176] Liu D, Huang Y, Huang C, et al. Calorie restriction with or without time‑restricted eating in weight loss[J]. N Engl J Med, 2022, 386(16): 1495‑1504. DOI: 10.1056/NEJMoa2114833.

[177] Varady KA, Cienfuegos S, Ezpeleta M, et al. Clinical application of intermittent fasting for weight loss: progress and future directions[J]. Nat Rev Endocrinol, 2022, 18(5):309‑321. DOI: 10.1038/s41574‑022‑00638‑x.

[178] 中华医学会内分泌学分会 . 肥胖患者的长期体重管理及药物临床应用指南(2024版)[J].中华内分泌代谢杂志, 2024, 40(7):

545‑564.

10.3760/cma.

j.

cn311282‑20240412‑00149.

[179] Almandoz JP, Wadden TA, Tewksbury C, et al. Nutritional considerations with antiobesity medications[J]. Obesity (Silver Spring), 2024, 32(9): 1613‑1631. DOI: 10.1002/oby.24067.

[180] Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes, 2022. a consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) [J]. Diabetes Care, 2022, 45(11): 2753‑2786. DOI:

10.2337/dci22‑0034.

[181] Handelsman Y, Anderson JE, Bakris GL, et al. DCRM 2.0: multispecialty practice recommendations for the management of diabetes, cardiorenal, and metabolic diseases[J]. Metabolism, 2024, 159: 155931. DOI:

10.1016/j.metabol.2024.155931.

[182] 中华医学会糖尿病学分会 . 中国糖尿病运动指南[M]. 北京:中华医学电子音像出版社, 2012.

[183] 国家老年医学中心, 中华医学会糖尿病学分会, 中国体育科学学会, 等 . 中国 2 型糖尿病运动治疗指南(2024 版)[J]. 中国运动医学杂志, 2024, 43(6):419‑452. DOI: 10.3969/j.

issn.1000‑6710.2024.06.001.

[184] Alvares TS, DE Souza LVM, Soares RN, et al. Cardiorespiratory fitness is impaired in type 1 and type 2 diabetes: a systematic review, Meta‑analysis, and Meta‑regression[J]. Med Sci Sports Exerc, 2024, 56(9):1553‑1562. DOI: 10.1249/MSS.0000000000003451.

[185] 张献博, 郝丽, 刘新康, 等 . 美国糖尿病学会立场声明:体力活动/运动与糖尿病[J]. 中华健康管理学杂志 , 2017, 11(4):286‑302. DOI: 10.3760/cma.j.issn.1674‑0815.2017.04.002.

[186] Dempsey PC, Larsen RN, Sethi P, et al. Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities[J]. Diabetes Care, 2016, 39(6): 964‑972. DOI: 10.2337/dc15‑2336.

[187] Kanaley JA, Colberg SR, Corcoran MH, et al. Exercise/physical activity in individuals with type 2 diabetes: a consensus statement from the American College of Sports Medicine[J]. Med Sci Sports Exerc, 2022, 54(2):353‑368. DOI: 10.1249/MSS.0000000000002800.

[188] Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta‑analysis[J]. Ann Intern Med, 2015, 162(2):123‑132. DOI: 10.7326/M14‑1651.

[189] Reusch JEB, Regensteiner JG, Stewart KJ, et al. Diabetes and exercise: from pathophysiology to clinical implementation [M]. 2nd ed. Totowa: Humana, 2018.

[190] Hawley JA, Zierath JR. Physical activity and type 2 diabetes: therapeutic effects and mechanisms of action[M]. Champaign: Human Kinetics, 2008.

[191] Bolen S, Feldman L, Vassy J, et al. Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus[J]. Ann Intern Med, 2007, 147(6): 386‑399. DOI:

10.7326/0003‑4819‑147‑6‑200709180‑00178.

[192] Sherifali D, Nerenberg K, Pullenayegum E, et al. The effect of oral antidiabetic agents on A1C levels: a systematic review and meta‑analysis[J]. Diabetes Care, 2010, 33(8):1859‑1864. DOI: 10.2337/dc09‑1727.

[193] Saenz A, Fernandez‑Esteban I, Mataix A, et al. Metformin monotherapy for type 2 diabetes mellitus[J]. Cochrane Database Syst Rev, 2005, (3): CD002966. DOI:

10.1002/14651858.CD002966.pub3.

[194] UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood‑glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34)[J]. Lancet, 1998, 352(9131):854‑865.

[195] Hong J, Zhang Y, Lai S, et al. Effects of metformin versus glipizide on cardiovascular outcomes in patients with type 2 diabetes and coronary artery disease[J]. Diabetes Care, 2013, 36(5):1304‑1311. DOI: 10.2337/dc12‑0719.

[196] Maruthur NM, Tseng E, Hutfless S, et al. Diabetes medications as monotherapy or metformin⁃based combination therapy for type 2 diabetes: a systematic review and Meta‑analysis[J]. Ann Intern Med, 2016, 164(11):740‑751. DOI: 10.7326/M15‑2650.

[197] Out M, Kooy A, Lehert P, et al. Long‑term treatment with metformin in type 2 diabetes and methylmalonic acid: Post hoc analysis of a randomized controlled 4.3 year trial[J]. J

Diabetes Complications, 2018, 32(2):171‑178. DOI: 10.1016/j.jdiacomp.2017.11.001.

[198] Aroda VR, Edelstein SL, Goldberg RB, et al. Long‑term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study[J]. J Clin Endocrinol Metab, 2016, 101(4): 1754‑1761. DOI: 10.1210/jc.2015‑3754.

[199] National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD: 2012 update[J]. Am J Kidney Dis, 2012, 60(5): 850‑886. DOI: 10.1053/j.

ajkd.2012.07.005.

[200] Hirst JA, Farmer AJ, Dyar A, et al. Estimating the effect of sulfonylurea on HbA1c in diabetes: a systematic review and meta‑analysis[J]. Diabetologia, 2013, 56(5): 973‑984. DOI: 10.1007/s00125‑013‑2856‑6.

[201] Hanefeld M, Monnier L, Schnell O, et al. Early treatment with basal insulin glargine in people with type 2 diabetes: lessons from ORIGIN and other cardiovascular trials[J]. Diabetes Ther, 2016, 7(2): 187‑201. DOI: 10.1007/s13300‑016‑0153‑3.

[202] Rosenstock J, Kahn SE, Johansen OE, et al. Effect of linagliptin vs glimepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes: the CAROLINA randomized clinical trial[J]. JAMA, 2019, 322(12):1155‑1166. DOI: 10.1001/jama.2019.13772.

[203] Landgraf R. Meglitinide analogues in the treatment of type 2 diabetes mellitus[J]. Drugs Aging, 2000, 17(5):411‑425. DOI: 10.2165/00002512‑200017050‑00007.

[204] Zhu XX, Pan CY, Li GW, et al. Addition of rosiglitazone to existing sulfonylurea treatment in chinese patients with type 2 diabetes and exposure to hepatitis B or C[J]. Diabetes Technol Ther, 2003, 5(1): 33‑42. DOI:

10.1089/152091503763816445.

[205] 吕朝晖, 潘长玉, 高妍, 等 . 随机、双盲、安慰剂对照评价盐酸吡格列酮并用磺酰脲类药物治疗 2 型糖尿病的有效性和安全性[J].中华内科杂志, 2011, 50(10):826‑830. DOI:

10.3760/cma.j.issn.0578‑1426.2011.10.008.

[206] 潘长玉, 高妍, 高鑫, 等 . 盐酸吡格列酮治疗2型糖尿病的有效性和安全性的多中心临床研究[J].中华内科杂志, 2002, 41(6):388‑392. DOI: 10.3760/j.issn:0578‑1426.2002.06.009.

[207] Hung YC, Chiu LT, Huang HY, et al. Pioglitazone for primary stroke prevention in Asian patients with type 2 diabetes and cardiovascular risk factors: a retrospective study[J]. Cardiovasc Diabetol, 2020, 19(1): 94. DOI:

10.1186/s12933‑020‑01056‑x.

[208] Spence JD, Viscoli CM, Inzucchi SE, et al. Pioglitazone therapy in patients with stroke and prediabetes: a post hoc analysis of the IRIS randomized clinical trial[J]. JAMA Neurol, 2019, 76(5): 526‑535. DOI: 10.1001/jamaneurol.2019.0079.

[209] de Jong M, van der Worp HB, van der Graaf Y, et al. Pioglitazone and the secondary prevention of cardiovascular

disease.

A

meta‑analysis

of randomized‑controlled trials[J]. Cardiovasc Diabetol, 2017, 16(1):134. DOI: 10.1186/s12933‑017‑0617‑4.

[210] Phatak HM, Yin DD. Factors associated with the effect‑size of thiazolidinedione (TZD) therapy on HbA(1c): a meta‑analysis of published randomized clinical trials[J]. Curr Med Res Opin, 2006, 22(11): 2267‑2278. DOI:

10.1185/030079906X148328.

[211] Hernandez AV, Usmani A, Rajamanickam A, et al.

Thiazolidinediones and risk of heart failure in patients with or at high risk of type 2 diabetes mellitus: a meta‑analysis and meta‑regression analysis of placebo‑controlled randomized clinical trials[J]. Am J Cardiovasc Drugs, 2011, 11(2): 115‑128. DOI:

10.2165/11587580‑000000000‑00000.

[212] Cai X, Han X, Luo Y, et al. Comparisons of the efficacy of alpha glucosidase inhibitors on type 2 diabetes patients between Asian and Caucasian[J]. PLoS One, 2013, 8(11):e79421. DOI: 10.1371/journal.pone.0079421.

[213] Holman RR, Coleman RL, Chan J, et al. Effects of acarbose on cardiovascular and diabetes outcomes in patients with coronary heart disease and impaired glucose tolerance (ACE): a randomised, double‑blind, placebo‑controlled trial[J]. Lancet Diabetes Endocrinol, 2017, 5(11):877‑886. DOI: 10.1016/S2213‑8587(17)30309‑1.

[214] 中华医学会糖尿病学分会 . 基于胰高血糖素样肽 1降糖药物的临床应用共识[J].中华糖尿病杂志, 2014, 6(1):14‑20. DOI: 10.3760/cma.j.issn.1674‑5809.2014.01.004.

[215] Ji L, Han P, Wang X, et al. Randomized clinical trial of the safety and efficacy of sitagliptin and metformin co‑administered to Chinese patients with type 2 diabetes mellitus[J]. J Diabetes Investig, 2016, 7(5): 727‑736. DOI:

10.1111/jdi.12511.

[216] Ji L, Li L, Kuang J, et al. Efficacy and safety of fixed‑dose combination therapy, alogliptin plus metformin, in Asian patients with type 2 diabetes: a phase 3 trial[J]. Diabetes Obes Metab, 2017, 19(5): 754‑758. DOI: 10.1111/dom.12875.

[217] Pan C, Yang W, Barona JP, et al. Comparison of vildagliptin and acarbose monotherapy in patients with type 2 diabetes: a 24‑week, double‑blind, randomized trial[J]. Diabet Med, 2008, 25(4): 435‑441. DOI: 10.1111/j.1464‑5491.2008.02391.x.

[218] Mohan V, Yang W, Son HY, et al. Efficacy and safety of sitagliptin in the treatment of patients with type 2 diabetes in China, India, and Korea[J]. Diabetes Res Clin Pract, 2009, 83(1): 106‑116. DOI: 10.1016/j.

diabres.2008.10.009.

[219] Pan CY, Yang W, Tou C, et al. Efficacy and safety of saxagliptin in drug‑naïve Asian patients with type 2 diabetes mellitus: a randomized controlled trial[J]. Diabetes Metab Res Rev, 2012, 28(3): 268‑275. DOI:

10.1002/dmrr.1306.

[220] Wu W, Li Y, Chen X, et al. Effect of linagliptin on glycemic control in Chinese patients with newly‑diagnosed, drug‑naïve type 2 diabetes mellitus: a randomized controlled trial[J]. Med Sci Monit, 2015, 21: 2678‑2684. DOI: 10.12659/MSM.894026.

[221] Pan C, Han P, Ji Q, et al. Efficacy and safety of alogliptin in patients with type 2 diabetes mellitus: a multicentre randomized double‑blind placebo‑controlled phase 3 study in mainland China, Taiwan, and Hong Kong[J]. J Diabetes, 2017, 9(4):386‑395. DOI: 10.1111/1753‑0407.12425.

[222] Ba J, Han P, Yuan G, et al. Randomized trial assessing the safety and efficacy of sitagliptin in Chinese patients with type 2 diabetes mellitus inadequately controlled on sulfonylurea alone or combined with metformin[J]. J Diabetes,

2017,

9(7):

667‑676.

10.1111/1753‑0407.12456.

[223] Wang W, Ning G, Ma J, et al. A randomized clinical trial of

the safety and efficacy of sitagliptin in patients with type 2 diabetes mellitus inadequately controlled by acarbose alone[J]. Curr Med Res Opin, 2017, 33(4): 693‑699. DOI:

10.1080/03007995.2016.1277200.

[224] Yang W, Guan Y, Shentu Y, et al. The addition of sitagliptin to ongoing metformin therapy significantly improves glycemic control in Chinese patients with type 2 diabetes[J]. J Diabetes, 2012, 4(3): 227‑237. DOI: 10.1111/j.1753‑0407.2012.00213.x.

[225] Yang W, Pan CY, Tou C, et al. Efficacy and safety of saxagliptin added to metformin in Asian people with type 2 diabetes mellitus: a randomized controlled trial[J]. Diabetes Res Clin Pract, 2011, 94(2): 217‑224. DOI:

10.1016/j.diabres.2011.07.035.

[226] Pan C, Xing X, Han P, et al. Efficacy and tolerability of vildagliptin as add‑on therapy to metformin in Chinese patients with type 2 diabetes mellitus[J]. Diabetes Obes Metab, 2012, 14(8): 737‑744. DOI: 10.1111/j.1463‑1326.2012.01593.x.

[227] Wang W, Yang J, Yang G, et al. Efficacy and safety of linagliptin in Asian patients with type 2 diabetes mellitus inadequately controlled by metformin: a multinational 24‑week, randomized clinical trial[J]. J Diabetes, 2016, 8(2):229‑237. DOI: 10.1111/1753‑0407.12284.

[228] Zeng Z, Yang JK, Tong N, et al. Efficacy and safety of linagliptin added to metformin and sulphonylurea in Chinese patients with type 2 diabetes: a sub‑analysis of data from a randomised clinical trial[J]. Curr Med Res Opin, 2013, 29(8):921‑929. DOI: 10.1185/03007995.2013.805123.

[229] 潘长玉, 李文慧, 曾姣娥, 等 . 阿格列汀治疗2型糖尿病有效性和安全性Ⅲ期临床研究试验设计和中国大陆基线情况[J]. 中华内科杂志 , 2013, 52(11):932‑935. DOI: 10.3760/cma.j.

issn.0578‑1426.2013.11.009.

[230] Shankar RR, Bao Y, Han P, et al. Sitagliptin added to stable insulin therapy with or without metformin in Chinese patients with type 2 diabetes[J]. J Diabetes Investig, 2017, 8(3):321‑329. DOI: 10.1111/jdi.12585.

[231] Ning G, Wang W, Li L, et al. Vildagliptin as add‑on therapy to insulin improves glycemic control without increasing risk of hypoglycemia in Asian, predominantly Chinese, patients with type 2 diabetes mellitus[J]. J Diabetes, 2016, 8(3):345‑353. DOI: 10.1111/1753‑0407.12303.

[232] Craddy P, Palin HJ, Johnson KI. Comparative effectiveness of dipeptidylpeptidase‑4 inhibitors in type 2 diabetes: a systematic review and mixed treatment comparison[J]. Diabetes Ther, 2014, 5(1): 1‑41. DOI: 10.1007/s13300‑014‑0061‑3.

[233] Mearns ES, Sobieraj DM, White CM, et al. Comparative efficacy and safety of antidiabetic drug regimens added to metformin monotherapy in patients with type 2 diabetes: a network meta‑analysis[J]. PLoS One, 2015, 10(4):e0125879. DOI: 10.1371/journal.pone.0125879.

[234] Cai X, Gao X, Yang W, et al. DPP‑4 inhibitor treatment in Chinese type 2 diabetes patients: a Meta‑analysis[J]. Diabetes Technol Ther, 2016, 18(12): 784‑793. DOI:

10.1089/dia.2016.0302.

[235] Bai N, Wang J, Liang W, et al. A multicenter, randomized, double‑blind, placebo‑controlled, and dose‑increasing study on the safety, tolerability and PK/PD of multiple doses of HSK7653 by oral administration in patients with type 2 diabetes mellitus in China[J]. Diabetes Ther, 2024,

15(1):183‑199. DOI: 10.1007/s13300‑023‑01496‑0.

[236] White WB, Cannon CP, Heller SR, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes[J]. N Engl J Med, 2013, 369(14): 1327‑1335. DOI: 10.1056/NEJMoa1305889.

[237] Scirica BM, Bhatt DL, Braunwald E, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus[J]. N Engl J Med, 2013, 369(14):1317‑1326. DOI:

10.1056/NEJMoa1307684.

[238] Green JB, Bethel MA, Armstrong PW, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes[J]. N Engl J Med, 2015, 373(3):232‑242. DOI: 10.1056/NEJMoa1501352.

[239] Rosenstock J, Perkovic V, Johansen OE, et al. Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk: the CARMELINA randomized clinical trial[J]. JAMA, 2019, 321(1): 69‑79. DOI: 10.1001/jama.2018.18269.

[240] Shi D, Chen L, Li G, et al. Pharmacokinetics, pharmacodynamics, and safety of single dose HSK7653 tablets in Chinese subjects with normal or impaired renal function[J]. Clin Pharmacokinet, 2024, 63(2): 227‑239. DOI: 10.1007/s40262‑023‑01333‑4.

[241] American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes‑2021[J]. Diabetes Care, 2021, 44(Suppl 1):S111‑S124. DOI: 10.2337/dc21‑S009.

[242] Rieg T, Vallon V. Development of SGLT1 and SGLT2 inhibitors[J]. Diabetologia, 2018, 61(10):2079‑2086. DOI:

10.1007/s00125‑018‑4654‑7.

[243] Perry RJ, Shulman GI. Sodium‑glucose cotransporter‑2 inhibitors: understanding the mechanisms for therapeutic promise and persisting risks[J]. J Biol Chem, 2020, 295(42): 14379‑14390. DOI: 10.1074/jbc.

REV120.008387.

[244] Scheen AJ. Sodium‑glucose cotransporter type 2 inhibitors for the treatment of type 2 diabetes mellitus[J]. Nat Rev Endocrinol, 2020, 16(10):556‑577. DOI: 10.1038/s41574‑020‑0392‑2.

[245] Marx N, Davies MJ, Grant PJ, et al. Guideline recommendations and the positioning of newer drugs in type 2 diabetes care[J]. Lancet Diabetes Endocrinol, 2021, 9(1):46‑52. DOI: 10.1016/S2213‑8587(20)30343‑0.

[246] Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes[J]. N Engl J Med, 2015, 373(22): 2117‑2128. DOI: 10.1056/NEJMoa1504720.

[247] Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes[J]. N Engl J Med, 2017, 377(7): 644‑657. DOI: 10.1056/NEJMoa1611925.

[248] Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes[J]. N Engl J Med, 2019, 380(4): 347‑357. DOI: 10.1056/NEJMoa1812389.

[249] Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure[J]. N Engl J Med, 2020, 383(15): 1413‑1424. DOI: 10.1056/NEJMoa2022190.

[250] Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction[J]. N Engl J

Med, 2021, 385(16): 1451‑1461. DOI: 10.1056/NEJMoa2107038.

[251] Cannon CP, Pratley R, Dagogo‑Jack S, et al. Cardiovascular outcomes with ertugliflozin in type 2 diabetes[J]. N Engl J Med, 2020, 383(15): 1425‑1435. DOI: 10.1056/NEJMoa2004967.

[252] Heerspink H, Stefánsson BV, Correa‑Rotter R, et al. Dapagliflozin in patients with chronic kidney disease[J]. N Engl J Med, 2020, 383(15): 1436‑1446. DOI: 10.1056/NEJMoa2024816.

[253] Herrington WG, Staplin N, Wanner C, et al. Empagliflozin in patients with chronic kidney disease[J]. N Engl J Med, 2023, 388(2):117‑127. DOI: 10.1056/NEJMoa2204233.

[254] Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy[J]. N Engl J Med, 2019, 380(24): 2295‑2306. DOI: 10.1056/NEJMoa1811744.

[255] Musso G, Saba F, Cassader M, et al. Diabetic ketoacidosis with SGLT2 inhibitors[J]. BMJ, 2020, 371: m4147. DOI:

10.1136/bmj.m4147.

[256] Baker ML, Perazella MA. SGLT2 inhibitor therapy in patients with type‑2 diabetes mellitus: is acute kidney injury a concern?[J]. J Nephrol, 2020, 33(5):985‑994. DOI:

10.1007/s40620‑020‑00712‑5.

[257] Zhu D, Li X, Ma J, et al. Dorzagliatin in drug‑naïve patients with type 2 diabetes: a randomized, double‑blind, placebo‑controlled phase 3 trial[J]. Nat Med, 2022, 28(5):965‑973. DOI: 10.1038/s41591‑022‑01802‑6.

[258] Yang W, Zhu D, Gan S, et al. Dorzagliatin add‑on therapy to metformin in patients with type 2 diabetes: a randomized, double‑blind, placebo‑controlled phase 3 trial[J]. Nat Med, 2022, 28(5): 974‑981. DOI: 10.1038/s41591‑022‑01803‑5.

[259] Ji L, Song W, Fang H, et al. Efficacy and safety of chiglitazar, a novel peroxisome proliferator‑activated receptor pan‑agonist, in patients with type 2 diabetes: a randomized, double‑blind, placebo‑controlled, phase 3 trial (CMAP) [J]. Sci Bull (Beijing), 2021, 66(15):1571‑1580. DOI: 10.1016/j.scib.2021.03.019.

[260] Wang W, Bain SC, Bian F, et al. Efficacy and safety of oral semaglutide monotherapy vs placebo in a predominantly Chinese population with type 2 diabetes (PIONEER 11): a double‑blind, Phase IIIa, randomised trial[J]. Diabetologia, 2024, 67(9): 1783‑1799. DOI: 10.1007/s00125‑024‑06142‑3.

[261] 严婷, 杨锐, 余丹峰, 等 . 吡格列酮二甲双胍片或二甲双胍治疗对 2 型糖尿病患者的多种脂肪细胞因子的影响[J].中华内分泌代谢杂志 , 2013, 29(6):509‑511. DOI: 10.3760/cma.j.issn.1000‑6699.2013.06.015.

[262] Pfützner A, Schöndorf T, Tschöpe D, et al. PIOfix‑study: effects of pioglitazone/metformin fixed combination in comparison with a combination of metformin with glimepiride on diabetic dyslipidemia[J]. Diabetes Technol Ther, 2011, 13(6):637‑643. DOI: 10.1089/dia.2010.0233.

[263] Reasner C, Olansky L, Seck TL, et al. The effect of initial therapy with the fixed‑dose combination of sitagliptin and metformin compared with metformin monotherapy in patients with type 2 diabetes mellitus[J]. Diabetes Obes Metab, 2011, 13(7): 644‑652. DOI: 10.1111/j.1463‑1326.2011.01390.x.

[264] Blüher M, Kurz I, Dannenmaier S, et al. Efficacy and safety

of vildagliptin in clinical practice‑results of the PROVIL‑study[J]. World J Diabetes, 2012, 3(9): 161‑169. DOI: 10.4239/wjd.v3.i9.161.

[265] Pfützner A, Paz‑Pacheco E, Allen E, et al. Initial combination therapy with saxagliptin and metformin provides sustained glycaemic control and is well tolerated for up to 76 weeks[J]. Diabetes Obes Metab, 2011, 13(6):567‑576. DOI: 10.1111/j.1463‑1326.2011.01385.x.

[266] Bajaj HS, Ye C, Jain E, et al. Glycemic Improvement with a fixed‑dose combination of DPP‑4 inhibitor + metformin in patients with type 2 diabetes (GIFT study) [J]. Diabetes Obes Metab, 2018, 20(1): 195‑199. DOI: 10.1111/dom.13040.

[267] Hadjadj S, Rosenstock J, Meinicke T, et al. Initial combination of empagliflozin and metformin in patients with type 2 diabetes[J]. Diabetes Care, 2016, 39(10):1718‑1728. DOI: 10.2337/dc16‑0522.

[268] Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al. The effect of intensive treatment of diabetes on the development and progression

of

long‑term

complications

in insulin‑dependent diabetes mellitus[J]. N Engl J Med, 1993,

329(14):

977‑986.

10.1056/

NEJM199309303291401.

[269] Shichiri M, Kishikawa H, Ohkubo Y, et al. Long‑term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients[J]. Diabetes Care, 2000, 23 Suppl 2:B21‑B29.

[270] Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient‑centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes[J]. Diabetes Care, 2015, 38(1): 140‑149. DOI: 10.2337/dc14‑2441.

[271] Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm‑2017 executive summary[J]. Endocr Pract, 2017, 23(2):207‑238. DOI: 10.4158/EP161682.CS.

[272] 中华糖尿病杂志指南与共识编写委员会 . 中国糖尿病药物注射技术指南(2016年版)[J].中华糖尿病杂志, 2017, 9(2):79‑105. DOI: 10.3760/cma.j.issn.1674-5809.2017.02.005.

[273] 中华医学会糖尿病学分会 . 中国血糖监测临床应用指南(2015 年版) [J]. 中华糖尿病杂志 , 2015, 7(10): 603‑613. DOI: 10.3760/cma.j.issn.1674‑5809.2015.10.004.

[274] Nishimura E, Pridal L, Glendorf T, et al. Molecular and pharmacological characterization of insulin icodec: a new basal insulin analog designed for once‑weekly dosing[J]. BMJ Open Diabetes Res Care, 2021, 9(1): e002301. DOI:

10.1136/bmjdrc‑2021‑002301.

[275] Rosenstock J, Bain SC, Gowda A, et al. Weekly icodec versus daily glargine U100 in type 2 diabetes without previous insulin[J]. N Engl J Med, 2023, 389(4): 297‑308. DOI: 10.1056/NEJMoa2303208.

[276] Lingvay I, Asong M, Desouza C, et al. Once‑weekly insulin icodec vs once‑daily insulin degludec in adults with insulin‑naive type 2 diabetes: the ONWARDS 3 randomized clinical trial[J]. JAMA, 2023, 330(3):228‑237. DOI: 10.1001/jama.2023.11313.

[277] Bajaj HS, Aberle J, Davies M, et al. Once‑weekly insulin Icodec with dosing guide App versus once‑daily basal insulin analogues in insulin‑naive type 2 diabetes (ONWARDS 5): a randomized trial[J]. Ann Intern Med, 2023, 176(11):1476‑1485. DOI: 10.7326/M23‑1288.

[278] Philis‑Tsimikas A, Asong M, Franek E, et al. Switching to once‑weekly insulin icodec versus once‑daily insulin degludec in individuals with basal insulin‑treated type 2 diabetes (ONWARDS 2): a phase 3a, randomised, open label, multicentre, treat‑to‑target trial[J]. Lancet Diabetes Endocrinol, 2023, 11(6): 414‑425. DOI: 10.1016/S2213‑8587(23)00093‑1.

[279] Mathieu C, Ásbjörnsdóttir B, Bajaj HS, et al. Switching to once‑weekly insulin icodec versus once‑daily insulin glargine U100 in individuals with basal‑bolus insulin‑treated type 2 diabetes (ONWARDS 4): a phase 3a, randomised, open‑label, multicentre, treat‑to‑target, non‑inferiority trial[J]. Lancet, 2023, 401(10392):1929‑1940. DOI: 10.1016/S0140‑6736(23)00520‑2.

[280] Gough SC, Bode BW, Woo VC, et al. One‑year efficacy and safety of a fixed combination of insulin degludec and liraglutide in patients with type 2 diabetes: results of a 26‑week extension to a 26‑week main trial[J]. Diabetes Obes Metab, 2015, 17(10): 965‑973. DOI: 10.1111/dom.12498.

[281] Buse JB, Vilsbøll T, Thurman J, et al. Contribution of liraglutide in the fixed‑ratio combination of insulin degludec and liraglutide (IDegLira) [J]. Diabetes Care, 2014, 37(11):2926‑2933. DOI: 10.2337/dc14‑0785.

[282] Linjawi S, Bode BW, Chaykin LB, et al. The efficacy of IDegLira (insulin Degludec/Liraglutide combination) in adults with type 2 diabetes inadequately controlled with a GLP‑1 receptor agonist and oral therapy: DUAL Ⅲ randomized clinical trial[J]. Diabetes Ther, 2017, 8(1):101‑114. DOI: 10.1007/s13300‑016‑0218‑3.

[283] Rodbard HW, Bode BW, Harris SB, et al. Safety and efficacy of insulin degludec/liraglutide (IDegLira) added to sulphonylurea alone or to sulphonylurea and metformin in insulin‑naïve people with type 2 diabetes: the DUAL Ⅳ trial[J]. Diabet Med, 2017, 34(2): 189‑196. DOI: 10.1111/dme.13256.

[284] Lingvay I, Pérez Manghi F, García‑Hernández P, et al. Effect of insulin glargine up‑titration vs insulin degludec/liraglutide on glycated hemoglobin levels in patients with uncontrolled type 2 diabetes: the DUAL V randomized clinical trial[J]. JAMA, 2016, 315(9):898‑907. DOI: 10.1001/jama.2016.1252.

[285] Harris SB, Kocsis G, Prager R, et al. Safety and efficacy of IDegLira titrated once weekly versus twice weekly in patients with type 2 diabetes uncontrolled on oral antidiabetic drugs: DUAL Ⅵ randomized clinical trial[J]. Diabetes Obes Metab, 2017, 19(6): 858‑865. DOI:

10.1111/dom.12892.

[286] Billings LK, Doshi A, Gouet D, et al. Efficacy and safety of IDegLira versus basal‑bolus insulin therapy in patients with type 2 diabetes uncontrolled on metformin and basal insulin: the DUAL Ⅶ randomized clinical trial[J]. Diabetes Care, 2018, 41(5): 1009‑1016. DOI: 10.2337/dc17‑1114.

[287] Aroda VR, González‑Galvez G, Grøn R, et al. Durability of insulin degludec plus liraglutide versus insulin glargine

U100 as initial injectable therapy in type 2 diabetes (DUAL Ⅷ): a multicentre, open‑label, phase 3b, randomised controlled trial[J]. Lancet Diabetes Endocrinol, 2019, 7(8): 596‑605. DOI: 10.1016/S2213‑8587(19)30184‑6.

[288] Philis‑Tsimikas A, Billings LK, Busch R, et al. Superior efficacy of insulin degludec/liraglutide versus insulin glargine U100 as add‑on to sodium‑glucose co‑transporter‑2 inhibitor therapy: a randomized clinical trial in people with uncontrolled type 2 diabetes[J]. Diabetes Obes Metab, 2019, 21(6): 1399‑1408. DOI:

10.1111/dom.13666.

[289] Wang W, Agner B, Luo B, et al. DUAL Ⅰ China: improved glycemic control with IDegLira versus its individual components in a randomized trial with Chinese participants with type 2 diabetes uncontrolled on oral antidiabetic drugs[J]. J Diabetes, 2022, 14(6): 401‑413. DOI: 10.1111/1753‑0407.13286.

[290] Pei Y, Agner BR, Luo B, et al. DUAL Ⅱ China: superior HbA1c reductions and weight loss with insulin degludec/liraglutide (IDegLira) versus insulin degludec in a randomized trial of Chinese people with type 2 diabetes inadequately controlled on basal insulin[J]. Diabetes Obes Metab, 2021, 23(12): 2687‑2696. DOI:

10.1111/dom.14522.

[291] Philis‑Tsimikas A, Aroda VR, De Block C, et al. Higher derived time in range with IDegLira versus insulin glargine U100 in people with type 2 diabetes[J]. J Diabetes Sci Technol, 2024, 18(3): 653‑659. DOI:

10.1177/19322968221149041.

[292] Liu M, Gu W, Chen L, et al. The efficacy and safety of iGlarLixi versus IDegAsp in Chinese people with type 2 diabetes suboptimally controlled with oral antidiabetic drugs: the Soli‑D randomized controlled trial[J]. Diabetes Obes Metab, 2024, 26(9): 3791‑3800. DOI: 10.1111/dom.15724.

[293] 中华医学会糖尿病学分会 . 中国 2 型糖尿病防治指南(2017 年版)[J]. 中华糖尿病杂志 , 2018, 10(1):4‑67. DOI:

10.3760/cma.j.issn.1674‑5809.2018.01.003.

[294] 纪立农, 陆菊明, 朱大龙, 等 . 成人2型糖尿病基础胰岛素临床应用中国专家指导建议 [J]. 中国糖尿病杂志 , 2017, 25(1):2‑9. DOI: 10.3969/j.issn.1006‑6187.2017.01.002.

[295] Horvath K, Jeitler K, Berghold A, et al. Long‑acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus[J]. Cochrane Database Syst Rev, 2007, (2): CD005613. DOI: 10.1002/14651858.

CD005613.pub3.

[296] Garber AJ, Wahlen J, Wahl T, et al. Attainment of glycaemic goals in type 2 diabetes with once‑, twice‑, or thrice‑daily dosing with biphasic insulin aspart 70/30 (the 1‑2‑3 study) [J]. Diabetes Obes Metab, 2006, 8(1): 58‑66. DOI:

10.1111/j.1463‑1326.2005.00563.x.

[297] Ji L, Wan H, Wen B, et al. Higher versus standard starting dose of insulin glargine 100 U/mL in overweight or obese Chinese patients with type 2 diabetes: results of a multicentre, open‑label, randomized controlled trial (BEYOND Ⅶ) [J]. Diabetes Obes Metab, 2020, 22(5):838‑846. DOI: 10.1111/dom.13967.

[298] Yang W, Ji Q, Zhu D, et al. Biphasic insulin aspart 30 three times daily is more effective than a twice‑daily regimen, without increasing hypoglycemia, in Chinese subjects

with type 2 diabetes inadequately controlled on oral antidiabetes drugs[J]. Diabetes Care, 2008, 31(5):852‑856. DOI: 10.2337/dc07‑1992.

[299] Holman RR, Thorne KI, Farmer AJ, et al. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes[J]. N Engl J Med, 2007, 357(17): 1716‑1730. DOI: 10.1056/NEJMoa075392.

[300] 中华医学会糖尿病学分会 . 新诊断2型糖尿病患者短期胰岛素强化治疗专家共识 [J]. 中华医学杂志 , 2013, 93(20):1524‑1526. DOI: 10.3760/cma.j.issn.0376‑2491.2013.20.002.

[301] Mehta R, Chen R, Hirose T, et al. Practical use of insulin degludec/insulin aspart in a multinational setting: beyond the guidelines[J]. Diabetes Obes Metab, 2020, 22(11):1961‑1975. DOI: 10.1111/dom.14128.

[302] 德谷胰岛素利拉鲁肽说明书[EB/OL].[2024‑02‑01].https://ypk.39.net/1000019030/manual/.

[303] 《德谷胰岛素利拉鲁肽注射液临床应用专家指导建议》编写组 . 德谷胰岛素利拉鲁肽注射液临床应用专家指导建议[J].中华糖尿病杂志, 2023, 15(3):209‑215. DOI: 10.3760/cma.j.

cn115791‑20221126‑00676.

[304] 甘 精 胰 岛 素 利 司 那 肽 注 射 液 ( Ⅰ) 说 明 书 [EB/OL].[2024‑02‑01]. https://www. xinyao. com.

cn/yaopin/jgC0200799.htm.

[305] Goudswaard AN, Furlong NJ, Rutten GE, et al. Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus[J]. Cochrane Database Syst Rev, 2004, 2004(4):CD003418. DOI: 10.1002/14651858.CD003418.pub2.

[306] Giugliano D, Chiodini P, Maiorino MI, et al. Intensification of insulin therapy with basal‑bolus or premixed insulin regimens in type 2 diabetes: a systematic review and meta‑analysis of randomized controlled trials[J]. Endocrine, 2016, 51(3): 417‑428. DOI: 10.1007/s12020‑015‑0718‑3.

[307] Jia W, Xiao X, Ji Q, et al. Comparison of thrice‑daily premixed insulin (insulin lispro premix) with basal‑bolus (insulin glargine once‑daily plus thrice‑daily prandial insulin lispro) therapy in east Asian patients with type 2 diabetes insufficiently controlled with twice‑daily premixed insulin: an open‑label, randomised, controlled trial[J]. Lancet Diabetes Endocrinol, 2015, 3(4): 254‑262. DOI: 10.1016/S2213‑8587(15)00041‑8.

[308] Dieuzeide G, Chuang LM, Almaghamsi A, et al. Safety and effectiveness of biphasic insulin aspart 30 in people with type 2 diabetes switching from basal‑bolus insulin regimens in the A1chieve study[J]. Prim Care Diabetes, 2014, 8(2):111‑117. DOI: 10.1016/j.pcd.2013.07.005.

[309] Mathieu C, Storms F, Tits J, et al. Switching from premixed insulin to basal‑bolus insulin glargine plus rapid‑acting insulin: the ATLANTIC study[J]. Acta Clin Belg, 2013, 68(1):28‑33. DOI: 10.2143/ACB.68.1.2062716.

[310] Watada H, Su Q, Li PF, et al. Comparison of insulin lispro mix 25 with insulin lispro mix 50 as an insulin starter in Asian patients with type 2 diabetes: a phase 4, open‑label, randomized trial (CLASSIFY study) [EB/OL]. [2024‑10‑05]. https://www. sci‑hub. st/10.1002/dmrr.2816.

[311] 祝方, 纪立农, 韩学尧, 等 . 短期胰岛素强化治疗诱导初诊 2 型糖尿病患者血糖长期良好控制的临床试验[J]. 中国糖尿 病 杂 志 , 2003, 11(1): 5‑9. DOI: 10.3321/j. issn:1006‑6187.2003.01.004.

[312] 翁建平, 李延兵, 许雯, 等 . 短期持续胰岛素输注治疗对初诊 2 型糖尿病患者胰岛 β 细胞功能的影响[J]. 中国糖尿病杂 志 , 2003, 11(1): 10‑15. DOI: 10.3969/j.

issn.1006‑6187.2003.01.005.

[313] Li Y, Xu W, Liao Z, et al. Induction of long‑term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta‑cell function[J]. Diabetes Care, 2004, 27(11): 2597‑2602. DOI: 10.2337/diacare.27.11.2597.

[314] Weng J, Li Y, Xu W, et al. Effect of intensive insulin therapy on beta‑cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel‑group trial[J]. Lancet, 2008, 371(9626): 1753‑1760. DOI: 10.1016/S0140‑6736(08)60762‑X.

[315] Siebenhofer A, Plank J, Berghold A, et al. Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus[J]. Cochrane Database Syst Rev, 2006, (2): CD003287. DOI: 10.1002/14651858.

CD003287.pub4.

[316] Gupta V. Glucagon‑like peptide‑1 analogues: an overview[J]. Indian J Endocrinol Metab, 2013, 17(3): 413‑421. DOI:

10.4103/2230‑8210.111625.

[317] Jones B. The therapeutic potential of GLP-1 receptor biased agonism[J]. Br J Pharmacol, 2022, 179(4): 492-510. DOI:

10.1111/bph.15497.

[318] Zhu D, Wang W, Tong G, et al. Efficacy and safety of GLP-1 analog ecnoglutide in adults with type 2 diabetes: a randomized, double-blind, placebo-controlled phase 2 trial[J]. Nat Commun, 2024, 15(1): 8408. DOI: 10.1038/s41467-024-52353-y.

[319] Usdin TB, Mezey E, Button DC, et al. Gastric inhibitory polypeptide receptor, a member of the secretin‑vasoactive intestinal peptide receptor family, is widely distributed in peripheral organs and the brain[J]. Endocrinology, 1993, 133(6): 2861‑2870. DOI: 10.1210/endo.133.6.8243312.

[320] Nauck MA, Quast DR, Wefers J, et al. The evolving story of incretins (GIP and GLP‑1) in metabolic and cardiovascular disease: a pathophysiological update[J]. Diabetes Obes Metab, 2021, 23 Suppl 3: 5‑29. DOI:

10.1111/dom.14496.

[321] Nauck MA, Meier JJ. The incretin effect in healthy individuals and those with type 2 diabetes: physiology, pathophysiology, and response to therapeutic interventions[J]. Lancet Diabetes Endocrinol, 2016, 4(6):525‑536. DOI: 10.1016/S2213‑8587(15)00482‑9.

[322] Christensen M, Vedtofte L, Holst JJ, et al. Glucose‑dependent insulinotropic polypeptide: a bifunctional glucose‑dependent regulator of glucagon and insulin secretion in humans[J]. Diabetes, 2011, 60(12):3103‑3109. DOI: 10.2337/db11‑0979.

[323] Hammoud R, Drucker DJ. Beyond the pancreas: contrasting cardiometabolic actions of GIP and GLP1[J]. Nat Rev Endocrinol, 2023, 19(4):201‑216. DOI: 10.1038/s41574‑022‑00783‑3.

[324] Samms RJ, Coghlan MP, Sloop KW. How may GIP enhance the therapeutic efficacy of GLP‑1? [J]. Trends Endocrinol Metab, 2020, 31(6): 410‑421. DOI: 10.1016/j.

tem.2020.02.006.

[325] Borner T, Geisler CE, Fortin SM, et al. GIP receptor

agonism attenuates GLP‑1 receptor agonist‑induced nausea and emesis in preclinical models[J]. Diabetes, 2021, 70(11):2545‑2553. DOI: 10.2337/db21‑0459.

[326] Zhang B, Cheng Z, Chen J, et al. Efficacy and safety of Mazdutide in Chinese patients with type 2 diabetes: a randomized, double-blind, placebo-controlled phase 2 trial[J]. Diabetes Care,2024,47(1):160-168. DOI: 10.2337/dc23-1287.

[327] Yao H, Zhang A, Li D, et al. Comparative effectiveness of GLP‑1 receptor agonists on glycaemic control, body weight, and lipid profile for type 2 diabetes: systematic review and network meta‑analysis[J]. BMJ, 2024, 384:e076410. DOI: 10.1136/bmj‑2023‑076410.

[328] Rosenstock J, Allison D, Birkenfeld AL, et al. Effect of additional oral semaglutide vs sitagliptin on glycated hemoglobin in adults with type 2 diabetes uncontrolled with metformin alone or with sulfonylurea: the PIONEER 3 randomized clinical trial[J]. JAMA, 2019, 321(15):1466‑1480. DOI: 10.1001/jama.2019.2942.

[329] Aroda VR, Rosenstock J, Terauchi Y, et al. PIONEER 1: randomized clinical trial of the efficacy and safety of oral semaglutide monotherapy in comparison with placebo in patients with type 2 diabetes[J]. Diabetes Care, 2019, 42(9):1724‑1732. DOI: 10.2337/dc19‑0749.

[330] Kristensen SL, Rørth R, Jhund PS, et al. Cardiovascular, mortality, and kidney outcomes with GLP‑1 receptor agonists in patients with type 2 diabetes: a systematic review and meta‑analysis of cardiovascular outcome trials[J]. Lancet Diabetes Endocrinol, 2019, 7(10):776‑785. DOI: 10.1016/S2213‑8587(19)30249‑9.

[331] Marso SP, Daniels GH, Brown‑Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes[J]. N Engl J Med, 2016, 375(4): 311‑322. DOI:

10.1056/NEJMoa1603827.

[332] Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND):

a

double‑blind,

randomised placebo‑controlled trial[J]. Lancet, 2019, 394(10193):121‑130. DOI: 10.1016/S0140‑6736(19)31149‑3.

[333] Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes[J]. N Engl J Med, 2016, 375(19): 1834‑1844. DOI: 10.1056/NEJMoa1607141.

[334] Yang W, Dong X, Li Q, et al. Efficacy and safety benefits ofiGlarLixi versus insulin glargine 100 U/mL or lixisenatide in Asian Pacific people with suboptimally controlled type 2 diabetes on oral agents: the LixiLan‑O‑AP randomized controlled trial[J]. Diabetes Obes Metab, 2022, 24(8): 1522‑1533. DOI: 10.1111/dom.14722.

[335] Yuan X, Guo X, Zhang J, et al. Improvedglycaemic control and weight benefit with iGlarLixi versus insulin glargine 100 U/mL in Chinese people with type 2 diabetes advancing their therapy from basal insulin plus oral antihyperglycaemic drugs: Results from the LixiLan‑L‑CN randomized controlled trial[J]. Diabetes Obes Metab, 2022, 24(11):2182‑2191. DOI: 10.1111/dom.14803.

[336] Schauer PR, Mingrone G, Ikramuddin S, et al. Clinical outcomes of metabolic surgery: efficacy of glycemic control, weight loss, and remission of diabetes[J]. Diabetes Care, 2016, 39(6): 902‑911. DOI: 10.2337/

dc16‑0382.

[337] Steven S, Hollingsworth KG, Al‑Mrabeh A, et al. Very low‑calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and nonresponders[J]. Diabetes Care, 2016, 39(5): 808‑815. DOI: 10.2337/dc15‑1942.

[338] Ji L, Li H, Guo X, et al. Impact of baseline BMI on glycemic control and weight change with metformin monotherapy in Chinese type 2 diabetes patients: phase Ⅳ open‑label trial[J]. PLoS One, 2013, 8(2): e57222. DOI: 10.1371/journal.pone.0057222.

[339] Kahan S, Fujioka K. Obesity pharmacotherapy in patients with type 2 diabetes[J]. Diabetes Spectr, 2017, 30(4):250‑257. DOI: 10.2337/ds17‑0044.

[340] Frías JP, Davies MJ, Rosenstock J, et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes[J]. N Engl J Med, 2021, 385(6): 503‑515. DOI: 10.1056/NEJMoa2107519.

[341] Gastaldelli A, Cusi K, Fernández Landó L, et al. Effect of tirzepatide versus insulin degludec on liver fat content and abdominal adipose tissue in people with type 2 diabetes (SURPASS‑3 MRI): a substudy of the randomised, open‑label, parallel‑group, phase 3 SURPASS‑3 trial[J]. Lancet Diabetes Endocrinol, 2022, 10(6): 393‑406. DOI:

10.1016/S2213‑8587(22)00070‑5.

[342] Davies M, Færch L, Jeppesen OK, et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double‑blind, double‑dummy, placebo‑controlled, phase 3 trial[J]. Lancet, 2021, 397(10278): 971‑984. DOI: 10.1016/S0140‑6736(21)00213‑0.

[343] Davies MJ, Bergenstal R, Bode B, et al. Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE diabetes randomized clinical trial[J]. JAMA, 2015, 314(7): 687‑699. DOI: 10.1001/jama.2015.9676.

[344] Shi Q, Wang Y, Hao Q, et al. Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta‑analysis of randomised controlled trials[J]. Lancet, 2024, 403(10434): e21‑e31. DOI: 10.1016/S0140‑6736(24)00351‑9.

[345] 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(9):959‑971. DOI:

10.3760/cma.j.cn115791‑20240731‑00396.

[346] Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long‑term remission of type 2 diabetes and with microvascular and macrovascular complications[J]. JAMA, 2014, 311(22): 2297‑2304. DOI:

10.1001/jama.2014.5988.

[347] Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes‑5‑year outcomes[J]. N Engl J Med, 2017, 376(7): 641‑651. DOI:

10.1056/NEJMoa1600869.

[348] Tu Y, Yu H, Bao Y, et al. Baseline of visceral fat area and decreased body weight correlate with improved pulmonary function after Roux‑en‑Y gastric bypass in Chinese obese patients with BMI 28‑35 kg/m² and type 2 diabetes: a 6‑month follow‑up[J]. BMC Endocr Disord, 2015, 15:26. DOI: 10.1186/s12902‑015‑0027‑0.

[349] Yu H, Chen J, Lu J, et al. Decreased visceral fat area correlates with improved arterial stiffness after

Roux‑en‑Y gastric bypass in Chinese obese patients with type 2 diabetes mellitus: a 12‑month follow‑up[J]. Surg Obes Relat Dis, 2016, 12(3): 550‑555. DOI: 10.1016/j.

soard.2015.09.003.

[350] Yu H, Zhang L, Bao Y, et al. Metabolic syndrome after Roux‑en‑Y gastric bypass surgery in Chinese obese patients with type 2 diabetes[J]. Obes Surg, 2016, 26(9):2190‑2197. DOI: 10.1007/s11695‑016‑2074‑7.

[351] Yu H, Di J, Bao Y, et al. Visceral fat area as a new predictor of short‑term diabetes remission after Roux‑en‑Y gastric bypass surgery in Chinese patients with a body mass index less than 35 kg/m2[J]. Surg Obes Relat Dis, 2015, 11(1):6‑11. DOI: 10.1016/j.soard.2014.06.019.

[352] 刘兴振, 邹大进 . 胃肠减肥术围手术期管理要点[J].中国实用内科杂志, 2012, 32(10):754‑756.

[353] 纪立农 . 手术治疗 2 型糖尿病:证据和立场[J]. 中国糖尿病杂 志 , 2012, 20(4): 241‑244. DOI: 10.3969/j.

issn.1006‑6187.2012.04.001.

[354] Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient‑‑2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery[J]. Endocr Pract, 2013, 19(2): 337‑372. DOI:

10.4158/EP12437.GL.

[355] 中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组 . 中国实用外科杂志 , 2024, 44(8):841‑849. D01: 10.19538/j.cjps.

issn1005‑2208.2024.08.01.

[356] Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery[J]. Obes Surg, 2023, 33(1): 3‑14. DOI:

10.1007/s11695‑022‑06332‑1.

[357] Sandoval DA, Patti ME. Glucose metabolism after bariatric surgery: implications for T2DM remission and hypoglycaemia[J]. Nat Rev Endocrinol. 2023 Mar; 19(3):164‑176. DOI: 10.1038/s41574‑022‑00757‑5.

[358] Riddle MC, Cefalu WT, Evans PH, et al. Consensus report: definition and interpretation of remission in type 2 diabetes[J]. Diabetes Care, 2021, 44(10):2438‑2444. DOI:

10.2337/dci21‑0034.

[359] Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes[J]. Lancet, 2012, 379(9833): 2300‑2311. DOI: 10.1016/S0140‑6736(12)60401‑2.

[360] Bao Y, Chen L, Chen L, et al. Chinese clinical guidelines for continuous glucose monitoring (2018 edition) [J]. Diabetes Metab Res Rev, 2019, 35(6): e3152. DOI:

10.1002/dmrr.3152.

[361] Ji L, Su Q, Feng B, et al. Structured self‑monitoring of blood glucose regimens improve glycemic control in poorly controlled Chinese patients on insulin therapy: results from COMPASS[J]. J Diabetes, 2017, 9(5):495‑501. DOI: 10.1111/1753‑0407.12434.

[362] Kan K, Zhu W, Lu F, et al. Contribution of structured self‑monitoring of blood glucose to the glycemic control and the quality of life in both insulin‑and noninsulin‑treated patients with poorly controlled diabetes[J]. Diabetes Technol Ther, 2017, 19(12):

707‑714. DOI: 10.1089/dia.2017.0275.

[363] Shen Y, Zhu W, Lu L, et al. Contribution of structured self‑monitoring of blood glucose to self‑efficacy in poorly controlled diabetes patients in China[J]. Diabetes Metab Res Rev, 2019, 35(1):e3067. DOI: 10.1002/dmrr.3067.

[364] 周健, 李红, 杨文英, 等 . 糖化血清白蛋白正常参考值的多中心临床研究[J]. 中华内科杂志 , 2009, (6):469‑472. DOI:

10.3760/cma.j.issn.0578‑1426.2009.06.013.

[365] 周翔海, 纪立农, 张秀英, 等 . 我国正常糖耐量人群糖化白蛋 白 的 参 考 范 围 [J]. 中 国 糖 尿 病 杂 志 , 2009, 17(8):572‑575. DOI: 10.3969/j.issn.1006‑6187.2009.08.003.

[366] He X, Mo Y, Ma X, et al. Associations of body mass index with glycated albumin and glycated albumin/glycated hemoglobin A1c ratio in Chinese diabetic and non‑diabetic populations[J]. Clin Chim Acta, 2018, 484:117‑121. DOI: 10.1016/j.cca.2018.05.044.

[367] Xu Y, Ma X, Shen Y, et al. Increasing waist circumference is associated with decreased levels of glycated albumin[J]. Clin Chim Acta, 2019, 495: 118‑122. DOI: 10.1016/j.

cca.2019.04.001.

[368] 中华医学会糖尿病学分会血糖监测学组 . 中国扫描式葡萄糖监测技术临床应用专家共识[J]. 中华糖尿病杂志, 2018, 10(11):697‑700. DOI: 10.3760/cma.j.issn.1674‑5809.2018.11.001.

[369] Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range[J]. Diabetes Care, 2019, 42(8): 1593‑1603. DOI: 10.2337/dci19‑0028.

[370] Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring[J]. Diabetes Care, 2017, 40(12): 1631‑1640. DOI: 10.2337/dc17‑1600.

[371] Beck RW, Bergenstal RM, Riddlesworth TD, et al. Validation of time in range as an outcome measure for diabetes clinical trials[J]. Diabetes Care, 2019, 42(3):400‑405. DOI: 10.2337/dc18‑1444.

[372] Lu J, Ma X, Zhou J, et al. Association of time in range, as assessed by continuous glucose monitoring, with diabetic retinopathy in type 2 diabetes[J]. Diabetes Care, 2018, 41(11):2370‑2376. DOI: 10.2337/dc18‑1131.

[373] Lu J, Ma X, Shen Y, et al. Time in range is associated with carotid intima‑media thickness in type 2 diabetes[J]. Diabetes Technol Ther, 2020, 22(2):72‑78. DOI: 10.1089/dia.2019.0251.

[374] Zhao W, Lu J, Zhang L, et al. Relationship between time in range and corneal nerve fiber loss in asymptomatic patients with type 2 diabetes[J]. Chin Med J (Engl), 2022, 135(16):1978‑1985. DOI: 10.1097/CM9.0000000000002140.

[375] Kristensen K, Ögge LE, Sengpiel V, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies[J]. Diabetologia, 2019, 62(7): 1143‑1153. DOI: 10.1007/s00125‑019‑4850‑0.

[376] Lu J, Wang C, Shen Y, et al. Time in range in relation to all‑cause and cardiovascular mortality in patients with type 2 diabetes: a prospective cohort study[J]. Diabetes Care, 2021, 44(2):549‑555. DOI: 10.2337/dc20‑1862.

[377] Wan J, Lu J, Li C, et al. Research progress in the application of time in range: more than a percentage[J]. Chin Med J (Engl), 2023, 136(5): 522‑527. DOI: 10.1097/CM9.0000000000002582.

[378] Lu J, Ma X, Zhang L, et al. Glycemic variability modifies the relationship between time in range and hemoglobin A1c estimated from continuous glucose monitoring: a preliminary study[J]. Diabetes Res Clin Pract, 2020, 161:

108032. DOI: 10.1016/j.diabres.2020.108032.

[379] Mo Y, Ma X, Lu J, et al. Defining the target value of the coefficient of variation by continuous glucose monitoring in Chinese people with diabetes[J]. J Diabetes Investig, 2021, 12(6):1025‑1034. DOI: 10.1111/jdi.13453.

[380] 陈莉明 . 糖尿病特殊人群的血糖监测[J].中华糖尿病杂志, 2016, 8(12): 709‑712. DOI: 10.3760/cma. j.

issn.1674‑5809.2016.12.002.

[381] Petersson J, Åkesson K, Sundberg F, et al. Translating glycated hemoglobin A1c into time spent in glucose target range: a multicenter study[J]. Pediatr Diabetes, 2019, 20(3):339‑344. DOI: 10.1111/pedi.12817.

[382] 中华医学会内分泌学分会 , 国家高性能医疗器械创新中心 . 动态葡萄糖图谱报告临床应用专家共识(2023 版)[J].

中华糖尿病杂志 , 2024, 16(2): 190‑201. DOI: 10.3760/cma.j.cn115791‑20231120‑00325.

[383] Liu L, Wan X, Liu J, et al. Increased 1, 5‑anhydroglucitol predicts glycemic remission in patients with newly diagnosed type 2 diabetes treated with short‑term intensive insulin therapy[J]. Diabetes Technol Ther, 2012, 14(9):756‑761. DOI: 10.1089/dia.2012.0055.

[384] Ying L, Ma X, Yin J, et al. The metabolism and transport of 1, 5‑anhydroglucitol in cells[J]. Acta Diabetol, 2018, 55(3):279‑286. DOI: 10.1007/s00592‑017‑1093‑8.

[385] Jian C, Zhao A, Ma X, et al. Diabetes screening: detection and application of saliva 1, 5‑anhydroglucitol by liquid chromatography‑mass spectrometry[J]. J Clin Endocrinol Metab, 2020, 105(6): dgaa114. DOI: 10.1210/clinem/dgaa114.

[386] American Diabetes Association Professional Practice Committee. 7. Diabetes technology: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S126‑S144. DOI: 10.2337/dc24‑S007.

[387] 中华医学会糖尿病学分会 . 胰岛素注射相关皮下脂肪增生防治中国专家共识 [J]. 国际内分泌代谢杂志 , 2021, 41(6):665‑672. DOI: 10.3760/cma.j.cn121383‑20211115‑11043.

[388] Chen L, Xing Q, Li J, et al. Injection technique education in patients with diabetes injecting insulin into areas of lipohypertrophy: a randomized controlled trial[J]. Diabetes Ther, 2021, 12(3): 813‑826. DOI: 10.1007/s13300‑021‑01013‑1.

[389] Weisman A, Bai JW, Cardinez M, et al. Effect of artificial pancreas systems on glycaemic control in patients with type 1 diabetes: a systematic review and meta‑analysis of outpatient randomised controlled trials[J]. Lancet Diabetes Endocrinol, 2017, 5(7): 501‑512. DOI: 10.1016/S2213‑8587(17)30167‑5.

[390] Speight J, Holmes‑Truscott E, Little SA, et al. Satisfaction with the use of different technologies for insulin delivery and glucose monitoring among adults with long‑standing type 1 diabetes and problematic hypoglycemia: 2‑year follow‑up in the HypoCOMPaSS randomized clinical trial[J]. Diabetes Technol Ther, 2019, 21(11): 619‑626. DOI:

10.1089/dia.2019.0152.

[391] 中华医学会内分泌学分会, 中华医学会糖尿病学分会, 中国医师协会内分泌代谢科医师分会 . 中国胰岛素泵治疗指南(2021年版)[J].中华内分泌代谢杂志, 2021, 37(8):679‑701.

DOI: 10.3760/cma.j.cn311282‑20210428‑00265.

[392] American Diabetes Association Professional Practice Committee. 16. Diabetes care in the hospital: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S295‑S306. DOI: 10.2337/dc24‑S016.

[393] Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycemic crises in adults with diabetes: a consensus report[J]. Diabetes Care, 2024, 47(8): 1257‑1275. DOI:

10.2337/dci24‑0032.

[394] 苏青 . 增强合理用药意识, 规避风险, 防范SGLT2i相关性糖尿病酮症酸中毒——对“两例糖尿病酮症酸中毒病例的分析”一文的编后评论 [J]. 中华内分泌代谢杂志 , 2019, 35(5):435‑436. DOI: 10.3760/cma.j.issn.1000‑6699.2019.05.016.

[395] 中华医学会内分泌学分会 . 中国糖尿病血酮监测专家共识[J]. 中华内分泌代谢杂志, 2014, 30(3):177‑183. DOI: 10.3760/cma.j.issn.1000‑6699.2014.03.001.

[396] Peters AL, Buschur EO, Buse JB, et al. Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium‑glucose cotransporter 2 inhibition[J]. Diabetes Care, 2015, 38(9):1687‑1693. DOI: 10.2337/dc15‑0843.

[397] Dhatariya KK, Joint British Diabetes Societies for Inpatient Care. The management of diabetic ketoacidosis in adults‑an updated guideline from the Joint British Diabetes Society for Inpatient Care[J]. Diabet Med, 2022, 39(6):e14788. DOI: 10.1111/dme.14788.

[398] Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes[J]. Diabetes Care, 2009, 32(7):1335‑1343. DOI: 10.2337/dc09‑9032.

[399] 中华医学会糖尿病学分会 . 中国高血糖危象诊断与治疗指南[J].中华糖尿病杂志, 2013, 5(8):449‑461. DOI: 10.3760/cma.j.issn.1674‑5809.2013.08.001.

[400] Frank LA, Solomon A. Hyperglycaemic hyperosmolar state[J]. Br J Hosp Med (Lond), 2016, 77(9): C130‑C133. DOI:

10.12968/hmed.2016.77.9.C130.

[401] 郝明, 匡洪宇 . 高血糖高渗综合征的诊治[J]. 中华内科杂志, 2016, 55(10): 804‑806. DOI: 10.3760/cma. j.

issn.0578‑1426.2016.10.018.

[402] Low Wang CC, Hess CN, Hiatt WR, et al. Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus‑mechanisms, management, and clinical considerations[J]. Circulation, 2016, 133(24): 2459‑2502. DOI: 10.1161/CIRCULATIONAHA.116.022194.

[403] Lam CSP, Voors AA, de Boer RA, et al. Heart failure with preserved ejection fraction: from mechanisms to therapies[J]. Eur Heart J, 2018, 39(30): 2780‑2792. DOI:

10.1093/eurheartj/ehy301.

[404] Mosenzon O, Alguwaihes A, Leon J, et al. CAPTURE: a multinational, cross‑sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries[J]. Cardiovasc Diabetol, 2021, 20(1): 154. DOI: 10.1186/s12933‑021‑01344‑0.

[405] Cavender MA, Steg PG, Smith SC Jr, et al. Impact of diabetes mellitus on hospitalization for heart failure, cardiovascular events, and death: outcomes at 4 years from the reduction of atherothrombosis for continued health (REACH) Registry[J]. Circulation, 2015, 132(10):923‑931. DOI: 10.1161/CIRCULATIONAHA.114.014796.

[406] McAllister DA, Read SH, Kerssens J, et al. Incidence of hospitalization for heart failure and case‑fatality among

3.25 million people with and without diabetes mellitus[J].

Circulation, 2018, 138(24): 2774‑2786. DOI: 10.1161/CIRCULATIONAHA.118.034986.

[407] Ji L, Hu D, Pan C, et al. Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients[J]. Am J Med, 2013, 126(10): 925.

e11‑e22. DOI: 10.1016/j.amjmed.2013.02.035.

[408] Selvin E, Marinopoulos S, Berkenblit G, et al. Meta‑analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus[J]. Ann Intern Med, 2004, 141(6):421‑431. DOI: 10.7326/0003‑4819‑141‑6‑200409210‑00007.

[409] Ray KK, Seshasai SR, Wijesuriya S, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta‑analysis of randomised controlled trials[J]. Lancet, 2009, 373(9677):1765‑1772. DOI: 10.1016/S0140‑6736(09)60697‑8.

[410] 杨兆军, 单忠艳, 田浩明, 等 . 中国四省市阿司匹林预防心血管疾病用药现状调查[J]. 中华糖尿病杂志 , 2011, 3(1):22‑26. DOI: 10.3760/cma.j.issn.1674‑5809.2011.01.005.

[411] Zhong VW, Yu D, Zhao L, et al. Achievement of guideline‑recommended targets in diabetes care in China: a nationwide cross‑sectional study[J]. Ann Intern Med, 2023, 176(8):1037‑1046. DOI: 10.7326/M23‑0442.

[412] Zelniker TA, Wiviott SD, Raz I, et al. Comparison of the effects of glucagon‑like peptide receptor agonists and sodium‑glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in type 2 diabetes mellitus[J]. Circulation, 2019, 139(17):2022‑2031. DOI: 10.1161/CIRCULATIONAHA.118.038868.

[413] Arnott C, Li Q, Kang A, et al. Sodium‑glucose cotransporter 2 inhibition for the prevention of cardiovascular events in patients with type 2 diabetes mellitus: a systematic review and Meta‑analysis[J]. J Am Heart Assoc, 2020, 9(3): e014908. DOI: 10.1161/JAHA.119.014908.

[414] Palmer SC, Tendal B, Mustafa RA, et al. Sodium‑glucose cotransporter protein‑2 (SGLT‑2) inhibitors and glucagon‑like peptide‑1 (GLP‑1) receptor agonists for type 2 diabetes: systematic review and network meta‑analysis of randomised controlled trials[J]. BMJ, 2021, 372:m4573. DOI: 10.1136/bmj.m4573.

[415] Sattar N, Lee M, Kristensen SL, et al. Cardiovascular, mortality, and kidney outcomes with GLP‑1 receptor agonists in patients with type 2 diabetes: a systematic review and meta‑analysis of randomised trials[J]. Lancet Diabetes Endocrinol, 2021, 9(10):653‑662. DOI: 10.1016/S2213‑8587(21)00203‑5.

[416] McMurray J, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction[J]. N Engl J Med, 2019, 381(21):1995‑2008. DOI:

10.1056/NEJMoa1911303.

[417] Yang S, Han Y, Yu C, et al. Development of a model to predict 10‑year risk of ischemic and hemorrhagic stroke and ischemic heart disease using the China Kadoorie biobank[J]. Neurology, 2022, 98(23): e2307‑e2317. DOI:

10.1212/WNL.0000000000200139.

[418] Liu J, Hong Y, D′Agostino RB Sr, et al. Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese multi‑provincial cohort study[J]. JAMA, 2004, 291(21):2591‑2599. DOI: 10.1001/jama. 291.21.2591. PMID:

15173150.

[419] Yang X, Li J, Hu D, et al. Predicting the 10‑year risks of atherosclerotic cardiovascular disease in Chinese population: the China‑PAR project (prediction for ASCVD risk in China) [J]. Circulation, 2016, 134(19): 1430‑1440. DOI: 10.1161/CIRCULATIONAHA.116.022367.

[420] Yang XL, Chen JC, Li JX, et al. Risk stratification of atherosclerotic cardiovascular disease in Chinese adults[J]. Chronic Dis Transl Med, 2016, 2(2):102‑109. DOI: 10.1016/j.cdtm.2016.10.001.

[421] Liu F, Li J, Chen J, et al. Predicting lifetime risk for developing atherosclerotic cardiovascular disease in Chinese population: the China‑PAR project[J]. Sci Bull (Beijing), 2018, 63(12): 779‑787. DOI: 10.1016/j.

scib.2018.05.020.

[422] US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for cardiovascular disease risk with electrocardiography: US preventive services task force recommendation statement[J]. JAMA, 2018, 319(22):2308‑2314. DOI: 10.1001/jama.2018.6848.

[423] Bhatia RS, Dorian P. Screening for cardiovascular disease risk with electrocardiography[J]. JAMA Intern Med, 2018, 178(9):1163‑1164. DOI: 10.1001/jamainternmed.2018.2773.

[424] Zhang YQ, Li Y, Dong YG, et al. A nationwide assessment of blood pressure control and the associated factors in Chinese type 2 diabetes mellitus patients[J]. J Clin Hypertens (Greenwich), 2019, 21(11): 1654‑1663. DOI:

10.1111/jch.13675.

[425] Bragg F, Halsey J, Guo Y, et al. Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: a prospective cohort study[J]. Lancet Reg Health West Pac, 2021, 7: 100085. DOI: 10.1016/j.

lanwpc.2020.100085.

[426] Zhang Y, Jiang X, Bo J, et al. Risk of stroke and coronary heart disease among various levels of blood pressure in diabetic and nondiabetic Chinese patients[J]. J Hypertens, 2018, 36(1):93‑100. DOI: 10.1097/HJH.0000000000001528.

[427] Emdin CA, Rahimi K, Neal B, et al. Blood pressure lowering in type 2 diabetes: a systematic review and meta‑analysis[J]. JAMA, 2015, 313(6): 603‑615. DOI:

10.1001/jama.2014.18574.

[428] 中国高血压防治指南修订委员会, 高血压联盟(中国), 中国医疗保健国际交流促进会高血压病学分会, 等 . 中国高血压防治指南(2024年修订版)[J]. 中华高血压杂志(中英文), 2024, 32(7): 603‑700.

[429] American Diabetes Association Professional Practice Committee. 10. Cardiovascular disease and risk management: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1): S179‑S218. DOI:

10.2337/dc24‑S010.

[430] Wu S, Chi H, Jin C, et al. The association of blood pressure with survival rate and cardiovascular events in Chinese patients with type 2 diabetes[J]. Int J Cardiol, 2013, 168(4):4514‑4515. DOI: 10.1016/j.ijcard.2013.06.111.

[431] Yang R, Bai J, Fang Z, et al. Effects of intensive blood pressure lowering in patients with diabetes: a pooled analysis of the STEP and ACCORD‑BP randomized trials[J]. Diabetes Obes Metab, 2023, 25(3):796‑804. DOI: 10.1111/dom.14927.

[432] Brunström M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta‑analyses[J]. BMJ, 2016, 352:i717. DOI: 10.1136/bmj.

i717.

[433] Bi Y, Li M, Liu Y, et al. Intensive blood‑pressure control in patients with type 2 diabetes[EB/OL]. [2024‑11‑30]. https://www. nejm. org/doi/10.1056/NEJMoa2412006?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed.

[434] Liu J, Li Y, Ge J, et al. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open‑label, blinded‑outcome, randomised trial[J]. Lancet, 2024, 404(10449): 245‑255. DOI: 10.1016/S0140‑6736(24)01028‑6.

[435] Joseph JJ, Deedwania P, Acharya T, et al. Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association[J]. Circulation, 2022, 145(9):e722‑e759. DOI: 10.1161/CIR.0000000000001040.

[436] Natale P, Palmer SC, Navaneethan SD, et al. Angiotensin‑converting‑enzyme

inhibitors

and angiotensin receptor blockers for preventing the progression of diabetic kidney disease[J]. Cochrane Database Syst Rev, 2024, 4(4): CD006257. DOI:

10.1002/14651858.CD006257.pub2.

[437] Xie M, Tang T, Liang H. Efficacy of single‑pill combination in uncontrolled essential hypertension: a systematic review and network meta‑analysis[J]. Clin Cardiol, 2023, 46(8):886‑898. DOI: 10.1002/clc.24082.

[438] Mancia G, Rea F, Corrao G, et al. Two‑drug combinations as first‑step antihypertensive treatment[J]. Circ Res, 2019,

124(7):

1113‑1123.

CIRCRESAHA.118.313294.

[439] Shi Q, Nong K, Vandvik PO, et al. Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta‑analysis of randomised controlled trials[J]. BMJ, 2023, 381: e074068. DOI: 10.1136/bmj‑2022‑074068.

[440] Hu M, Cai X, Yang W, et al. Effect of hemoglobin A1c reduction or weight reduction on blood pressure in glucagon‑like peptide‑1 receptor agonist and sodium‑glucose cotransporter‑2 inhibitor treatment in type 2 diabetes mellitus: a Meta‑analysis[J]. J Am Heart Assoc, 2020, 9(7): e015323. DOI: 10.1161/JAHA.119.015323.

[441] 中国血脂管理指南修订联合专家委员会 . 中国血脂管理指南(2023 年)[J]. 中国循环杂志, 2023, 38(3):237‑271. DOI:

10.3969/j.issn.1000‑3614.2023.03.001.

[442] Goldberg RB, Stone NJ, Grundy SM. The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/

NLA/PCNA guidelines on the management of blood cholesterol in diabetes[J]. Diabetes Care, 2020, 43(8):1673‑1678. DOI: 10.2337/dci19‑0036.

[443] Cao Y, Yan L, Guo N, et al. Non‑high‑density lipoprotein cholesterol and risk of cardiovascular disease in the general population and patients with type 2 diabetes: a systematic review and meta‑analysis[J]. Diabetes Res Clin Pract, 2019, 147:1‑8. DOI: 10.1016/j.diabres.2018.11.002.

[444] Cholesterol Treatment Trialists′ (CTT) Collaboration. Effects of statin therapy on diagnoses of new‑onset diabetes and worsening glycaemia in large‑scale randomised blinded statin trials: an individual

participant data meta‑analysis[J]. Lancet Diabetes Endocrinol, 2024, 12(5): 306‑319. DOI: 10.1016/S2213‑8587(24)00040‑8.

[445] Patrono C, Baigent C. Role of aspirin in primary prevention of cardiovascular disease[J]. Nat Rev Cardiol, 2019, 16(11):675‑686. DOI: 10.1038/s41569‑019‑0225‑y.

[446] American Diabetes Association. 10. Cardiovascular disease and risk management: standards of medical care in diabetes‑2020[J]. Diabetes Car, 2020, 43(Suppl 1):S111‑S134. DOI: 10.2337/dc20‑S010.

[447] Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC guidelines on diabetes, pre‑diabetes, and cardiovascular diseases developed in collaboration with the EASD[J]. Eur Heart J, 2020, 41(2): 255‑323. DOI: 10.1093/eurheartj/ehz486.

[448] Mora S, Ames JM, Manson JE. Low‑dose aspirin in the primary prevention of cardiovascular disease: shared decision making in clinical practice[J]. JAMA, 2016, 316(7):709‑710. DOI: 10.1001/jama.2016.8362.

[449] McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly[J]. N Engl J Med, 2018, 379(16): 1509‑1518. DOI: 10.1056/NEJMoa1805819.

[450] Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J]. J Am Coll Cardiol, 2019, 74(10):1376‑1414. DOI: 10.1016/j.

jacc.2019.03.009.

[451] Macdonald S. Aspirin use to be banned in under 16 year olds[J]. BMJ, 2002, 325(7371): 988. DOI: 10.1136/bmj.325.7371.988/c.

[452] Lotrionte M, Biasucci LM, Peruzzi M, et al. Which aspirin dose and preparation is best for the long‑term prevention of cardiovascular disease and cancer? Evidence from a systematic review and network Meta‑analysis[J]. Prog Cardiovasc Dis, 2016, 58(5): 495‑504. DOI: 10.1016/j.

pcad.2016.02.001.

[453] Bethel MA, Harrison P, Sourij H, et al. Randomized controlled trial comparing impact on platelet reactivity of twice‑daily with once‑daily aspirin in people with type 2 diabetes[J]. Diabet Med, 2016, 33(2): 224‑230. DOI:

10.1111/dme.12828.

[454] Rothwell PM, Cook NR, Gaziano JM, et al. Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials[J]. Lancet, 2018, 392(10145):387‑399. DOI: 10.1016/S0140‑6736(18)31133‑4.

[455] Bhatt DL, Bonaca MP, Bansilal S, et al. Reduction in ischemic events with ticagrelor in diabetic patients with prior myocardial infarction in PEGASUS‑TIMI 54[J]. J Am Coll Cardiol, 2016, 67(23): 2732‑2740. DOI: 10.1016/j.

jacc.2016.03.529.

[456] Bhatt DL, Eikelboom JW, Connolly SJ, et al. Role of combination antiplatelet and anticoagulation therapy in diabetes mellitus and cardiovascular disease: insights from the COMPASS trial[J]. Circulation, 2020, 141(23):1841‑1854. DOI: 10.1161/CIRCULATIONAHA.120.046448.

[457] Connolly SJ, Eikelboom JW, Bosch J, et al. Rivaroxaban with or without aspirin in patients with stable coronary

artery disease: an international, randomised, double‑blind, placebo‑controlled trial[J]. Lancet, 2018, 391(10117): 205‑218. DOI: 10.1016/S0140‑6736(17)32458‑3.

[458] Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in peripheral artery disease after revascularization[J]. N Engl J Med, 2020, 382(21): 1994‑2004. DOI: 10.1056/NEJMoa2000052.

[459] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease[J]. Kidney Int, 2022, 102(5S): S1‑S127. DOI:

10.1016/j.kint.2022.06.008.

[460] Ye X, Yu R, Jiang F, et al. Osteocalcin and risks of incident diabetes and diabetic kidney disease: a 4.6-year prospective cohort study[J]. Diabetes Care, 2022, 45(4):830‑836. DOI: 10.2337/dc21‑2113.

[461] Marre M, Chatellier G, Leblanc H, et al. Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria[J]. BMJ, 1988, 297(6656):1092‑1095. DOI: 10.1136/bmj.297.6656.1092.

[462] Li L, Ji L, Guo X, et al. Prevalence of microvascular diseases among tertiary care Chinese with early versus late onset of type 2 diabetes[J]. J Diabetes Complications, 2015, 29(1):32‑37. DOI: 10.1016/j.jdiacomp.2014.08.010.

[463] Lu J, Mu Y, Su Q, et al. Reduced kidney function is associated with cardiometabolic risk factors, prevalent and predicted risk of cardiovascular disease in Chinese adults: results from the REACTION study[J]. J Am Heart Assoc, 2016, 5(7): e003328. DOI: 10.1161/JAHA.116.003328.

[464] Fufaa GD, Weil EJ, Nelson RG, et al. Association of urinary KIM‑1, L‑FABP, NAG and NGAL with incident end‑stage renal disease and mortality in American Indians with type 2 diabetes mellitus[J]. Diabetologia, 2015, 58(1):188‑198. DOI: 10.1007/s00125‑014‑3389‑3.

[465] Satirapoj B, Pooluea P, Nata N, et al. Urinary biomarkers of tubular injury to predict renal progression and end stage renal disease in type 2 diabetes mellitus with advanced nephropathy: a prospective cohort study[J]. J Diabetes Complications, 2019, 33(9): 675‑681. DOI:

10.1016/j.jdiacomp.2019.05.013.

[466] Clara T, Huili Z, Jian‑Jun L, et al. Association of major candidate protein biomarkers and long‑term diabetic kidney disease progression among Asians with young‑onset type 2 diabetes mellitus[J]. Diabetes Res Clin Pract, 2024, 216: 111821. DOI: 10.1016/j.

diabres.2024.111821.

[467] Houeiss P, Njeim R, Tamim H, et al. Urinary 20‑HETE: a prospective non‑invasive prognostic and diagnostic marker for diabetic kidney disease[J]. J Adv Res, 2023, 44:109‑117. DOI: 10.1016/j.jare.2022.04.013.

[468] American Diabetes Association Professional Practice Committee. 11. Chronic kidney disease and risk management: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1): S219‑S230. DOI:

10.2337/dc24‑S011.

[469] Luk A, Hui E, Sin MC, et al. Declining trends of cardiovascular‑renal complications and mortality in type 2 diabetes: the Hong Kong diabetes database[J]. Diabetes Care, 2017, 40(7):928‑935. DOI: 10.2337/dc16‑2354.

[470] 中华医学会糖尿病学分会微血管并发症学组 . 中国糖尿病肾脏病防治指南(2021年版)[J].中华糖尿病杂志, 2021, 13(8):762‑784. DOI: 10.3760/cma.j.cn115791‑20210706‑00369.

[471] de Boer IH, Caramori ML, Chan J, et al. Executive summary of the 2020 KDIGO diabetes management in CKD guideline: evidence‑based advances in monitoring and treatment[J]. Kidney Int, 2020, 98(4): 839‑848. DOI:

10.1016/j.kint.2020.06.024.

[472] Hodson EM, Cooper TE. Altered dietary salt intake for preventing diabetic kidney disease and its progression[J]. Cochrane Database Syst Rev, 2023, 1(1): CD006763. DOI:

10.1002/14651858.CD006763.pub3.

[473] Mills KT, Chen J, Yang W, et al. Sodium excretion and the risk of cardiovascular disease in patients with chronic kidney disease[J]. JAMA, 2016, 315(20): 2200‑2210. DOI:

10.1001/jama.2016.4447.

[474] Chen Y, Wang X, Jia Y, et al. Effect of a sodium restriction diet on albuminuria and blood pressure in diabetic kidney disease patients: a meta‑analysis[J]. Int Urol Nephrol, 2022, 54(6): 1249‑1260. DOI: 10.1007/s11255‑021‑03035‑x.

[475] Hughes‑Austin JM, Rifkin DE, Beben T, et al. The relation of serum potassium concentration with cardiovascular events and mortality in community‑living individuals[J]. Clin J Am Soc Nephrol, 2017, 12(2): 245‑252. DOI:

10.2215/CJN.06290616.

[476] Bandak G, Sang Y, Gasparini A, et al. Hyperkalemia after initiating renin‑angiotensin system blockade: the stockholm creatinine measurements (SCREAM) project[J]. J Am Heart Assoc, 2017, 6(7):e005428. DOI: 10.1161/JAHA.116.005428.

[477] McGuire DK, Shih WJ, Cosentino F, et al. Association of SGLT2 inhibitors with cardiovascular and kidney outcomes in patients with type 2 diabetes: a Meta‑analysis[J]. JAMA Cardiol, 2021, 6(2): 148‑158. DOI:

10.1001/jamacardio.2020.4511.

[478] Li CJ, Li J, Zhang QM, et al. Efficacy and safety comparison between liraglutide as add‑on therapy to insulin and insulin dose‑increase in Chinese subjects with poorly controlled type 2 diabetes and abdominal obesity[J]. Cardiovasc Diabetol, 2012, 11: 142. DOI:

10.1186/1475‑2840‑11‑142.

[479] Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo‑controlled trial[J]. Lancet, 2019, 394(10193): 131‑138. DOI:

10.1016/S0140‑6736(19)31150‑X.

[480] Romera I, Cebrián‑Cuenca A, Álvarez‑Guisasola F, et al. A review of practical issues on the use of glucagon‑like peptide‑1 receptor agonists for the management of type 2 diabetes[J]. Diabetes Ther, 2019, 10(1): 5‑19. DOI:

10.1007/s13300‑018‑0535‑9.

[481] American Diabetes Association. 11. Microvascular complications and foot care: standards of medical care in diabetes‑2020[J]. Diabetes Care, 2020, 43(Suppl 1):S135‑S151. DOI: 10.2337/dc20‑S011.

[482] Fried LF, Emanuele N, Zhang JH, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy[J]. N Engl J Med, 2013, 369(20):1892‑1903. DOI: 10.1056/NEJMoa1303154.

[483] Parving HH, Lehnert H, Bröchner‑Mortensen J, et al. The effect of Irbesartan on the development of diabetic

nephropathy in patients with type 2 diabetes[J]. N Engl J Med, 2001, 345(12): 870‑878. DOI: 10.1056/NEJMoa011489.

[484] Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO‑HOPEsubstudy[J]. Lancet, 2000, 355(9200):253‑259.

[485] O′Hare P, Bilbous R, Mitchell T, et al. Low‑dose ramipril reduces microalbuminuria in type 1 diabetic patients without hypertension: results of a randomized controlled trial[J]. Diabetes Care, 2000, 23(12): 1823‑1829. DOI:

10.2337/diacare.23.12.1823.

[486] Marre M, Lievre M, Chatellier G, et al. Effects of low dose ramipril on cardiovascular and renal outcomes in patients with type 2 diabetes and raised excretion of urinary albumin: randomised, double blind, placebo controlled trial (the DIABHYCAR study) [J]. BMJ, 2004, 328(7438):495. DOI: 10.1136/bmj.37970.629537.0D.

[487] James MT, Grams ME, Woodward M, et al. A Meta‑analysis of the association of estimated gfr, albuminuria, diabetes mellitus, and hypertension with acute kidney injury[J]. Am J Kidney Dis, 2015, 66(4): 602‑612. DOI: 10.1053/j.

ajkd.2015.02.338.

[488] Collard D, Brouwer TF, Peters R, et al. Creatinine rise during blood pressure therapy and the risk of adverse clinical outcomes in patients with type 2 diabetes mellitus[J]. Hypertension, 2018, 72(6): 1337‑1344. DOI: 10.1161/HYPERTENSIONAHA.118.11944.

[489] Malhotra R, Craven T, Ambrosius WT, et al. Effects of intensive blood pressure lowering on kidney tubule injury in CKD: a longitudinal subgroup analysis in SPRINT[J]. Am J Kidney Dis, 2019, 73(1): 21‑30. DOI: 10.1053/j.

ajkd.2018.07.015.

[490] Mauer M, Zinman B, Gardiner R, et al. Renal and retinal effects of enalapril and losartan in type 1 diabetes[J]. N Engl J Med, 2009, 361(1): 40‑51. DOI: 10.1056/NEJMoa0808400.

[491] Bangalore S, Fakheri R, Toklu B, et al. Diabetes mellitus as a compelling indication for use of renin angiotensin system blockers: systematic review and meta‑analysis of randomized trials[J]. BMJ, 2016, 352:i438. DOI: 10.1136/bmj.i438.

[492] Bakris GL, Agarwal R, Anker SD, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes[J]. N Engl J Med, 2020, 383(23): 2219‑2229. DOI: 10.1056/NEJMoa2025845.

[493] Filippatos G, Anker SD, Agarwal R, et al. Finerenone and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes[J]. Circulation, 2021, 143(6):540‑552. DOI: 10.1161/CIRCULATIONAHA.120.051898.

[494] Mottl AK, Nicholas SB. KDOQI commentary on the KDIGO 2022 update to the clinical practice guideline for diabetes management in CKD[J]. Am J Kidney Dis, 2024, 83(3):277‑287. DOI: 10.1053/j.ajkd.2023.09.003.

[495] Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline[J]. Ann Intern Med, 2013, 158(11): 825‑830. DOI: 10.7326/0003‑4819‑158‑11‑201306040‑00007.

[496] de Boer IH, Khunti K, Sadusky T, et al. Diabetes

management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) [J]. Diabetes Care, 2022, 45(12): 3075‑3090. DOI: 10.2337/dci22‑0027.

[497] Cheung N, Mitchell P, Wong TY. Diabetic retinopathy[J]. Lancet, 2010, 376(9735): 124‑136. DOI: 10.1016/S0140‑6736(09)62124‑3.

[498] Hou X, Wang L, Zhu D, et al. Prevalence of diabetic retinopathy and vision‑threatening diabetic retinopathy in adults with diabetes in China[J]. Nat Commun, 2023, 14(1):4296. DOI: 10.1038/s41467‑023‑39864‑w.

[499] American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S231‑S243. DOI: 10.2337/dc24‑S012.

[500] 中华医学会糖尿病学分会视网膜病变学组 . 糖尿病视网膜病变防治专家共识[J].中华糖尿病杂志, 2018, 10(4):241‑247. DOI: 10.3760/cma.j.issn.1674‑5809.2018.04.001.

[501] Olsen BS, Sjølie AK, Hougaard P, et al. The significance of the prepubertal diabetes duration for the development of retinopathy and nephropathy in patients with type 1 diabetes[J]. J Diabetes Complications, 2004, 18(3):160‑164. DOI: 10.1016/S1056‑8727(03)00073‑4.

[502] 中华医学会糖尿病学分会视网膜病变学组 . 糖尿病相关眼病防治多学科中国专家共识(2021年版)[J].中华糖尿病杂志 , 2021, 13(11): 1026‑1042. DOI: 10.3760/cma. j.

cn115791‑20211006‑00534.

[503] Parving HH, Gall MA, Skøtt P, et al. Prevalence and causes of albuminuria in non‑insulin‑dependent diabetic patients[J]. Kidney Int, 1992, 41(4):758‑762. DOI: 10.1038/ki.1992.118.

[504] Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic retinopathy

preferred

practice

pattern®[J]. Ophthalmology, 2020, 127(1): P66‑P145. DOI: 10.1016/j.

ophtha.2019.09.025.

[505] 中华医学会糖尿病学分会微血管并发症学组 . 糖尿病肾病防治专家共识(2014 年版)[J]. 中华糖尿病杂志, 2014, 6(11):792‑801. DOI: 10.3760/cma.j.issn.1674‑5809.2014.11.004.

[506] Agardh E, Tababat‑Khani P. Adopting 3‑year screening intervals for sight‑threatening retinal vascular lesions in type 2 diabetic subjects without retinopathy[J]. Diabetes Care, 2011, 34(6):1318‑1319. DOI: 10.2337/dc10‑2308.

[507] Dai L, Wu L, Li H, et al. A deep learning system for detecting diabetic retinopathy across the disease spectrum[J]. Nat Commun, 2021, 12(1): 3242. DOI:

10.1038/s41467‑021‑23458‑5.

[508] Ruamviboonsuk P, Tiwari R, Sayres R, et al. Real‑time diabetic retinopathy screening by deep learning in a multisite national screening programme: a prospective interventional cohort study[J]. Lancet Digit Health, 2022, 4(4):e235‑e244. DOI: 10.1016/S2589‑7500(22)00017‑6.

[509] van der Heijden AA, Abramoff MD, Verbraak F, et al. Validation of automated screening for referable diabetic retinopathy with the IDx‑DR device in the Hoorn Diabetes Care System[J]. Acta Ophthalmol, 2018, 96(1):63‑68. DOI:

10.1111/aos.13613.

[510] Dong L, He W, Zhang R, et al. Artificial intelligence for screening of multiple retinal and optic nerve diseases[J]. JAMA Netw Open, 2022, 5(5): e229960. DOI: 10.1001/jamanetworkopen.2022.9960.

[511] Tomić M, Vrabec R, Hendelja Đ, et al. Diagnostic accuracy

of hand‑held fundus camera and artificial intelligence in diabetic retinopathy screening[J]. Biomedicines, 2023, 12(1):34. DOI: 10.3390/biomedicines12010034.

[512] Guan Z, Li H, Liu R, et al. Artificial intelligence in diabetes management: advancements, opportunities, and challenges[J]. Cell Rep Med, 2023, 4(10): 101213. DOI:

10.1016/j.xcrm.2023.101213.

[513] Dai L, Sheng B, Chen T, et al. A deep learning system for predicting time to progression of diabetic retinopathy[J]. Nat Med, 2024, 30(2): 584‑594. DOI: 10.1038/s41591‑023‑02702‑z.

[514] Sheng B, Guan Z, Lim LL, et al. Large language models for diabetes care: potentials and prospects[J]. Sci Bull (Beijing), 2024, 69(5): 583‑588. DOI: 10.1016/j.

scib.2024.01.004.

[515] Wong TY, Sun J, Kawasaki R, et al. Guidelines on diabetic eye care: the international council of ophthalmology recommendations for screening, follow‑up, referral, and treatment based on resource settings[J]. Ophthalmology, 2018, 125(10): 1608‑1622. DOI: 10.1016/j.

ophtha.2018.04.007.

[516] Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association[J]. Diabetes Care, 2017, 40(3): 412‑418. DOI: 10.2337/dc16‑2641.

[517] National Institute for Health and Care Excellence. Type 2 diabetes in adults: management[EB/OL]. (2015‑12‑02) [2024‑11‑25]. https://www. nice. org. uk/guidance/ng28/resources/type‑2‑diabetes‑in‑adults‑management‑pdf‑18

37338615493.

[518] UK Prospective Diabetes Study (UKPDS) Group. Intensive blood‑glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)[J]. Lancet, 1998, 352(9131):837‑853.

[519] Fan YP, Wu CT, Lin JL, et al. Metformin treatment is associated with a decreased risk of nonproliferative diabetic retinopathy in patients with type 2 diabetes mellitus: a population‑based cohort study[J]. J Diabetes Res, 2020, 2020:9161039. DOI: 10.1155/2020/9161039.

[520] Eleftheriadou A, Riley D, Zhao SS, et al. Risk of diabetic retinopathy and diabetic macular oedema with sodium‑glucose cotransporter 2 inhibitors and glucagon‑like peptide 1 receptor agonists in type 2 diabetes: a real‑world data study from a global federated database[J]. Diabetologia, 2024, 67(7): 1271‑1282. DOI:

10.1007/s00125‑024‑06132‑5.

[521] Yen FS, Wei JC, Yu TS, et al. Sodium‑glucose cotransporter 2 inhibitors and risk of retinopathy in patients with type 2 diabetes[J]. JAMA Netw Open, 2023, 6(12): e2348431. DOI: 10.1001/jamanetworkopen.2023.48431.

[522] Merante D, Menchini F, Truitt KE, et al. Diabetic macular edema: correlations with available diabetes therapies‑‑evidence across a qualitative review of published literature from MEDLINE and EMBASE[J]. Drug Saf,

2010,

33(8):

643‑652.

10.2165/11538340‑000000000‑00000.

[523] 司美格鲁肽注射液说明书[EB/OL]. [2024‑02‑01]. https://dailymed. nlm. nih. gov/dailymed/drugInfo. cfm? setid=adec4fd2‑6858‑4c99‑91d4‑531f5f2a2d79.

[524] National Institute for Health and Care Excellence.

Diabetic

retinopathy:

management

and monitoring[EB/OL]. (2024‑08‑13) [2024‑11‑26]. https://www. nice. org. uk/guidance/ng242/resources/diabetic‑re t i n o p a t hy‑management‑and‑monitoring‑pdf‑66143953240261.

[525] Wang B, Wang F, Zhang Y, et al. Effects of RAS inhibitors on diabetic retinopathy: a systematic review and meta‑analysis[J]. Lancet Diabetes Endocrinol, 2015, 3(4):263‑274. DOI: 10.1016/S2213‑8587(14)70256‑6.

[526] Chew EY, Davis MD, Danis RP, et al. The effects of medical management on the progression of diabetic retinopathy in persons with type 2 diabetes: the action to control cardiovascular risk in diabetes (accord) eye study[J]. Ophthalmology, 2014, 121(12):2443‑2451. DOI: 10.1016/j.ophtha.2014.07.019.

[527] Deng X, Mo Y, Zhu X, et al. The effectiveness and safety of Chinese patent medicines plus calcium dobesilate for the treatment of diabetic retinopathy: a network meta‑analysis[J]. Heliyon, 2024, 10(3): e24533. DOI:

10.1016/j.heliyon.2024.e24533.

[528] Cheng Y, Yu X, Zhang J, et al. Pancreatic kallikrein protects against diabetic retinopathy in KK Cg‑A(y)/J and high‑fat diet/streptozotocin‑induced mouse models of type 2 diabetes[J]. Diabetologia, 2019, 62(6): 1074‑1086. DOI:

10.1007/s00125‑019‑4838‑9.

[529] Pop‑Busui R, Boulton AJ, Feldman EL, et al. Diabetic neuropathy: a position statement by the American Diabetes Association[J]. Diabetes Care, 2017, 40(1):136‑154. DOI: 10.2337/dc16‑2042.

[530] Callaghan BC, Gallagher G, Fridman V, et al. Diabetic neuropathy: what does the future hold? [J]. Diabetologia, 2020,

63(5):

891‑897.

10.1007/

s00125‑020‑05085‑9.

[531] Melmed S, Koenig R, Rosen CJ. Williams textbook of endocrinology[M].14th ed. Amsterdam: Elsevier, 2019.

[532] Wang W, Ji Q, Ran X, et al. Prevalence and risk factors of diabetic peripheral neuropathy: a population‑based cross‑sectional study in China[J]. Diabetes Metab Res Rev, 2023, 39(8):e3702. DOI: 10.1002/dmrr.3702.

[533] Li C, Wang W, Ji Q, et al. Prevalence of painful diabetic peripheral neuropathy in type 2 diabetes mellitus and diabetic peripheral neuropathy: a nationwide cross‑sectional study in mainland China[J]. Diabetes Res Clin Pract, 2023, 198: 110602. DOI: 10.1016/j.

diabres.2023.110602.

[534] Sloan G, Shillo P, Selvarajah D, et al. A new look at painful diabetic neuropathy[J]. Diabetes Res Clin Pract, 2018, 144:177‑191. DOI: 10.1016/j.diabres.2018.08.020.

[535] Eid S, Sas KM, Abcouwer SF, et al. New insights into the mechanisms of diabetic complications: role of lipids and lipid metabolism[J]. Diabetologia, 2019, 62(9):1539‑1549. DOI: 10.1007/s00125‑019‑4959‑1.

[536] Yagihashi S, Mizukami H, Sugimoto K. Mechanism of diabetic neuropathy: where are we now and where to go? [J]. J Diabetes Investig, 2011, 2(1): 18‑32. DOI: 10.1111/j.2040‑1124.2010.00070.x.

[537] Smith BE. Focal and entrapment neuropathies[J]. Handb Clin Neurol, 2014, 126: 31‑43. DOI: 10.1016/B978‑0‑444‑53480‑4.00003-5.

[538] Tracy JA, Dyck PJ. The spectrum of diabetic neuropathies[J]. Phys Med Rehabil Clin N Am, 2008, 19(1): 1‑26, v. DOI:

10.1016/j.pmr.2007.10.010.

[539] Laughlin RS, Dyck PJ. Electrodiagnostic testing in lumbosacral plexopathies[J]. Phys Med Rehabil Clin N Am, 2013, 24(1):93‑105. DOI: 10.1016/j.pmr.2012.08.014.

[540] Massie R, Mauermann ML, Staff NP, et al. Diabetic cervical radiculoplexus neuropathy: a distinct syndrome expanding the spectrum of diabetic radiculoplexus neuropathies[J]. Brain, 2012, 135(Pt 10):3074‑3088. DOI:

10.1093/brain/aws244.

[541] Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment[J]. Muscle Nerve, 2002, 25(4):477‑491. DOI: 10.1002/mus.10080.

[542] 蔡洁, 董继宏, 汪昕 . 糖尿病性周围神经病常用评分量表比较与研究 [J]. 中华临床医师杂志 (电子版), 2009, 3(1):12‑17. DOI: 10.3969/j.issn.1674‑0785.2009.01.004.

[543] Lauria G, Dacci P, Lombardi R, et al. Side and time variability of intraepidermal nerve fiber density[J]. Neurology, 2015, 84(23): 2368‑2371. DOI: 10.1212/WNL.0000000000001666.

[544] Baron R, Maier C, Attal N, et al. Peripheral neuropathic pain: a mechanism‑related organizing principle based on sensory profiles[J]. Pain, 2017, 158(2): 261‑272. DOI:

10.1097/j.pain.0000000000000753.

[545] Ishibashi F, Kojima R, Taniguchi M, et al. The expanded bead size of corneal C‑nerve fibers visualized by corneal confocal microscopy is associated with slow conduction velocity of the peripheral nerves in patients with type 2 diabetes mellitus[J]. J Diabetes Res, 2016, 2016:3653459. DOI: 10.1155/2016/3653459.

[546] Xiong Q, Lu B, Ye HY, et al. Corneal confocal microscopy as a non‑invasive test to assess diabetic peripheral neuropathy[J]. Diabetes Res Clin Pract, 2018, 136: 85‑92. DOI: 10.1016/j.diabres.2017.11.026.

[547] American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes‑2020[J]. Diabetes Care, 2020, 43(Suppl 1):S14‑S31. DOI: 10.2337/dc20‑S002.

[548] Tesfaye S, Boulton AJ, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments[J]. Diabetes Care, 2010, 33(10):2285‑2293. DOI: 10.2337/dc10‑1303.

[549] Yun JS, Park YM, Cha SA, et al. Progression of cardiovascular autonomic neuropathy and cardiovascular disease in type 2 diabetes[J]. Cardiovasc Diabetol, 2018, 17(1):109. DOI: 10.1186/s12933‑018‑0752‑6.

[550] Spallone V. Update on the impact, diagnosis and management of cardiovascular autonomic neuropathy in diabetes: what is defined, what is new, and what is unmet[J]. Diabetes Metab J, 2019, 43(1):3‑30. DOI: 10.4093/dmj.2018.0259.

[551] Spallone V, Ziegler D, Freeman R, et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management[J]. Diabetes Metab Res Rev, 2011, 27(7): 639‑653. DOI: 10.1002/dmrr.1239.

[552] Kempler P, Amarenco G, Freeman R, et al. Management strategies for gastrointestinal, erectile, bladder, and sudomotor dysfunction in patients with diabetes[J]. Diabetes Metab Res Rev, 2011, 27(7): 665‑677. DOI:

10.1002/dmrr.1223.

[553] Bharucha AE, Kudva YC, Prichard DO. Diabetic

gastroparesis[J]. Endocr Rev, 2019, 40(5): 1318‑1352. DOI: 10.1210/er.2018‑00161.

[554] 中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会 . 中国糖尿病足防治指南(2019 版)(Ⅱ)[J]. 中华糖尿病杂志 , 2019, 11(3):161‑189. DOI: 10.3760/cma.j.issn.1674‑5809.2019.03.005.

[555] Han L, Ji L, Chang J, et al. Peripheral neuropathy is associated with insulin resistance independent of metabolic syndrome[J]. Diabetol Metab Syndr, 2015, 7:14. DOI: 10.1186/s13098‑015‑0010‑y.

[556] Hsieh RY, Huang IC, Chen C, et al. Effects of oral alpha‑lipoic acid treatment on diabetic polyneuropathy: a Meta‑analysis and systematic review[J]. Nutrients, 2023, 15(16):3634. DOI: 10.3390/nu15163634.

[557] Kishi Y, Schmelzer JD, Yao JK, et al. Alpha‑lipoic acid: effect on glucose uptake, sorbitol pathway, and energy metabolism in experimental diabetic neuropathy[J]. Diabetes, 1999, 48(10): 2045‑2051. DOI: 10.2337/diabetes.48.10.2045.

[558] 李平, 马建华, 高佳麟, 等 . 依帕司他治疗糖尿病周围神经病变安全性和有效性的随机、对照、多中心临床研究[J].

中华内分泌代谢杂志 , 2015, (9):743‑747. DOI: 10.3760/cma.j.issn.1000‑6699.2015.09.001.

[559] Baba M, Matsui N, Kuroha M, et al. Mirogabalin for the treatment of diabetic peripheral neuropathic pain: a randomized, double‑blind, placebo‑controlled phase Ⅲ study in Asian patients[J]. J Diabetes Investig, 2019, 10(5):1299‑1306. DOI: 10.1111/jdi.13013.

[560] Baba M, Kuroha M, Ohwada S, et al. Results of mirogabalin treatment for diabetic peripheral neuropathic pain in Asian subjects: a phase 2, double‑blind, randomized, placebo‑controlled, study[J]. Pain Ther, 2020, 9(1):261‑278. DOI: 10.1007/s40122‑020‑00156‑6.

[561] Tesfaye S, Vileikyte L, Rayman G, et al. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management[J]. Diabetes Metab Res Rev, 2011, 27(7): 629‑638. DOI: 10.1002/dmrr.1225.

[562] Baron R, Mayoral V, Leijon G, et al. 5% Lidocaine medicated plaster versus pregabalin in post‑herpetic neuralgia and diabetic polyneuropathy: an open‑label, non‑inferiority two‑stage RCT study[J]. Curr Med Res Opin, 2009, 25(7):1663‑1676. DOI: 10.1185/03007990903047880.

[563] Tong Y, Guo H, Han B. Fifteen‑day acupuncture treatment relieves diabetic peripheral neuropathy[J]. J Acupunct Meridian Stud, 2010, 3(2): 95‑103. DOI: 10.1016/S2005‑2901(10)60018‑0.

[564] Garrow AP, Xing M, Vere J, et al. Role of acupuncture in the management of diabetic painful neuropathy (DPN): a pilot RCT[J]. Acupunct Med, 2014, 32(3): 242‑249. DOI:

10.1136/acupmed‑2013‑010495.

[565] Jordan J, Shannon JR, Black BK, et al. The pressor response to water drinking in humans: a sympathetic reflex? [J]. Circulation, 2000, 101(5): 504‑509. DOI:

10.1161/01.cir.101.5.504.

[566] Parsaik AK, Singh B, Altayar O, et al. Midodrine for orthostatic hypotension: a systematic review and meta‑analysis of clinical trials[J]. J Gen Intern Med, 2013, 28(11):1496‑1503. DOI: 10.1007/s11606‑013‑2520‑3.

[567] Elgebaly A, Abdelazeim B, Mattar O, et al. Meta‑analysis of the safety and efficacy of droxidopa for neurogenic

orthostatic hypotension[J]. Clin Auton Res, 2016, 26(3):171‑180. DOI: 10.1007/s10286‑016‑0349‑7.

[568] van Lieshout JJ, ten Harkel AD, Wieling W. Fludrocortisone and sleeping in the head‑up position limit the postural decrease in cardiac output in autonomic failure[J]. Clin Auton Res, 2000, 10(1): 35‑42. DOI: 10.1007/BF02291388.

[569] Singer W, Sandroni P, Opfer‑Gehrking TL, et al. Pyridostigmine treatment trial in neurogenic orthostatic hypotension[J]. Arch Neurol, 2006, 63(4): 513‑518. DOI:

10.1001/archneur.63.4.noc50340.

[570] Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis[J]. Am J Gastroenterol, 2013, 108(1): 18‑37; quiz 38. DOI:

10.1038/ajg.2012.373.

[571] Truzzi JC, de Almeida FG, Sacomani CA, et al. Neurogenic bladder‑concepts and treatment recommendations[J]. Int Braz J Urol, 2022, 48(2): 220‑243. DOI: 10.1590/S1677‑5538.IBJU.2021.0098.

[572] 杨靖, 张英梅, 葛均波 . 泛血管疾病防控——从疾病治疗到综合管理[J]. 中华心血管病杂志(网络版), 2021, 4(1):1‑6. DOI: 10.3760/cma.j.cn116031.2021.1000096.

[573] Olivier CB, Mulder H, Hiatt WR, et al. Incidence, characteristics, and outcomes of myocardial infarction in patients with peripheral artery disease: insights from the EUCLID trial[J]. JAMA Cardiol, 2019, 4(1): 7‑15. DOI:

10.1001/jamacardio.2018.4171.

[574] 国家心血管病中心 , 中国心血管健康与疾病报告编写组 , 胡盛寿 . 中国心血管健康与疾病报告 2023概要[J].中国循环 杂 志 , 2024, 39(7): 625‑660. DOI: 10.3969/j.

issn.1000‑3614.2024.07.001.

[575] Wang Z, Wang X, Hao G, et al. A national study of the prevalence and risk factors associated with peripheral arterial disease from China: the China hypertension survey, 2012‑2015[J]. Int J Cardiol, 2019, 275: 165‑170. DOI: 10.1016/j.ijcard.2018.10.047.

[576] Zhang X, Ran X, Xu Z, et al. Epidemiological characteristics of lower extremity arterial disease in Chinese diabetes patients at high risk: a prospective, multicenter, cross‑sectional study[J]. J Diabetes Complications, 2018, 32(2):150‑156. DOI: 10.1016/j.jdiacomp.2017.10.003.

[577] Golledge J. Update on the pathophysiology and medical treatment of peripheral artery disease[J]. Nat Rev Cardiol, 2022, 19(7):456‑474. DOI: 10.1038/s41569‑021‑00663‑9.

[578] Prompers L, Schaper N, Apelqvist J, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE study[J]. Diabetologia, 2008, 51(5): 747‑755. DOI: 10.1007/s00125‑008‑0940‑0.

[579] 班绎娟, 冉兴无, 杨川, 等 . 中国部分省市糖尿病足病临床资料和住院费用等比较[J].中华糖尿病杂志, 2014, (7):499‑503. DOI: 10.3760/cma.j.issn.1674‑5809.2014.07.005.

[580] Li X, Wang YZ, Yang XP, et al. Prevalence of and risk factors for abnormal ankle‑brachial index in patients with type 2 diabetes[J]. J Diabetes, 2012, 4(2): 140‑146. DOI:

10.1111/j.1753‑0407.2011.00171.x.

[581] Agnelli G, Belch J, Baumgartner I, et al. Morbidity and mortality associated with atherosclerotic peripheral artery disease: a systematic review[J]. Atherosclerosis, 2020,

293:

94‑100.

10.1016/j.

atherosclerosis.2019.09.012.

[582] Sartipy F, Sigvant B, Lundin F, et al. Ten year mortality in different peripheral arterial disease stages: a population based observational study on outcome[J]. Eur J Vasc Endovasc Surg, 2018, 55(4): 529‑536. DOI: 10.1016/j.

ejvs.2018.01.019.

[583] Steg PG, Bhatt DL, Wilson PW, et al. One‑year cardiovascular event rates in outpatients with atherothrombosis[J]. JAMA, 2007, 297(11): 1197‑1206. DOI: 10.1001/jama.297.11.1197.

[584] Li J, Luo Y, Xu Y, et al. Risk factors of peripheral arterial disease and relationship between low ankle‑brachial index and mortality from all‑cause and cardiovascular disease in Chinese patients with type 2 diabetes[J]. Circ J, 2007, 71(3):377‑381. DOI: 10.1253/circj.71.377.

[585] Stehouwer CD, Clement D, Davidson C, et al. Peripheral arterial disease: a growing problem for the internist[J]. Eur J Intern Med, 2009, 20(2): 132‑138. DOI: 10.1016/j.

ejim.2008.09.013.

[586] Hirsch AT, Murphy TP, Lovell MB, et al. Gaps in public knowledge of peripheral arterial disease: the first national PAD public awareness survey[J]. Circulation, 2007,

116(18):

2086‑2094.

CIRCULATIONAHA.107.725101.

[587] Welten GM, Schouten O, Hoeks SE, et al. Long‑term prognosis of patients with peripheral arterial disease: a comparison in patients with coronary artery disease[J]. J Am Coll Cardiol, 2008, 51(16):1588‑1596. DOI: 10.1016/j.

jacc.2007.11.077.

[588] 冉兴无 . 糖尿病周围动脉病变:一个处于灰区的危险状态[J].

中华医学杂志, 2012, 92(4):217‑218. DOI: 10.3760/cma.j.

issn.0376‑2491.2012.04.001.

[589] Shah AD, Langenberg C, Rapsomaniki E, et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1.9 million people[J]. Lancet Diabetes Endocrinol, 2015, 3(2): 105‑113. DOI: 10.1016/S2213‑8587(14)70219‑0.

[590] 中华医学会糖尿病学分会 . 2型糖尿病患者合并下肢动脉病变的筛查及管理规范[J]. 中华糖尿病杂志 , 2013, 5(2):82‑88. DOI: 10.3760/cma.j.issn.1674‑5809.2013.02.006.

[591] Mazzolai L, Teixido‑Tura G, Lanzi S, et al. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases[J]. Eur Heart J, 2024, 45(36): 3538‑3700. DOI: 10.1093/eurheartj/ehae179.

[592] Fitridge R, Chuter V, Mills J, et al. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer[J]. Diabetes Metab Res Rev, 2024, 40(3):e3686. DOI: 10.1002/dmrr.3686.

[593] Aboyans V, Ricco JB, Bartelink M, et al. Editor′s choice‑2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS)[J]. Eur J Vasc Endovasc Surg, 2018, 55(3): 305‑368. DOI:

10.1016/j.ejvs.2017.07.018.

[594] Abaraogu UO, Dall PM, Seenan CA. The effect of structured patient education on physical activity in patients with peripheral arterial disease and intermittent claudication: a systematic review[J]. Eur J Vasc Endovasc Surg, 2017, 54(1):58‑68. DOI: 10.1016/j.ejvs.2017.04.003.

[595] Lyu X, Li S, Peng S, et al. Intensive walking exercise for lower extremity peripheral arterial disease: a systematic

review and meta‑analysis[J]. J Diabetes, 2016, 8(3):363‑377. DOI: 10.1111/1753‑0407.12304.

[596] Lane R, Harwood A, Watson L, et al. Exercise for intermittent claudication[J]. Cochrane Database Syst Rev, 2017, 12(12): CD000990. DOI: 10.1002/14651858.

CD000990.pub4.

[597] Hageman D, Fokkenrood HJ, Gommans LN, et al. Supervised exercise therapy versus home‑based exercise therapy versus walking advice for intermittent claudication[J]. Cochrane Database Syst Rev, 2018, 4(4):CD005263. DOI: 10.1002/14651858.CD005263.pub4.

[598] Chiarito M, Sanz‑Sánchez J, Cannata F, et al. Monotherapy with a P2Y(12) inhibitor or aspirin for secondary prevention in patients with established atherosclerosis: a systematic review and meta‑analysis[J]. Lancet, 2020, 395(10235): 1487‑1495. DOI: 10.1016/S0140‑6736(20)30315‑9.

[599] De Carlo M, Di Minno G, Sayre T, et al. Efficacy and safety of antiplatelet therapies in symptomatic peripheral artery disease: a systematic review and network Meta‑analysis[J]. Curr Vasc Pharmacol, 2021, 19(5): 542‑555. DOI:

10.2174/1570161118666200820141131.

[600] Kokkinidis DG, Arfaras‑Melainis A, Giannopoulos S, et al. Statin therapy for reduction of cardiovascular and limb‑related events in critical limb ischemia: a systematic review and meta‑analysis[J]. Vasc Med, 2020, 25(2):106‑117. DOI: 10.1177/1358863X19894055.

[601] Shahin Y, Barnes R, Barakat H, et al. Meta‑analysis of angiotensin converting enzyme inhibitors effect on walking ability and ankle brachial pressure index in patients

with

intermittent

claudication[J]. Atherosclerosis, 2013, 231(2): 283‑290. DOI: 10.1016/j.

atherosclerosis.2013.09.037.

[602] Bodewes T, Darling JD, O′Donnell T, et al. Long‑term mortality benefit of renin‑angiotensin system inhibitors in patients with chronic limb‑threatening ischemia undergoing vascular intervention[J]. J Vasc Surg, 2018, 67(3):800‑808.e1. DOI: 10.1016/j.jvs.2017.07.130.

[603] Broderick C, Forster R, Abdel‑Hadi M, et al. Pentoxifylline for intermittent claudication[J]. Cochrane Database Syst Rev, 2020, 10(10): CD005262. DOI: 10.1002/14651858.

CD005262.pub4.

[604] Brown T, Forster RB, Cleanthis M, et al. Cilostazol for intermittent claudication[J]. Cochrane Database Syst Rev, 2021, 6(6): CD003748. DOI: 10.1002/14651858.

CD003748.pub5.

[605] Kamoen V, Vander Stichele R, Campens L, et al. Propionyl‑L‑carnitine for intermittent claudication[J]. Cochrane Database Syst Rev, 2021, 12(12): CD010117. DOI: 10.1002/14651858.CD010117.pub2.

[606] Liang X, Wang Y, Zhao C, et al. Systematic review the efficacy and safety of cilostazol, pentoxifylline, beraprost in the treatment of intermittent claudication: a network meta‑analysis[J]. PLoS One, 2022, 17(11):e0275392. DOI:

10.1371/journal.pone.0275392.

[607] Cunningham MA, Swanson V, Holdsworth RJ, et al. Late effects of a brief psychological intervention in patients with intermittent claudication in a randomized clinical trial[J]. Br J Surg, 2013, 100(6): 756‑760. DOI: 10.1002/bjs.9100.

[608] McElroy IE, Suarez L, Tan TW. The impact of mental

health on patient outcomes in peripheral arterial disease and critical limb threatening ischemia and potential avenues to treatment[J]. Ann Vasc Surg, 2024, 107:181‑185. DOI: 10.1016/j.avsg.2024.01.028.

[609] Smolderen KG, Samaan Z, Decker C, et al. Association between mental health burden, clinical presentation, and outcomes in individuals with symptomatic peripheral artery disease: a scientific statement from the American Heart Association[J]. Circulation, 2023, 148(19):1511‑1528. DOI: 10.1161/CIR.0000000000001178.

[610] Aboyans V, Bauersachs R, Mazzolai L, et al. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy[J]. Eur Heart J, 2021, 42(39): 4013‑4024. DOI: 10.1093/eurheartj/ehab390.

[611] Bonaca MP, Barnes GD, Bauersachs R, et al. Antithrombotic strategies for patients with peripheral artery disease: JACC scientific statement[J]. J Am Coll Cardiol, 2024, 84(10): 936‑952. DOI: 10.1016/j.

jacc.2024.06.027.

[612] Kaplovitch E, Eikelboom JW, Dyal L, et al. Rivaroxaban and aspirin in patients with symptomatic lower extremity peripheral artery disease: a subanalysis of the COMPASS randomized clinical trial[J]. JAMA Cardiol, 2021, 6(1):21‑29. DOI: 10.1001/jamacardio.2020.4390.

[613] 中国医师协会心血管内科医师分会 . 泛血管疾病抗栓治疗中国专家共识 (2024 版)[J]. 中华医学杂志 , 2024, 104(12):906‑923. DOI: 10.3760/cma.j.cn112137‑20231101‑00959.

[614] Baubeta Fridh E, Andersson M, Thuresson M, et al. Amputation rates, mortality, and pre‑operative comorbidities in patients revascularised for intermittent claudication or critical limb ischaemia: a population based study[J]. Eur J Vasc Endovasc Surg, 2017, 54(4):480‑486. DOI: 10.1016/j.ejvs.2017.07.005.

[615] Kayssi A, Al‑Atassi T, Oreopoulos G, et al. Drug‑eluting balloon angioplasty versus uncoated balloon angioplasty for peripheral arterial disease of the lower limbs[J]. Cochrane Database Syst Rev, 2016, 2016(8): CD011319. DOI: 10.1002/14651858.CD011319.pub2.

[616] Kayssi A, Al‑Jundi W, Papia G, et al. Drug‑eluting balloon angioplasty versus uncoated balloon angioplasty for the treatment of in‑stent restenosis of the femoropopliteal arteries[J]. Cochrane Database Syst Rev, 2019, 1(1):CD012510. DOI: 10.1002/14651858.CD012510.pub2.

[617] Gouëffic Y, Brodmann M, Deloose K, et al. Drug‑eluting devices for lower limb peripheral arterial disease[J]. EuroIntervention, 2024, 20(18): e1136‑e1153. DOI:

10.4244/EIJ‑D‑23‑01080.

[618] 冉兴无, 郑月宏 . 加强多学科协作,提高糖尿病缺血性足溃疡的治愈率[J].中华糖尿病杂志, 2016, 8(7):385‑387. DOI:

10.3760/cma.j.issn.1674‑5809.2016.07.001.

[619] 冉兴无, 许樟荣 . 以创新促发展, 应对日益增多的难治性糖尿病足溃疡 [J]. 四川大学学报 ( 医学版), 2022, 53(6):945‑948. DOI: 10.12182/20221160501.

[620] Wolf H, Singh N. Using Multidisciplinary teams to improve outcomes for treating chronic‑limb threatening ischemia[J]. Ann Vasc Surg, 2024, 107: 37‑42. DOI: 10.1016/j.

avsg.2023.11.055.

[621] Ceccato D, Ragazzo S, Boscaro F, et al. Chronic limb‑threatening ischemia with no revascularization option: result from a multidisciplinary care model[J]. Eur J Intern Med, 2024, 125: 137‑138. DOI: 10.1016/j.

ejim.2024.02.036.

[622] Campbell DB, Gutta G, Sobol CG, et al. How multidisciplinary clinics may mitigate socioeconomic barriers to care for chronic limb‑threatening ischemia[J]. J Vasc Surg, 2024, 80(4): 1226‑1237. e2. DOI: 10.1016/j.

jvs.2024.05.033.

[623] Zhang H, Huang C, Bai J, et al. Effect of diabetic foot ulcers and other risk factors on the prevalence of lower extremity amputation: a meta‑analysis[J]. Int Wound J, 2023, 20(8):3035‑3047. DOI: 10.1111/iwj.14179.

[624] Chen L, Sun S, Gao Y, et al. Global mortality of diabetic foot ulcer: a systematic review and meta‑analysis of observational studies[J]. Diabetes Obes Metab, 2023, 25(1):36‑45. DOI: 10.1111/dom.14840.

[625] McDermott K, Fang M, Boulton A, et al. Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers[J]. Diabetes Care, 2023, 46(1): 209‑221. DOI:

10.2337/dci22‑0043.

[626] Cheng B, Jiang Y, Fu X, et al. Epidemiological characteristics and clinical analyses of chronic cutaneous wounds of inpatients in China: prevention and control[J]. Wound Repair Regen, 2020, 28(5): 623‑630. DOI:

10.1111/wrr.12825.

[627] Jiang Y, Huang S, Fu X, et al. Epidemiology of chronic cutaneous wounds in China[J]. Wound Repair Regen, 2011, 19(2):181‑188. DOI: 10.1111/j.1524‑475X.2010.00666.x.

[628] Fu X, Sheng Z, Cherry GW, et al. Epidemiological study of chronic dermal ulcers in China[J]. Wound Repair Regen, 1998, 6(1):21‑27. DOI: 10.1046/j.1524‑475x.1998.60105.x.

[629] Du F, Ma J, Gong H, et al. Microbial infection and antibiotic susceptibility of diabetic foot ulcer in China: literature review[J]. Front Endocrinol (Lausanne), 2022, 13:

881659. DOI: 10.3389/fendo.2022.881659.

[630] Yang S, Hu L, Zhao Y, et al. Prevalence of multidrug‑resistant bacterial infections in diabetic foot ulcers: a meta‑analysis[J]. Int Wound J, 2024, 21(4):e14864. DOI: 10.1111/iwj.14864.

[631] Jiang Y, Wang X, Xia L, et al. A cohort study of diabetic patients and diabetic foot ulceration patients in China[J]. Wound Repair Regen, 2015, 23(2): 222‑230. DOI:

10.1111/wrr.12263.

[632] Wang A, Xu Z, Mu Y, et al. Clinical characteristics and medical costs in patients with diabetic amputation and nondiabetic patients with nonacute amputation in central urban hospitals in China[J]. Int J Low Extrem Wounds, 2014, 13(1):17‑21. DOI: 10.1177/1534734614521235.

[633] Jiang Y, Ran X, Jia L, et al. Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China[J]. Int J Low Extrem Wounds, 2015, 14(1): 19‑27. DOI: 10.1177/1534734614564867.

[634] Xu Z, Ran X. Diabetic foot care in China: challenges and strategy[J]. Lancet Diabetes Endocrinol, 2016, 4(4):297‑298. DOI: 10.1016/S2213‑8587(16)00051‑6.

[635] 张会峰, 许樟荣, 冉兴无 . 糖尿病足的相关定义和标准[J].中华糖尿病杂志, 2020, 12(6):363‑368. DOI: 10.3760/cma.j.

cn115791‑20200430‑00258.

[636] Bus SA, Sacco I, Monteiro‑Soares M, et al. Guidelines on

the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update) [J]. Diabetes Metab Res Rev, 2024, 40(3):e3651. DOI: 10.1002/dmrr.3651.

[637] Morton LM, Phillips TJ. Wound healing and treating wounds: differential diagnosis and evaluation of chronic wounds[J]. J Am Acad Dermatol, 2016, 74(4): 589‑605; quiz 605‑606. DOI: 10.1016/j.jaad.2015.08.068.

[638] Smith RG. Validation of Wagner′s classification: a literature review[J]. Ostomy Wound Manage, 2003, 49(1):54‑62.

[639] 中华医学会糖尿病学分会糖尿病足与周围血管病学组 . 中国糖尿病足诊治临床路径(2023版)[J].中华内分泌代谢杂志 , 2023, 39(2): 93‑102. DOI: 10.3760/cma. j.

cn311282‑20221014‑00583.

[640] 中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会 . 中国糖尿病足防治指南(2019 版) (Ⅰ) [J]. 中华糖尿病杂志 , 2019, 11(2):92‑108. DOI: 10.3760/cma.j.issn.1674‑5809.2019.02.004.

[641] van Netten JJ, Raspovic A, Lavery LA, et al. Prevention of foot ulcers in persons with diabetes at risk of ulceration: a systematic review and meta‑analysis[J]. Diabetes Metab Res Rev, 2024, 40(3):e3652. DOI: 10.1002/dmrr.3652.

[642] van Netten JJ, Bus SA, Apelqvist J, et al. Definitions and criteria for diabetes‑related foot disease (IWGDF 2023 update) [J]. Diabetes Metab Res Rev, 2024, 40(3): e3654. DOI: 10.1002/dmrr.3654.

[643] Schaper NC, van Netten JJ, Apelqvist J, et al. Practical guidelines on the prevention and management of diabetes‑related foot disease (IWGDF 2023 update) [J]. Diabetes Metab Res Rev, 2024, 40(3): e3657. DOI:

10.1002/dmrr.3657.

[644] Van Netten JJ, Aan De Stegge WB, Dijkgraaf M, et al. Cost‑effectiveness of temperature monitoring to help prevent foot ulcer recurrence in people with diabetes: a multicenter randomized controlled trial[J]. Diabetes Metab Res Rev, 2024, 40(4): e3805. DOI: 10.1002/dmrr.3805.

[645] Drovandi A, Seng L, Golledge J. Effectiveness of educational interventions for diabetes‑related foot disease: a systematic review and meta‑analysis[J]. Diabetes Metab Res Rev, 2024, 40(3): e3746. DOI:

10.1002/dmrr.3746.

[646] Vedhara K, Beattie A, Metcalfe C, et al. Development and preliminary evaluation of a psychosocial intervention for modifying psychosocial risk factors associated with foot re‑ulceration in diabetes[J]. Behav Res Ther, 2012, 50(5):323‑332. DOI: 10.1016/j.brat.2012.02.013.

[647] Orlando G, Brown S, Jude E, et al. Acute effects of vibrating insoles on dynamic balance and gait quality in individuals with diabetic peripheral neuropathy: a randomized crossover study[J]. Diabetes Care, 2024, 47(6):1004‑1011. DOI: 10.2337/dc23‑1858.

[648] Armstrong DG, Tan TW, Boulton A, et al. Diabetic foot ulcers: a review[J]. JAMA, 2023, 330(1): 62‑75. DOI:

10.1001/jama.2023.10578.

[649] 孙舒瑶, 冉兴无 . 糖尿病足溃疡的局部处理[J].中华糖尿病杂 志 , 2013, 5(6): 324‑327. DOI: 10.3760/cma. j.

issn.1674‑5809.2013.06.002.

[650] Forsythe RO, Apelqvist J, Boyko EJ, et al. Effectiveness of revascularisation of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic

review[J]. Diabetes Metab Res Rev, 2020, 36 Suppl 1:e3279. DOI: 10.1002/dmrr.3279.

[651] 《多学科合作下糖尿病足防治专家共识(2020版)》编写组 . 多学科合作下糖尿病足防治专家共识(2020版)全版[J].中华烧伤杂志 , 2020, 36(8): E01‑E52. DOI: 10.3760/cma. j.

cn501120‑20200217‑01000.

[652] Wang A, Lv G, Cheng X, et al. Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition) [J]. Burns Trauma, 2020, 8: tkaa017. DOI: 10.1093/burnst/tkaa017.

[653] 中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会 . 中国糖尿病足防治指南(2019 版)(Ⅲ)[J]. 中华糖尿病杂志 , 2019, 11(4):238‑247. DOI: 10.3760/cma.j.issn.1674‑5809.2019.04.004.

[654] Senneville É, Albalawi Z, van Asten SA, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes‑related foot infections (IWGDF/IDSA 2023) [J]. Diabetes Metab Res Rev, 2024, 40(3): e3687. DOI:

10.1002/dmrr.3687.

[655] 邓晓龙, 肖立虎, 陈大伟, 等 . 糖尿病足溃疡伴感染无菌棉拭子擦拭取样及深部组织活检取样细菌培养的一致性研究[J]. 中华糖尿病杂志 , 2014, (7):504‑508. DOI: 10.3760/cma.j.issn.1674‑5809.2014.07.006.

[656] Cortes‑Penfield NW, Armstrong DG, Brennan MB, et al. Evaluation and management of diabetes‑related foot infections[J]. Clin Infect Dis, 2023, 77(3): e1‑e13. DOI:

10.1093/cid/ciad255.

[657] 孙幸幸, 王鹏华, 张靖航, 等 . 糖尿病足感染患者感染症状消失后能否停用抗生素[J].中华糖尿病杂志, 2016, 8(6):346‑350. DOI: 10.3760/cma.j.issn.1674‑5809.2016.06.007.

[658] International Diabetes Federation. IDF clinical practice recommendation on the diabetic foot: a guide for health care professionals[EB/OL]. (2017‑05‑10) [2024‑11‑27]. https://www.doc88.com/p‑4703973664034.html?r=1.

[659] Saco M, Howe N, Nathoo R, et al. Comparing the efficacies of alginate, foam, hydrocolloid, hydrofiber, and hydrogel dressings in the management of diabetic foot ulcers and venous leg ulcers: a systematic review and meta‑analysis examining how to dress for success[J]. Dermatol Online J, 2016, 22(8):13030/qt7ph5v17z.

[660] Zhang N, Liu Y, Yan W, et al. The effect of negative pressure wound therapy on the outcome of diabetic foot ulcers: a meta‑analysis[J]. Int Wound J, 2024, 21(4):e14886. DOI: 10.1111/iwj.14886.

[661] Dalmedico MM, do Rocio Fedalto A, Martins WA, et al. Effectiveness of negative pressure wound therapy in treating diabetic foot ulcers: a systematic review and meta‑analysis of randomized controlled trials[J]. Wounds, 2024, 36(8):281‑289. DOI: 10.25270/wnds/23140.

[662] Ji S, Liu X, Huang J, et al. Consensus on the application of negative pressure wound therapy of diabetic foot wounds[J]. Burns Trauma, 2021, 9: tkab018. DOI: 10.1093/burnst/tkab018.

[663] Wong A, Hooi N, Yeo B, et al. Improving diabetic wound‑healing outcomes with topical growth factor therapies[J]. J Clin Endocrinol Metab, 2024, 109(8):e1642‑e1651. DOI: 10.1210/clinem/dgae128.

[664] Li L, Chen D, Wang C, et al. Autologous platelet‑rich gel for treatment of diabetic chronic refractory cutaneous ulcers: a prospective, randomized clinical trial[J]. Wound Repair

Regen, 2015, 23(4):495‑505. DOI: 10.1111/wrr.12294.

[665] Su YN, Li J, Feng DH, et al. Efficacy and safety of autologous platelet‑rich plasma for diabetic foot ulcers: a systematic review and meta‑analysis[J]. J Wound Care, 2023,

32(12):

773‑786.

10.12968/

jowc.2023.32.12.773.

[666] Peng Y, Wang J, Liu X, et al. Efficacy of platelet‑rich plasma in the treatment of diabetic foot ulcers: a systematic review and Meta‑analysis[J]. Ann Vasc Surg, 2024, 98:365‑373. DOI: 10.1016/j.avsg.2023.05.045.

[667] Hosseini RS, Hasanpour K, Khoshnevis M, et al. Therapeutic effect of silver nanoparticles in the management of diabetic ulcers: a systematic review and Meta‑analysis on RCTs[J]. Int J Low Extrem Wounds, 2024: 15347346241241836. DOI:

10.1177/15347346241241836.

[668] Luo Y, Li L, Zhao P, et al. Effectiveness of silver dressings in the treatment of diabetic foot ulcers: a systematic review and meta‑analysis[J]. J Wound Care, 2022, 31(11):979‑986. DOI: 10.12968/jowc.2022.31.11.979.

[669] Huang W, Chen Y, Wang N, et al. The efficacy and safety of acellular matrix therapy for diabetic foot ulcers: a Meta‑analysis of randomized clinical trials[J]. J Diabetes Res, 2020, 2020:6245758. DOI: 10.1155/2020/6245758.

[670] Sui L, Xie Q, Jiang HT, et al. Effectiveness and safety of dermal matrix used for diabetic foot ulcer: a systematic review and meta‑analysis of randomized controlled trials[J]. BMC Endocr Disord, 2024, 24(1): 23. DOI: 10.1186/s12902‑024‑01550‑3.

[671] Santema TB, Poyck PP, Ubbink DT. Systematic review and meta‑analysis of skin substitutes in the treatment of diabetic foot ulcers: highlights of a Cochrane systematic review[J]. Wound Repair Regen, 2016, 24(4): 737‑744. DOI: 10.1111/wrr.12434.

[672] Tchero H, Herlin C, Bekara F, et al. Failure rates of artificial dermis products in treatment of diabetic foot ulcer: a systematic review and network meta‑analysis[J]. Wound Repair Regen, 2017, 25(4): 691‑696. DOI:

10.1111/wrr.12554.

[673] Huang W, Chen Y, Wang N, et al. Effectiveness and safety of human amnion/chorion membrane therapy for diabetic foot ulcers: an updated meta‑analysis of randomized clinical trials[J]. Wound Repair Regen, 2020, 28(6):739‑750. DOI: 10.1111/wrr.12851.

[674] Lazzarini PA, Jarl G, Gooday C, et al. Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review[J]. Diabetes Metab Res Rev, 2020, 36(Suppl 1):e3275. DOI: 10.1002/dmrr.3275.

[675] Bus SA, Armstrong DG, Crews RT, et al. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update) [J]. Diabetes Metab Res Rev, 2024, 40(3):e3647. DOI: 10.1002/dmrr.3647.

[676] Bus SA, Armstrong DG, Gooday C, et al. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)[J]. Diabetes Metab Res Rev, 2020, 36 (Suppl 1):e3274. DOI: 10.1002/dmrr.3274.

[677] Bus SA. The role of pressure offloading on diabetic foot ulcer healing and prevention of recurrence[J]. Plast Reconstr Surg, 2016, 138(3 Suppl): 179S‑187S. DOI:

10.1097/PRS.0000000000002686.

[678] Bus SA, van Deursen RW, Armstrong DG, et al. Footwear and offloading interventions to prevent and heal foot

ulcers and reduce plantar pressure in patients with diabetes: a systematic review[J]. Diabetes Metab Res Rev, 2016, 32 (Suppl 1): 99‑118. DOI: 10.1002/dmrr.2702.

[679] Brouwer RJ, Lalieu RC, Hoencamp R, et al. A systematic review and meta‑analysis of hyperbaric oxygen therapy for diabetic foot ulcers with arterial insufficiency[J]. J Vasc Surg, 2020, 71(2): 682‑692. e1. DOI: 10.1016/j.

jvs.2019.07.082.

[680] Lalieu RC, Brouwer RJ, Ubbink DT, et al. Hyperbaric oxygen therapy for nonischemic diabetic ulcers: a systematic review[J]. Wound Repair Regen, 2020, 28(2):266‑275. DOI: 10.1111/wrr.12776.

[681] Tao L, Yuan X. Efficacy and safety of hyperbaric oxygen therapy in the management of diabetic foot ulcers: a systematic review and meta‑analysis[J]. Int Wound J, 2024, 21(3):e14507. DOI: 10.1111/iwj.14507.

[682] Chen HR, Lu SJ, Wang Q, et al. Application of hyperbaric oxygen therapy in diabetic foot ulcers: a meta‑analysis[J]. Int Wound J, 2024, 21(4): e14621. DOI: 10.1111/iwj.14621.

[683] Sun XK, Li R, Yang XL, et al. Efficacy and safety of topical oxygen therapy for diabetic foot ulcers: an updated systematic review and meta‑analysis[J]. Int Wound J, 2022, 19(8):2200‑2209. DOI: 10.1111/iwj.13830.

[684] Carter MJ, Frykberg RG, Oropallo A, et al. Efficacy of topical wound oxygen therapy in healing chronic diabetic foot ulcers: systematic review and Meta‑analysis[J]. Adv Wound Care (New Rochelle), 2023, 12(4): 177‑186. DOI:

10.1089/wound.2022.0041.

[685] Ahluwalia R, Maffulli N, Lázaro‑Martínez JL, et al. Diabetic foot off loading and ulcer remission: exploring surgical off‑loading[J]. Surgeon, 2021, 19(6): e526‑e535. DOI:

10.1016/j.surge.2021.01.005.

[686] Brekelmans W, van Laar W, Tolen NJ, et al. Recurrent diabetic foot ulcers: results of a maximal multidisciplinary approach including reconstructive foot/ankle surgery[J]. Int Wound J, 2023, 20(6):1866‑1873. DOI: 10.1111/iwj.14045.

[687] Lei Y, Jiang P, Tian T. Comparative analysis of surgical and non‑surgical wound approaches in diabetic foot ulcer treatment: Meta‑analysis and systematic review[J]. Int Wound J, 2024, 21(4):e14601. DOI: 10.1111/iwj.14601.

[688] Frykberg RG, Wukich DK, Kavarthapu V, et al. Surgery for the diabetic foot: a key component of care[J]. Diabetes Metab Res Rev, 2020, 36 (Suppl 1):e3251. DOI: 10.1002/dmrr.3251.

[689] Fu JF, Liang L, Gong CX, et al. Status and trends of diabetes in Chinese children: analysis of data from 14 medical centers[J]. World J Pediatr, 2013, 9(2): 127‑134. DOI:

10.1007/s12519‑013‑0414‑4.

[690] Wu H, Zhong J, Yu M, et al. Incidence and time trends of type 2 diabetes mellitus in youth aged 5‑19 years: a population‑based registry in Zhejiang, China, 2007 to 2013[J]. BMC Pediatr, 2017, 17(1): 85. DOI: 10.1186/s12887‑017‑0834‑8.

[691] 曹冰燕, 米杰, 巩纯秀, 等 . 儿童2型糖尿病和糖调节异常筛查方案的研究 [J]. 中国循证儿科杂志 , 2008, 3(2):88‑95. DOI: 10.3969/j.issn.1673‑5501.2008.02.004.

[692] Copeland KC, Zeitler P, Geffner M, et al. Characteristics of adolescents and youth with recent‑onset type 2 diabetes: the TODAY cohort at baseline[J]. J Clin Endocrinol Metab,

2011, 96(1):159‑167. DOI: 10.1210/jc.2010‑1642.

[693] DuBose SN, Hermann JM, Tamborlane WV, et al. Obesity in youth with type 1 diabetes in Germany, Austria, and the United States[J]. J Pediatr, 2015, 167(3): 627‑632. e1‑e4. DOI: 10.1016/j.jpeds.2015.05.046.

[694] Ferrara CT, Geyer SM, Liu YF, et al. Excess BMI in childhood: a modifiable risk factor for type 1 diabetes development? [J]. Diabetes Care, 2017, 40(5): 698‑701. DOI: 10.2337/dc16‑2331.

[695] Dabelea D, Rewers A, Stafford JM, et al. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study[J]. Pediatrics, 2014, 133(4):e938‑e945. DOI: 10.1542/peds.2013‑2795.

[696] Xu ZR, Zhang MY, Ni JW, et al. Clinical characteristics and beta‑cell function of Chinese children and adolescents with type 2 diabetes from 2009 to 2018[J]. World J Pediatr, 2019, 15(4): 405‑411. DOI: 10.1007/s12519‑019‑00243‑5.

[697] Sauder KA, Stafford JM, The NS, et al. Dietary strategies to manage diabetes and glycemic control in youth and young adults with youth‑onset type 1 and type 2 diabetes: the SEARCH for diabetes in youth study[J]. Pediatr Diabetes, 2020, 21(7):1093‑1101. DOI: 10.1111/pedi.13091.

[698] U. S. Food and Drug Administration. FDA approves new treatment for pediatric patients with type 2 diabetes[EB/OL].

[2024‑11‑27].

https://www.

fda.

gov/news‑events/press‑announcements/fda‑approves‑ne w‑treatment‑pediatric‑patients‑type‑2‑diabetes.

[699] U. S. Food and Drug Administration. Bydureon BCise (exenatide extended‑release) approved in the US for the treatment of type‑2 diabetes in paediatric patients ages 10 years and older[EB/OL]. [2024‑11‑27]. https://www.

rxlist.com/bydureon‑bcise‑drug.htm.

[700] U. S. Food and Drug Administration. FDA approves new class of medicines to treat pediatric type 2 diabetes[EB/OL].

gov/news‑events/press‑announcements/fda‑approves‑ne w‑class‑medicines‑treat‑pediatric‑type‑2‑diabetes.

[701] Liu M, Huang Y, Xu X, et al. Normal and defective pathways in biogenesis and maintenance of the insulin storage pool[J]. J Clin Invest, 2021, 131(2):e142240. DOI:

10.1172/JCI142240.

[702] Beltrand J, Elie C, Busiah K, et al. Sulfonylurea therapy benefits neurological and psychomotor functions in patients with neonatal diabetes owing to potassium channel mutations[J]. Diabetes Care, 2015, 38(11):2033‑2041. DOI: 10.2337/dc15‑0837.

[703] Greeley S, Polak M, Njølstad PR, et al. ISPAD clinical practice consensus guidelines 2022: the diagnosis and management of monogenic diabetes in children and adolescents[J]. Pediatr Diabetes, 2022, 23(8): 1188‑1211. DOI: 10.1111/pedi.13426.

[704] Yang Y, Zhou TC, Liu YY, et al. Identification of HNF4A mutation p. T130I and HNF1A mutations p. I27L and p.

S487N in a Han Chinese family with early‑onset maternally inherited type 2 diabetes[J]. J Diabetes Res, 2016, 2016:3582616. DOI: 10.1155/2016/3582616.

[705] Pearson ER, Boj SF, Steele AM, et al. Macrosomia and hyperinsulinaemic hypoglycaemia in patients with heterozygous mutations in the HNF4A gene[J]. PLoS Med, 2007, 4(4):e118. DOI: 10.1371/journal.pmed.0040118.

[706] Xiao YP, Xu XH, Fang YL, et al. GCK mutations in Chinese MODY2 patients: a family pedigree report and review of Chinese literature[J]. J Pediatr Endocrinol Metab, 2016, 29(8):959‑964. DOI: 10.1515/jpem‑2015‑0354.

[707] Ng MC, Cockburn BN, Lindner TH, et al. Molecular genetics of diabetes mellitus in Chinese subjects: identification of mutations in glucokinase and hepatocyte nuclear factor‑1alpha genes in patients with early‑onset type 2 diabetes mellitus/MODY[J]. Diabet Med, 1999, 16(11):956‑963. DOI: 10.1046/j.1464‑5491.1999.00188.x.

[708] Menzel R, Kaisaki PJ, Rjasanowski I, et al. A low renal threshold for glucose in diabetic patients with a mutation in the hepatocyte nuclear factor‑1alpha (HNF‑1alpha) gene[J]. Diabet Med, 1998, 15(10): 816‑820. DOI:

10.1002/(SICI)1096‑9136(199810)15: 10&lt; 816::AID‑DIA714&gt;3.0.CO;2‑P.

[709] Xu JY, Dan QH, Chan V, et al. Genetic and clinical characteristics of maturity‑onset diabetes of the young in Chinese patients[J]. Eur J Hum Genet, 2005, 13(4):422‑427. DOI: 10.1038/sj.ejhg.5201347.

[710] So WY, Ng MC, Horikawa Y, et al. Genetic variants of hepatocyte nuclear factor‑1beta in Chinese young‑onset diabetic patients with nephropathy[J]. J Diabetes Complications, 2003, 17(6): 369‑373. DOI: 10.1016/s1056‑8727(02)00221‑0.

[711] Wang C, Fang Q, Zhang R, et al. Scanning for MODY5 gene mutations in Chinese early onset or multiple affected diabetes pedigrees[J]. Acta Diabetol, 2004, 41(4):137‑145. DOI: 10.1007/s00592‑004‑0157‑8.

[712] Wang C, Zhang R, Lu J, et al. Phenotypic heterogeneity in Chinese patients with hepatocyte nuclear factor‑1β mutations[J]. Diabetes Res Clin Pract, 2012, 95(1):119‑124. DOI: 10.1016/j.diabres.2011.10.007.

[713] Horikawa Y, Iwasaki N, Hara M, et al. Mutation in hepatocyte nuclear factor‑1 beta gene (TCF2) associated with MODY[J]. Nat Genet, 1997, 17(4): 384‑385. DOI:

10.1038/ng1297‑384.

[714] Yan J, Jiang F, Zhang R, et al. Whole‑exome sequencing identifies a novel INS mutation causative of maturity‑onset diabetes of the young 10[J]. J Mol Cell Biol, 2017, 9(5):376‑383. DOI: 10.1093/jmcb/mjx039.

[715] Liu L, Nagashima K, Yasuda T, et al. Mutations in KCNJ11 are associated with the development of autosomal dominant, early‑onset type 2 diabetes[J]. Diabetologia, 2013,

56(12):

2609‑2618.

s00125‑013‑3031‑9.

[716] Forbes JM, Thorburn DR. Mitochondrial dysfunction in diabetic kidney disease[J]. Nat Rev Nephrol, 2018, 14(5):291‑312. DOI: 10.1038/nrneph.2018.9.

[717] Guéry B, Choukroun G, Noël LH, et al. The spectrum of systemic involvement in adults presenting with renal lesion and mitochondrial tRNA(Leu) gene mutation[J]. J Am Soc Nephrol, 2003, 14(8): 2099‑2108. DOI:

10.1097/01.asn.0000080180.51098.02.

[718] Yeung RO, Al Jundi M, Gubbi S, et al. Management of mitochondrial diabetes in the era of novel therapies[J]. J Diabetes Complications, 2021, 35(1): 107584. DOI:

10.1016/j.jdiacomp.2020.107584.

[719] Dyment DA, Smith AC, Alcantara D, et al. Mutations in PIK3R1 cause SHORT syndrome[J]. Am J Hum Genet, 2013, 93(1):158‑166. DOI: 10.1016/j.ajhg.2013.06.005.

[720] Byun DJ, Braunstein R, Flynn J, et al. Immune checkpoint inhibitor‑associated diabetes: a single‑institution experience[J]. Diabetes Care, 2020, 43(12): 3106‑3109. DOI: 10.2337/dc20‑0609.

[721] Gregory GA, Robinson T, Linklater SE, et al. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study[J]. Lancet Diabetes Endocrinol, 2022, 10(10): 741‑760. DOI:

10.1016/S2213‑8587(22)00218‑2.

[722] Tomic D, Harding JL, Jenkins AJ, et al. The epidemiology of type 1 diabetes mellitus in older adults[EB/OL]. (2024‑10‑24) [2024‑11‑27]. https://www. nature.

com/articles/s41574‑024‑01046‑z.

[723] Yang K, Yang X, Jin C, et al. Global burden of type 1 diabetes in adults aged 65 years and older, 1990‑2019: population based study[J]. BMJ, 2024, 385:e078432. DOI:

10.1136/bmj‑2023‑078432.

[724] Mayer‑Davis EJ, Lawrence JM, Dabelea D, et al. Incidence trends of type 1 and type 2 diabetes among youths, 2002‑2012[J]. N Engl J Med, 2017, 376(15): 1419‑1429. DOI: 10.1056/NEJMoa1610187.

[725] Dabelea D, Mayer‑Davis EJ, Saydah S, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009[J]. JAMA, 2014, 311(17):1778‑1786. DOI: 10.1001/jama.2014.3201.

[726] International Diabetes Federation. IDF diabetes atlas [EB/OL]. 10th ed. [2024‑11‑27]. https://diabetesatlas.

org/atlas/tenth‑edition/.

[727] 中国医师协会内分泌代谢科医师分会, 国家代谢性疾病临床医学研究中心 . 成人隐匿性自身免疫糖尿病诊疗中国专家 共 识 (2021 版) [J]. 中 华 医 学 杂 志 , 2021, 101(38):3077‑3091.

cn112137‑20210629‑01463.

[728] Xiang Y, Liu B, Yun C, et al. Frequency, clinical features, inflammatory cytokines and genetic background of latent autoimmune diabetes in youth in youth‑onset type 2 diabetes: results from a nationwide, multicentre, clinic‑based, cross‑sectional study (LADA China) [J]. Diabetes Obes Metab, 2021, 23(6): 1282‑1291. DOI:

10.1111/dom.14336.

[729] Zhou Z, Xiang Y, Ji L, et al. Frequency, immunogenetics, and clinical characteristics of latent autoimmune diabetes in China (LADA China study): a nationwide, multicenter, clinic‑based cross‑sectional study[J]. Diabetes, 2013, 62(2):543‑550. DOI: 10.2337/db12‑0207.

[730] Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association[J]. Diabetes Care, 2015, 38(10): 1964‑1974. DOI: 10.2337/dc15‑1419.

[731] Ziegler AG, Rewers M, Simell O, et al. Seroconversion to multiple islet autoantibodies and risk of progression to diabetes in children[J]. JAMA, 2013, 309(23): 2473‑2479. DOI: 10.1001/jama.2013.6285.

[732] Krischer JP. The use of intermediate endpoints in the design of type 1 diabetes prevention trials[J]. Diabetologia, 2013, 56(9): 1919‑1924. DOI: 10.1007/s00125‑013‑2960‑7.

[733] Sosenko JM, Palmer JP, Rafkin‑Mervis L, et al. Incident dysglycemia and progression to type 1 diabetes among participants in the diabetes prevention trial‑type 1[J].

Diabetes Care, 2009, 32(9): 1603‑1607. DOI: 10.2337/dc08‑2140.

[734] Elding Larsson H, Vehik K, Gesualdo P, et al. Children followed in the TEDDY study are diagnosed with type 1 diabetes at an early stage of disease[J]. Pediatr Diabetes, 2014, 15(2):118‑126. DOI: 10.1111/pedi.12066.

[735] Chen Y, Xie Y, Xia Y, et al. Prevalence, clinical characteristics and HLA genotypes of idiopathic type 1 diabetes: a cross‑sectional study[J]. Diabetes Metab Res Rev, 2023, 39(6):e3676. DOI: 10.1002/dmrr.3676.

[736] Park SS, Jang SS, Ahn CH, et al. Identifying pathogenic variants of monogenic diabetes using targeted panel sequencing in an East Asian population[J]. J Clin Endocrinol Metab, 2019, 104(9): 4188‑4198. DOI:

10.1210/jc.2018‑02397.

[737] Li M, Wang S, Xu K, et al. High prevalence of a monogenic cause in Han Chinese diagnosed with type 1 diabetes, partly driven by nonsyndromic recessive WFS1 mutations[J]. Diabetes, 2020, 69(1):121‑126. DOI: 10.2337/db19‑0510.

[738] Imagawa A, Hanafusa T, Awata T, et al. Report of the Committee of the Japan Diabetes Society on the Research of Fulminant and Acute-onset Type 1 Diabetes Mellitus: new diagnostic criteria of fulminant type 1 diabetes mellitus (2012) [J]. J Diabetes Investig, 2012, 3(6):536-539. DOI: 10.1111/jdi.12024.

[739] Deng C, Xie Y, Liu F, et al. Simplified integration of optimal self‑management behaviors is associated with improved HbA1c in patients with type 1 diabetes[J]. J Endocrinol Invest, 2024, 47(11): 2691‑2699. DOI: 10.1007/s40618‑024‑02357‑8.

[740] Xie Y, Liu F, Huang F, et al. Establishment of a type 1 diabetes structured education programme suitable for Chinese patients: type 1 diabetes education in lifestyle and self adjustment (TELSA) [J]. BMC Endocr Disord, 2020, 20(1):37. DOI: 10.1186/s12902‑020‑0514‑9.

[741] American Diabetes Association Professional Practice Committee. 14. Children and adolescents: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S258‑S281. DOI: 10.2337/dc24‑S014.

[742] 国家代谢性疾病临床医学研究中心(长沙), 中国 1 型糖尿病联盟 . 1 型糖尿病自我管理教育与支持专家共识(2023 版)[J]. 中华糖尿病杂志 , 2023, 15(8):679‑689. DOI:

10.3760/cma.j.cn115791‑20230610‑00246.

[743] Liu F, Guan Y, Li X, et al. Different effects of structured education on glycemic control and psychological outcomes in adolescent and adult patients with type 1 diabetes: a systematic review and Meta‑analysis[J]. Int J Endocrinol, 2020, 2020:9796019. DOI: 10.1155/2020/9796019.

[744] 中华医学会糖尿病学分会1型糖尿病学组, 《中国1型糖尿病患者在校管理手册》编写委员会 . 中国1型糖尿病患者在校管理手册[J].中华糖尿病杂志, 2024, 16(10):1074‑1083. DOI:

10.3760/cma.j.cn115791‑20240821‑00505.

[745] Jackson CC, Albanese‑O′Neill A, Butler KL, et al. Diabetes care in the school setting: a position statement of the American Diabetes Association[J]. Diabetes Care, 2015, 38(10):1958‑1963. DOI: 10.2337/dc15‑1418.

[746] Dong J, Li M, Peng R, et al. ACACA reduces lipid accumulation through dual regulation of lipid metabolism and mitochondrial function via AMPK‑PPARα‑CPT1A axis[J]. J Transl Med, 2024, 22(1): 196. DOI: 10.1186/s12967‑024‑04942‑0.

[747] Bell KJ, Smart CE, Steil GM, et al. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era[J]. Diabetes Care, 2015, 38(6): 1008‑1015. DOI: 10.2337/dc15‑0100.

[748] Moser O, Riddell MC, Eckstein ML, et al. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA) [J]. Diabetologia, 2020, 63(12): 2501‑2520. DOI:

10.1007/s00125‑020‑05263‑9.

[749] Miller KM, Beck RW, Bergenstal RM, et al. Evidence of a strong association between frequency of self‑monitoring of blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants[J]. Diabetes Care, 2013, 36(7):2009‑2014. DOI: 10.2337/dc12‑1770.

[750] de Bock M, Codner E, Craig ME, et al. ISPAD clinical practice consensus guidelines 2022: glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes[J]. Pediatr Diabetes, 2022, 23(8):1270‑1276. DOI: 10.1111/pedi.13455.

[751] 中华医学会儿科学分会内分泌遗传代谢学组, 中华儿科杂志编辑委员会 . 中国儿童 1型糖尿病标准化诊断与治疗专家共识(2020 版)[J]. 中华儿科杂志 , 2020, 58(6):447‑454. DOI: 10.3760/cma.j.cn112140‑20200221‑00124.

[752] 中华医学会糖尿病学分会 . 中国血糖监测临床应用指南(2021 年版)[J]. 中华糖尿病杂志 , 2021, 13(10):936‑948. DOI: 10.3760/cma.j.cn115791‑20210810‑00436.

[753] Battelino T, Alexander CM, Amiel SA, et al. Continuous glucose monitoring and metrics for clinical trials: an international consensus statement[J]. Lancet Diabetes Endocrinol, 2023, 11(1): 42‑57. DOI: 10.1016/S2213‑8587(22)00319‑9.

[754] Hood KK, Beavers DP, Yi‑Frazier J, et al. Psychosocial burden and glycemic control during the first 6 years of diabetes: results from the SEARCH for diabetes in youth study[J]. J Adolesc Health, 2014, 55(4): 498‑504. DOI:

10.1016/j.jadohealth.2014.03.011.

[755] March C, Sherman J, Bannuru RR, et al. Care of young children with diabetes in the childcare and community setting: a statement of the American Diabetes Association[J]. Diabetes Care, 2023, 46(12): 2102‑2111. DOI: 10.2337/dci23‑0083.

[756] Renard E, Weinstock RS, Aleppo G, et al. Efficacy and safety of a tubeless AID system compared with pump therapy with CGM in the treatment of type 1 diabetes in adults with suboptimal glycemia: a randomized, parallel‑group clinical trial[J]. Diabetes Care, 2024, 47(12):2248‑2257. DOI: 10.2337/dc24‑1550.

[757] Rickels MR, Robertson RP. Pancreatic islet transplantation in humans: recent progress and future directions[J]. Endocr Rev, 2019, 40(2): 631‑668. DOI: 10.1210/er.2018‑00154.

[758] Wang S, Du Y, Zhang B, et al. Transplantation of chemically induced pluripotent stem‑cell‑derived islets under abdominal anterior rectus sheath in a type 1 diabetes patient[J]. Cell, 2024, 187(22): 6152‑6164. e18.

DOI: 10.1016/j.cell.2024.09.004.

[759] Deng C, Xie Y, Li J, et al. Care, control and complications of hospitalised patients with type 1 diabetes in China: a nationwide‑based registry study[J]. Diabetes Metab Res Rev, 2024, 40(3):e3796. DOI: 10.1002/dmrr.3796.

[760] 中国高血压防治指南修订委员会, 高血压联盟(中国), 中华医学会心血管病学分会中国医师协会高血压专业委员会, 等 . 中国高血压防治指南(2018 年修订版)[J]. 中国心血管杂 志 , 2019, 24(1): 24‑56. DOI: 10.3969/j.

issn.1007‑5410.2019.01.002.

[761] 《中华儿科杂志》编辑委员会, 中华医学会儿科学分会儿童保健学组, 中华医学会儿科学分会心血管学组, 等 . 儿童青少年血脂异常防治专家共识 [J]. 中华儿科杂志 , 2009, 47(6):426‑428. DOI: 10.3760/cma.j.issn.0578‑1310.2009.06.007.

[762] Al Ozairi E, Steenackers N, Pazmino S, et al. Prevalence of obesity in people with and without type 1 diabetes across Belgium, Kuwait, and Mexico: an IMI2 SOPHIA study[J]. EClinicalMedicine, 2024, 77: 102869. DOI: 10.1016/j.

eclinm.2024.102869.

[763] Phillip M, Achenbach P, Addala A, et al. Consensus guidance for monitoring individuals with islet autoantibody‑positive pre‑stage 3 type 1 diabetes[J]. Diabetes Care, 2024, 47(8): 1276‑1298. DOI: 10.2337/dci24‑0042.

[764] Herold KC, Delong T, Perdigoto AL, et al. The immunology of type 1 diabetes[J]. Nat Rev Immunol, 2024, 24(6):435‑451. DOI: 10.1038/s41577‑023‑00985‑4.

[765] Herold KC, Bundy BN, Long SA, et al. An anti‑CD3 antibody, teplizumab, in relatives at risk for type 1 diabetes[J]. N Engl J Med, 2019, 381(7): 603‑613. DOI:

10.1056/NEJMoa1902226.

[766] Sims EK, Bundy BN, Stier K, et al. Teplizumab improves and stabilizes beta cell function in antibody‑positive high‑risk individuals[J]. Sci Transl Med, 2021, 13(583):eabc8980. DOI: 10.1126/scitranslmed.abc8980.

[767] 翁建平, 纪立农, 董四平 . 1型糖尿病整合医疗管理路径[M]. 北京:人民卫生出版社, 2021.

[768] Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular outcomes in type 1 diabetes: the DCCT/EDIC study 30‑year follow‑up[J]. Diabetes Care, 2016, 39(5): 686‑693. DOI: 10.2337/dc15‑1990.

[769] Amiel SA. The consequences of hypoglycaemia[J]. Diabetologia, 2021, 64(5): 963‑970. DOI: 10.1007/s00125‑020‑05366‑3.

[770] Hölzen L, Schultes B, Meyhöfer SM, et al. Hypoglycemia unawareness‑a review on pathophysiology and clinical implications[J]. Biomedicines, 2024, 12(2): 391. DOI:

10.3390/biomedicines12020391.

[771] McCall AL, Lieb DC, Gianchandani R, et al. Management of individuals with diabetes at high risk for hypoglycemia: an Endocrine Society clinical practice guideline[J]. J Clin Endocrinol Metab, 2023, 108(3): 529‑562. DOI: 10.1210/clinem/dgac596.

[772] Chen S, Lu J, Peng D, et al. Incidence rate and risk factors for hypoglycemia among individuals with type 1 diabetes or type 2 diabetes in China receiving insulin treatment[J]. Diabetes Res Clin Pract, 2023, 206:110987. DOI: 10.1016/j.diabres.2023.110987.

[773] Urakami T. The advanced diabetes technologies for reduction of the frequency of hypoglycemia and minimizing the occurrence of severe hypoglycemia in children and adolescents with type 1 diabetes[J]. J Clin Med, 2023, 12(3):781. DOI: 10.3390/jcm12030781.

[774] Kong A, Lim S, Yoo SH, et al. Asia‑Pacific consensus recommendations for application of continuous glucose monitoring in diabetes management[J]. Diabetes Res Clin Pract, 2023, 201: 110718. DOI: 10.1016/j.

diabres.2023.110718.

[775] Laffel LM, Kanapka LG, Beck RW, et al. Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes: a randomized clinical trial[J]. JAMA, 2020, 323(23):2388‑2396. DOI: 10.1001/jama.2020.6940.

[776] Champakanath A, Akturk HK, Alonso GT, et al. Continuous glucose monitoring initiation within first year of type 1 diabetes diagnosis is associated with improved glycemic outcomes: 7‑year follow‑up study[J]. Diabetes Care, 2022, 45(3):750‑753. DOI: 10.2337/dc21‑2004.

[777] Sanchez‑Rangel E, Deajon‑Jackson J, Hwang JJ. Pathophysiology and management of hypoglycemia in diabetes[J]. Ann N Y Acad Sci, 2022, 1518(1):25‑46. DOI:

10.1111/nyas.14904.

[778] American Diabetes Association. 15. Diabetes care in the hospital: standards of medical care in diabetes‑2020[J]. Diabetes Care, 2020, 43(Suppl 1): S193‑S202. DOI:

10.2337/dc20‑S015.

[779] 中国医师协会内分泌代谢科医师分会, 中国住院患者血糖管理专家组 . 中国住院患者血糖管理专家共识[J]. 中华内分泌代谢杂志 , 2017, 33(1): 1‑10. DOI: 10.3760/cma. j.

issn.1000‑6699.2017.01.001.

[780] Galindo RJ, Migdal AL, Davis GM, et al. Comparison of the freestyle libre pro flash continuous glucose monitoring (CGM) system and point‑of‑care capillary glucose testing in hospitalized patients with type 2 diabetes treated with basal‑bolus insulin regimen[J]. Diabetes Care, 2020, 43(11):2730‑2735. DOI: 10.2337/dc19‑2073.

[781] Spanakis EK, Urrutia A, Galindo RJ, et al. Continuous glucose monitoring‑guided insulin administration in hospitalized patients with diabetes: a randomized clinical trial[J]. Diabetes Care, 2022, 45(10): 2369‑2375. DOI:

10.2337/dc22‑0716.

[782] Wright JJ, Williams AJ, Friedman SB, et al. Accuracy of continuous glucose monitors for inpatient diabetes management[J]. J Diabetes Sci Technol, 2023, 17(5):1252‑1255. DOI: 10.1177/19322968221076562.

[783] Umpierrez

G,

Korytkowski

M.

Diabetic emergencies‑ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia[J]. Nat Rev Endocrinol, 2016, 12(4):222‑232. DOI: 10.1038/nrendo.2016.15.

[784] He XD, Li LT, Wang SQ, et al. Role of clinical pharmacists in multidisciplinary collaborative management of blood glucose in COVID‑19 patients with hyperglycemia[J]. Res Social Adm Pharm, 2024, 20(6): 65‑71. DOI: 10.1016/j.

sapharm.2024.02.007.

[785] Garg R, Schuman B, Bader A, et al. Effect of preoperative diabetes management on glycemic control and clinical outcomes after elective surgery[J]. Ann Surg, 2018, 267(5):858‑862. DOI: 10.1097/SLA.0000000000002323.

[786] Wang YJ, Seggelke S, Hawkins RM, et al. Impact of glucose

management team on outcomes of hospitalizaron in patients with type 2 diabetes admitted to the medical service[J]. Endocr Pract, 2016, 22(12): 1401‑1405. DOI:

10.4158/EP161414.OR.

[787] Bansal V, Mottalib A, Pawar TK, et al. Inpatient diabetes management by specialized diabetes team versus primary service team in non‑critical care units: impact on 30‑day readmission rate and hospital cost[J]. BMJ Open Diabetes Res Care, 2018, 6(1): e000460. DOI: 10.1136/bmjdrc‑2017‑000460.

[788] Bellido V, Suarez L, Rodriguez MG, et al. Comparison of basal‑bolus and premixed insulin regimens in hospitalized patients with type 2 diabetes[J]. 2015, 38(12):2211‑2216.

[789] American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes‑2020[J]. Diabetes Care, 2020, 43(Suppl 1):S98‑S110. DOI: 10.2337/dc20‑S009.

[790] Kosiborod MN, Angermann CE, Collins SP, et al. Effects of empagliflozin on symptoms, physical limitations, and quality of life in patients hospitalized for acute heart failure: results from the EMPULSE trial[J]. Circulation, 2022, 146(4):279‑288. DOI: 10.1161/CIRCULATIONAHA.122.059725.

[791] Bellon F, Solà I, Gimenez‑Perez G, et al. Perioperative glycaemic control for people with diabetes undergoing surgery[J]. Cochrane Database Syst Rev, 2023, 8(8):CD007315. DOI: 10.1002/14651858.CD007315.pub3.

[792] Rayman G. Enhancing perioperative diabetes care: strategies and challenges[J]. Diabetes Care, 2024, 47(6):921‑923. DOI: 10.2337/dci24‑0010.

[793] Simha V, Shah P. Perioperative glucose control in patients with diabetes undergoing elective surgery[J]. JAMA, 2019, 321(4):399‑400. DOI: 10.1001/jama.2018.20922.

[794] Crowley K, Scanaill PÓ, Hermanides J, et al. Current practice in the perioperative management of patients with diabetes mellitus: a narrative review[J]. Br J Anaesth, 2023, 131(2):242‑252. DOI: 10.1016/j.bja.2023.02.039.

[795] Himes CP, Ganesh R, Wight EC, et al. Perioperative evaluation and management of endocrine disorders[J]. Mayo Clin Proc, 2020, 95(12):2760‑2774. DOI: 10.1016/j.

mayocp.2020.05.004.

[796] Fu Y, Lee CH, Chi CC. Association of psoriasis with inflammatory bowel disease: a systematic review and Meta‑analysis[J]. AMA Dermatol, 2018, 154(12):1417‑1423. DOI: 10.1001/jamadermatol.2018.3631.

[797] Jinjing W, Kang C, Xufei L, et al. Chinese clinical practice guidelines for perioperative blood glucose management[J]. Diabetes Metab Res Rev, 2021, 37(7):e3439. DOI: 10.1002/dmrr.3439.

[798] Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016[J]. Intensive Care Med, 2017, 43(3):304‑377. DOI: 10.1007/s00134‑017‑4683‑6.

[799] Rajan N, Duggan EW, Abdelmalak BB, et al. Society for Ambulatory Anesthesia Updated Consensus Statement on perioperative blood glucose management in adult patients with diabetes mellitus undergoing ambulatory surgery[J]. Anesth Analg, 2024, 139(3): 459‑477. DOI:

10.1213/ANE.0000000000006791.

[800] Sudhakaran S, Surani SR. Guidelines for perioperative management of the diabetic patient[J]. Surg Res Pract,

2015, 2015:284063. DOI: 10.1155/2015/284063.

[801] Ma D, Chen C, Lu Y, et al. Short‑term effects of continuous subcutaneous insulin infusion therapy in perioperative patients with diabetes mellitus[J]. Diabetes Technol Ther, 2013, 15(12):1010‑1018. DOI: 10.1089/dia.2013.0117.

[802] Barker P, Creasey PE, Dhatariya K, et al. Peri‑operative management of the surgical patient with diabetes 2015: association of Anaesthetists of Great Britain and Ireland[J]. Anaesthesia, 2015, 70(12): 1427‑1440. DOI: 10.1111/anae.13233.

[803] Agency for Healthcare Research and Quality. Readmissions and adverse events after discharge[EB/OL]. (2019‑10‑28) [2024‑11‑27]. https://psnet.ahrq.

gov/primers/primer/11.

[804] Sweeting A, Hannah W, Backman H, et al. Epidemiology and management of gestational diabetes[J]. Lancet, 2024, 404(10448): 175‑192. DOI: 10.1016/S0140‑6736(24)00825‑0.

[805] World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy[M]. Geneva: World Health Organization, 2013.

[806] Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J]. Diabetes Care, 2010, 33(3):676‑682. DOI: 10.2337/dc09‑1848.

[807] McIntyre HD, Sacks DA, Barbour LA, et al. Issues with the diagnosis and classification of hyperglycemia in early pregnancy[J]. Diabetes Care, 2016, 39(1): 53‑54. DOI:

10.2337/dc15‑1887.

[808] Araki E, Goto A, Kondo T, et al. Japanese clinical practice guideline for diabetes 2019[J]. Diabetol Int, 2020, 11(3):165‑223. DOI: 10.1007/s13340‑020‑00439‑5.

[809] Queensland Clinical Guidelines. Gestational diabetes mellitus (GDM). [2024‑11‑27]. https://www. health. qld.

gov.au/__data/assets/pdf_file/0022/950503/g‑gdm.pdf.

[810] Zhang X, Wei Y, Fan L, et al. A multicenter all‑inclusive prospective study on the relationship between glycemic control markers and maternal and neonatal outcomes in pregnant women[J]. J Matern Fetal Neonatal Med, 2021, 34(19):3154‑3161. DOI: 10.1080/14767058.2019.1678139.

[811] American Diabetes Association Professional Practice Committee. 15. Management of diabetes in pregnancy: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S282‑S294. DOI: 10.2337/dc24‑S015.

[812] American College of Obstetricians and Gynecologists′ Committee on Practice Bulletins—Obstetrics. ACOG practice bulletin no. 201: pregestational diabetes mellitus[J]. Obstet Gynecol, 2018, 132(6): e228‑e248. DOI: 10.1097/AOG.0000000000002960.

[813] Berger H, Gagnon R, Sermer M. Guideline No. 393‑diabetes in pregnancy[J]. J Obstet Gynaecol Can, 2019, 41(12): 1814‑1825. e1. DOI: 10.1016/j.

jogc.2019.03.008.

[814] Hiramatsu Y, Shimizu I, Omori Y, et al. Determination of reference intervals of glycated albumin and hemoglobin A1c in healthy pregnant Japanese women and analysis of their time courses and influencing factors during pregnancy[J]. Endocr J, 2012, 59(2): 145‑151. DOI:

10.1507/endocrj.k10e‑410.

[815] Sugawara D, Sato H, Makita E, et al. Clinical usefulness of

glycated albumin and glycated albumin‑to‑glycated hemoglobin ratio of gestational diabetes mellitus in late pregnancy for predicting infant complications[J]. Pediatr Neonatol, 2022, 63(3): 239‑246. DOI: 10.1016/j.

pedneo.2021.10.007.

[816] 中华医学会妇产科学分会妊娠期高血压疾病学组 . 妊娠期高血压疾病诊治指南(2020)[J].中华妇产科杂志, 2020, 55(4):227‑238. DOI: 10.3760/cma.j.cn112141‑20200114‑00039.

[817] Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care[J]. Int J Gynaecol Obstet, 2015, 131 Suppl 3: S173‑S211. DOI: 10.1016/S0020‑7292(15)30033‑3.

[818] 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会 . 妊娠期高血糖诊治指南(2022)[第一部分][J]. 中华妇产科杂志 , 2022, 57(1): 3‑12. DOI: 10.3760/cma. j.

cn112141‑20210917‑00528.

[819] Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures‑2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists‑executive summary[J]. Endocr Pract, 2019, 25(12):1346‑1359. DOI:

10.4158/GL‑2019‑0406.

[820] Diabetes in pregnancy: management from preconception to the postnatal period [EB/OL]. (2020‑12‑16) [2024‑11‑27].

30310‑7.

[827] Rowan JA, Rush EC, Plank LD, et al. Metformin in gestational diabetes: the offspring follow‑up (MiG TOFU): body composition and metabolic outcomes at 7‑9 years of age[J]. BMJ Open Diabetes Res Care, 2018, 6(1):e000456. DOI: 10.1136/bmjdrc‑2017‑000456.

[828] Feig DS, Sanchez JJ, Murphy KE, et al. Outcomes in children of women with type 2 diabetes exposed to metformin versus placebo during pregnancy (MiTy Kids): a 24‑month follow‑up of the MiTy randomised controlled trial[J]. Lancet Diabetes Endocrinol, 2023, 11(3):191‑202. DOI: 10.1016/S2213‑8587(23)00004‑9.

[829] Barbour LA, Feig DS. Metformin for gestational diabetes mellitus: progeny, perspective, and a personalized approach[J]. Diabetes Care, 2019, 42(3): 396‑399. DOI:

10.2337/dci18‑0055.

[830] Hale TW, Kristensen JH, Hackett LP, et al. Transfer of metformin into human milk[J]. Diabetologia, 2002, 45(11):1509‑1514. DOI: 10.1007/s00125‑002‑0939‑x.

[831] Briggs GG, Ambrose PJ, Nageotte MP, et al. Excretion of metformin into breast milk and the effect on nursing infants[J]. Obstet Gynecol, 2005, 105(6): 1437‑1441. DOI:

10.1097/01.AOG.0000163249.65810.5b.

[832] Vounzoulaki E, Khunti K, Abner SC, et al. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta‑analysis[J]. BMJ, 2020, 369:m1361. DOI: 10.1136/bmj.m1361.

[833] 中华人民共和国民政部 . 2021 年民政事业发展统计公报[EB/OL].(2022‑08‑26) [2024‑11‑27]. https://www.mca.gov.

cn/images3/www2017/file/202208/2021mzsyfztjgb.pdf.

[834] Sun H, Saeedi P, Karuranga S, et al. IDF diabetes atlas: global, regional and country‑level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract, 2022, 183: 109119. DOI: 10.1016/j.

diabres.2021.109119.

[835] 中国老年医学学会老年内分泌代谢分会, 国家老年疾病临床医学研究中心(解放军总医院), 中国老年糖尿病诊疗措施专家共识编写组 . 中国老年 2型糖尿病诊疗措施专家共识 (2018 年版) [J]. 中华内科杂志 , 2018, 57(9): 626‑641. DOI: 10.3760/cma.j.issn.0578‑1426.2018.09.004.

[836] 阚芳芳, 方福生, 孙般诺, 等 . 不同发病年龄老年2型糖尿病的临床特点[J].中华保健医学杂志, 2015, 17(5):360‑363.

[837] Wang T, Feng X, Zhou J, et al. Type 2 diabetes mellitus is associated with increased risks of sarcopenia and pre‑sarcopenia in Chinese elderly[J]. Sci Rep, 2016, 6:

38937. DOI: 10.1038/srep38937.

[838] Miller ME, Bonds DE, Gerstein HC, et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study[J]. BMJ, 2010, 340: b5444. DOI:

10.1136/bmj.b5444.

[839] American Diabetes Association Professional Practice Committee. 13. Older adults: standards of care in diabetes‑2024[J]. Diabetes Care, 2024, 47(Suppl 1):S244‑S257. DOI: 10.2337/dc24‑S013.

[840] American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults[J]. J Am Geriatr Soc, 2012, 60(4): 616‑631. DOI: 10.1111/j.1532‑5415.2012.03923.x.

[841] Feinkohl I, Aung PP, Keller M, et al. Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh type 2 diabetes study[J]. Diabetes Care, 2014, 37(2):507‑515. DOI: 10.2337/dc13‑1384.

[842] Kalyani RR, Tian J, Xue QL, et al. Hyperglycemia and incidence of frailty and lower extremity mobility limitations in older women[J]. J Am Geriatr Soc, 2012, 60(9):1701‑1707. DOI: 10.1111/j.1532‑5415.2012.04099.x.

[843] Sato M, Ye W, Sugihara T, et al. Fracture risk and healthcare resource utilization and costs among osteoporosis patients with type 2 diabetes mellitus and without diabetes mellitus in Japan: retrospective analysis of a hospital claims database[J]. BMC Musculoskelet Disord, 2016, 17(1): 489. DOI: 10.1186/s12891‑016‑1344‑9.

[844] Kimbro LB, Mangione CM, Steers WN, et al. Depression and all‑cause mortality in persons with diabetes mellitus: are older adults at higher risk? Results from the translating research into action for diabetes study[J]. J Am Geriatr Soc, 2014, 62(6): 1017‑1022. DOI: 10.1111/jgs.12833.

[845] Yaffe K, Falvey C, Hamilton N, et al. Diabetes, glucose control, and 9‑year cognitive decline among older adults without dementia[J]. Arch Neurol, 2012, 69(9):1170‑1175. DOI: 10.1001/archneurol.2012.1117.

[846] 国家老年医学中心, 中华医学会老年医学分会, 中国老年保健协会糖尿病专业委员会 . 中国老年糖尿病诊疗指南(2024 版)[J]. 中华糖尿病杂志 , 2024, 16(2):147‑189. DOI:

10.3760/cma.j.cn115791‑20240112‑00020.

[847] Zhang W, Zhang S, Deng Y, et al. Trial of intensive blood‑pressure control in older patients with hypertension[J]. N Engl J Med, 2021, 385(14):1268‑1279. DOI: 10.1056/NEJMoa2111437.

[848] 田慧, 李春霖, 杨光, 等 . 二甲双胍在老年2型糖尿病患者应用的安全性评估[J].中华内科杂志, 2008, 47(11):914‑918. DOI: 10.3321/j.issn:0578‑1426.2008.11.012.

[849] 母义明 , 纪立农 , 宁光 , 等 . 二甲双胍临床应用专家共识(2016 年版)[J]. 中国糖尿病杂志 , 2016, 24(10):871‑884. DOI: 10.3969/j.issn.1006‑6187.2016.10.02.

[850] Lipska KJ, Krumholz H, Soones T, et al. Polypharmacy in the aging patient: a review of glycemic control in older adults with type 2 diabetes[J]. JAMA, 2016, 315(10):1034‑1045. DOI: 10.1001/jama.2016.0299.

[851] Prabhakar NR, Peng YJ, Nanduri J. Hypoxia‑inducible factors and obstructive sleep apnea[J]. J Clin Invest, 2020, 130(10):5042‑5051. DOI: 10.1172/JCI137560.

[852] Wang C, Tan J, Miao Y, et al. Obstructive sleep apnea, prediabetes and progression of type 2 diabetes: a systematic review and meta‑analysis[J]. J Diabetes Investig, 2022, 13(8):1396‑1411. DOI: 10.1111/jdi.13793.

[853] Koh HE, van Vliet S, Cao C, et al. Effect of obstructive sleep apnea on glucose metabolism[J]. Eur J Endocrinol, 2022, 186(4):457‑467. DOI: 10.1530/EJE‑21‑1025.

[854] Paschou SA, Bletsa E, Saltiki K, et al. Sleep apnea and cardiovascular risk in patients with prediabetes and type 2 diabetes[J]. Nutrients, 2022, 14(23): 4989. DOI:

10.3390/nu14234989.

[855] Zamarrón E, Jaureguizar A, García‑Sánchez A, et al. Obstructive sleep apnea is associated with impaired renal function in patients with diabetic kidney disease[J]. Sci Rep, 2021, 11(1):5675. DOI: 10.1038/s41598‑021‑85023‑w.

[856] Wei D, Chew M, Sabanayagam C. Obstructive sleep apnoea, other sleep parameters and diabetic retinopathy[J]. Curr Diab Rep, 2021, 21(12): 58. DOI: 10.1007/s11892‑021‑01425‑0.

[857] Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association[J]. Circulation, 2021, 144(3): e56‑e67. DOI: 10.1161/CIR.0000000000000988.

[858] Reutrakul S, Mokhlesi B. Obstructive sleep apnea and diabetes: a state of the art review[J]. Chest, 2017, 152(5):1070‑1086. DOI: 10.1016/j.chest.2017.05.009.

[859] Abourjeili J, Salameh E, Noureddine M, et al. Obstructive sleep apnea: beyond the dogma of obesity![J]. Respir Med, 2024, 222:107512. DOI: 10.1016/j.rmed.2023.107512.

[860] Kurnool S, McCowen KC, Bernstein NA, et al. Sleep apnea, obesity, and diabetes‑an intertwined trio[J]. Curr Diab Rep, 2023, 23(7): 165‑171. DOI: 10.1007/s11892‑023‑01510‑6.

[861] Subramanian A, Adderley NJ, Tracy A, et al. Risk of incident obstructive sleep apnea among patients with type 2 diabetes[J]. Diabetes Care, 2019, 42(5): 954‑963. DOI: 10.2337/dc18‑2004.

[862] Mokhlesi B, Tjaden AH, Temple KA, et al. Obstructive sleep apnea, glucose tolerance, and β‑cell function in adults with prediabetes or untreated type 2 diabetes in the restoring insulin secretion (RISE) study[J]. Diabetes Care, 2021, 44(4):993‑1001. DOI: 10.2337/dc20‑2127.

[863] Tahrani AA. Obstructive sleep apnoea in diabetes: does it matter?[J]. Diab Vasc Dis Res, 2017, 14(5):454‑462. DOI:

10.1177/1479164117714397.

[864] Huang T, Lin BM, Stampfer MJ, et al. A population‑based study of the bidirectional association between obstructive sleep apnea and type 2 diabetes in three prospective U.S. cohorts[J]. Diabetes Care, 2018, 41(10): 2111‑2119. DOI:

10.2337/dc18‑0675.

[865] Zhang R, Guo X, Guo L, et al. Prevalence and associated factors of obstructive sleep apnea in hospitalized patients with type 2 diabetes in Beijing, China[J]. J Diabetes, 2015, 7(1):16‑23. DOI: 10.1111/1753‑0407.12180.

[866] Ding S, Zhang P, Wang L, et al. Prevalence of obstructive sleep apnea syndrome in hospitalized patients with type 2 diabetes in Beijing, China[J]. J Diabetes Investig, 2022, 13(11):1889‑1896. DOI: 10.1111/jdi.13868.

[867] Bonsignore MR. Obesity and obstructive sleep apnea[J]. Handb Exp Pharmacol, 2022, 274: 181‑201. DOI:

10.1007/164_2021_558.

[868] Foster GD, Sanders MH, Millman R, et al. Obstructive sleep apnea among obese patients with type 2 diabetes[J]. Diabetes Care, 2009, 32(6): 1017‑1019. DOI: 10.2337/dc08‑1776.

[869] Meyer EJ, Wittert GA. Approach the patient with obstructive sleep apnea and obesity[J]. J Clin Endocrinol Metab, 2024, 109(3): e1267‑e1279. DOI: 10.1210/clinem/dgad572.

[870] Chang JL, Goldberg AN, Alt JA, et al. International consensus statement on obstructive sleep apnea[J]. Int Forum Allergy Rhinol, 2023, 13(7): 1061‑1482. DOI:

10.1002/alr.23079.

[871] Turnbull CD, Stradling JR. To screen or not to screen for obstructive sleep apnea, that is the question[J]. Sleep Med

Rev, 2017, 36:125‑127. DOI: 10.1016/j.smrv.2017.03.002.

[872] Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline[J]. J Clin Sleep Med, 2017, 13(3):479‑504. DOI: 10.5664/jcsm.6506.

[873] Rosen IM, Kirsch DB, Carden KA, et al. Clinical use of a home sleep apnea test: an updated American Academy of Sleep Medicine position statement[J]. J Clin Sleep Med, 2018, 14(12):2075‑2077. DOI: 10.5664/jcsm.7540.

[874] 惠馨颉, 肖毅 . 睡眠呼吸障碍年度进展2023[J].中华结核和呼 吸 杂 志 , 2024, 47(1): 59‑63. DOI: 10.3760/cma. j.

cn112147‑20231031‑00280.

[875] McEvoy RD. Importance of lifestyle change for patients with sleep apnoea[J]. Respirology, 2019, 24(8): 710‑711. DOI: 10.1111/resp.13627.

[876] Georgoulis M, Yiannakouris N, Kechribari I, et al. The effectiveness of a weight‑loss Mediterranean diet/lifestyle intervention in the management of obstructive sleep apnea: results of the “MIMOSA” randomized clinical trial[J]. Clin Nutr, 2021, 40(3):850‑859. DOI: 10.1016/j.clnu.2020.08.037.

[877] 中国医师协会睡眠医学专业委员会 . 成人阻塞性睡眠呼吸暂停多学科诊疗指南[J]. 中华医学杂志, 2018, 98(24):1902‑1914. DOI: 10.3760/cma.j.issn.0376‑2491.2018.24.003.

[878] Peng J, Yuan Y, Zhao Y, et al. Effects of exercise on patients with obstructive sleep apnea: a systematic review and Meta‑analysis[J]. Int J Environ Res Public Health, 2022, 19(17):10845. DOI: 10.3390/ijerph191710845.

[879] Kuna ST, Reboussin DM, Strotmeyer ES, et al. Effects of weight loss on obstructive sleep apnea severity. Ten‑year results of the sleep AHEAD study[J]. Am J Respir Crit Care Med, 2021, 203(2): 221‑229. DOI: 10.1164/rccm.201912‑2511OC.

[880] Al Oweidat K, Toubasi AA, Tawileh R, et al. Bariatric surgery and obstructive sleep apnea: a systematic review and meta‑analysis[J]. Sleep Breath, 2023, 27(6):2283‑2294. DOI: 10.1007/s11325‑023‑02840‑1.

[881] Blackman A, Foster GD, Zammit G, et al. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial[J]. Int J Obes (Lond), 2016, 40(8): 1310‑1319. DOI: 10.1038/ijo.2016.52.

[882] Le K, Le K, Foo F. The impact of glucagon‑like peptide 1 receptor agonists on obstructive sleep apnoea: a scoping review[J]. Pharmacy (Basel), 2024, 12(1): 11. DOI:

10.3390/pharmacy12010011.

[883] Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity[J]. N Engl J Med, 2022, 387(3):205‑216. DOI: 10.1056/NEJMoa2206038.

[884] Papaetis GS. GLP‑1 receptor agonists, SGLT‑2 inhibitors, and obstructive sleep apnoea: can new allies face an old enemy?[J]. Arch Med Sci Atheroscler Dis, 2023, 8:e19‑e34. DOI: 10.5114/amsad/161170.

[885] Labarca G, Reyes T, Jorquera J, et al. CPAP in patients with obstructive sleep apnea and type 2 diabetes mellitus: systematic review and meta‑analysis[J]. Clin Respir J, 2018, 12(8):2361‑2368. DOI: 10.1111/crj.12915.

[886] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等 . 成人阻塞性睡眠呼吸暂停基层诊疗指南(2018年)[J].中

华全科医师杂志, 2019, 18(1):21‑29. DOI: 10.3760/cma.j.

issn.1671‑7368.2019.01.007.

[887] Qu J, Zhang J, Chen Y, et al. Aetiology of severe community acquired pneumonia in adults identified by combined detection methods: a multi‑centre prospective study in China[J]. Emerg Microbes Infect, 2022, 11(1): 556‑566. DOI: 10.1080/22221751.2022.2035194.

[888] Liu YN, Zhang YF, Xu Q, et al. Infection and co‑infection patterns of community‑acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study[J]. Lancet Microbe, 2023, 4(5):e330‑e339. DOI: 10.1016/S2666‑5247(23)00031‑9.

[889] 中国疾病预防控制中心新型冠状病毒肺炎应急响应机制流行病学组 . 新型冠状病毒肺炎流行病学特征分析[J]. 中华流行病学杂志 , 2020, 41(2): 145‑151. DOI: 10.3760/cma.j.issn.0254‑6450.2020.02.003.

[890] Chee YJ, Ng S, Yeoh E. Diabetic ketoacidosis precipitated by Covid‑19 in a patient with newly diagnosed diabetes mellitus[J]. Diabetes Res Clin Pract, 2020, 164: 108166. DOI: 10.1016/j.diabres.2020.108166.

[891] Holt R, Cockram CS, Ma R, et al. Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment[J]. Diabetologia, 2024, 67(7): 1168‑1180. DOI: 10.1007/s00125‑024‑06102‑x.

[892] Kiranmala K, Johnson R, Savio J, et al. Microbiologic profile and clinical practices in urinary tract infections in a tertiary care center in Southern India[J]. J Family Med Prim Care, 2019, 8(9): 2888‑2892. DOI: 10.4103/jfmpc.

jfmpc_346_19.

[893] Nichols GA, Brodovicz KG, Kimes TM, et al. Prevalence and incidence of urinary tract and genital infections among patients with and without type 2 diabetes[J]. J Diabetes Complications, 2017, 31(11): 1587‑1591. DOI: 10.1016/j.

jdiacomp.2017.07.018.

[894] Li D, Wang T, Shen S, et al. Urinary tract and genital infections in patients with type 2 diabetes treated with sodium‑glucose co‑transporter 2 inhibitors: a meta‑analysis of randomized controlled trials[J]. Diabetes Obes Metab, 2017, 19(3): 348‑355. DOI: 10.1111/dom.12825.

[895] Hosseininasab Nodoushan SA, Nabavi A. The interaction of helicobacter pylori infection and type 2 diabetes mellitus[J]. Adv Biomed Res, 2019, 8: 15. DOI: 10.4103/abr.abr_37_18.

[896] Ferreira G, Stuurman AL, Horsmans Y, et al. Hepatitis B virus infection and the risk of liver disease progression in type 2 diabetic patients with potential nonalcoholic fatty liver disease: a retrospective, observational, cohort study in the United Kingdom Clinical Practice Research Datalink[J]. Eur J Gastroenterol Hepatol, 2020, 32(1):101‑109. DOI: 10.1097/MEG.0000000000001537.

[897] Lin PY, Chen SC, Lo TC, et al. Dual infection with hepatitis B virus and hepatitis C virus correlated with type 2 diabetes mellitus[J]. Exp Clin Endocrinol Diabetes, 2020, 128(1):38‑42. DOI: 10.1055/a‑0794‑6135.

[898] Goeijenbier M, van Sloten TT, Slobbe L, et al. Benefits of flu vaccination for persons with diabetes mellitus: a review[J]. Vaccine, 2017, 35(38): 5095‑5101. DOI:

10.1016/j.vaccine.2017.07.095.

[899] D′Aiuto F, Gkranias N, Bhowruth D, et al. Systemic effects of periodontitis treatment in patients with type 2

diabetes: a 12 month, single‑centre, investigator‑masked, randomised trial[J]. Lancet Diabetes Endocrinol, 2018, 6(12):954‑965. DOI: 10.1016/S2213‑8587(18)30038‑X.

[900] Genco RJ, Borgnakke WS. Diabetes as a potential risk for periodontitis: association studies[J]. Periodontol 2000, 2020, 83(1):40‑45. DOI: 10.1111/prd.12270.

[901] Nibali L, Gkranias N, Mainas G, et al. Periodontitis and implant complications in diabetes[J]. Periodontol 2000, 2022, 90(1):88‑105. DOI: 10.1111/prd.12451.

[902] Graves DT, Ding Z, Yang Y. The impact of diabetes on periodontal diseases[J]. Periodontol 2000, 2020, 82(1):214‑224. DOI: 10.1111/prd.12318.

[903] Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective[J]. Ann Periodontol, 2001, 6(1): 99‑112. DOI:

10.1902/annals.2001.6.1.99.

[904] Bitencourt FV, Nascimento GG, Costa SA, et al. Co‑occurrence of periodontitis and diabetes‑related complications[J]. J Dent Res, 2023, 102(10): 1088‑1097. DOI: 10.1177/00220345231179897.

[905] Genco RJ, Graziani F, Hasturk H. Effects of periodontal disease on glycemic control, complications, and incidence of diabetes mellitus[J]. Periodontol 2000, 2020, 83(1):59‑65. DOI: 10.1111/prd.12271.

[906] Wu CZ, Yuan YH, Liu HH, et al. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus[J]. BMC Oral Health, 2020, 20(1): 204. DOI: 10.1186/s12903‑020‑01180‑w.

[907] Su Y, Ye L, Hu C, et al. Periodontitis as a promoting factor of T2D: current evidence and mechanisms[J]. Int J Oral Sci, 2023, 15(1):25. DOI: 10.1038/s41368‑023‑00227‑2.

[908] 陆颖理 . 口腔疾病与糖尿病[M]. 上海: 上海科学技术出版社, 2011:10.

[909] 陆颖理, 王长谦 . 内科学:供口腔医学专业用[M]. 北京: 人民卫生出版社, 2017:6.

[910] Mealey BL. Periodontal disease and diabetes. a two‑way street[J]. J Am Dent Assoc, 2006, 137 Suppl:26S‑31S. DOI:

10.14219/jada.archive.2006.0404.

[911] Demmer RT, Jacobs DR Jr, Desvarieux M. Periodontal disease and incident type 2 diabetes: results from the First National Health and Nutrition Examination Survey and its epidemiologic follow‑up study[J]. Diabetes Care, 2008, 31(7):1373‑1379. DOI: 10.2337/dc08‑0026.

[912] Rapone B, Ferrara E, Corsalini M, et al. The effect of gaseous ozone therapy in conjunction with periodontal treatment on glycated hemoglobin level in subjects with type 2 diabetes mellitus: an unmasked randomized controlled trial[J]. Int J Environ Res Public Health, 2020, 17(15):5467. DOI: 10.3390/ijerph17155467.

[913] Song TJ, Jeon J, Kim J. Cardiovascular risks of periodontitis and oral hygiene indicators in patients with diabetes mellitus[J]. Diabetes Metab, 2021, 47(6):101252. DOI: 10.1016/j.diabet.2021.101252.

[914] Li X, Zheng J, Ma X, et al. The oral microbiome of pregnant women facilitates gestational diabetes discrimination[J]. J Genet Genomics, 2021, 48(1): 32‑39. DOI: 10.1016/j.

jgg.2020.11.006.

[915] Petrou‑Amerikanou C, Markopoulos AK, Belazi M, et al. Prevalence of oral lichen planus in diabetes mellitus according to the type of diabetes[J]. Oral Dis, 1998, 4(1):37‑40. DOI: 10.1111/j.1601‑0825.1998.tb00253.x.

[916] Albrecht M, Bánóczy J, Dinya E, et al. Occurrence of oral leukoplakia and lichen planus in diabetes mellitus[J]. J Oral Pathol Med, 1992, 21(8): 364‑366. DOI: 10.1111/j.1600‑0714.1992.tb01366.x.

[917] 穆宏, 杨凤英 . 糖尿病口腔病变的诊断和处理[J].中华全科医学, 2017, 15(9):1461‑1462.

[918] Li JX, Cummins CL. Fresh insights into glucocorticoid‑induced diabetes mellitus and new therapeutic directions[J]. Nat Rev Endocrinol, 2022, 18(9):540‑557. DOI: 10.1038/s41574‑022‑00683‑6.

[919] Scaroni C, Zilio M, Foti M, et al. Glucose metabolism abnormalities in cushing syndrome: from molecular basis to clinical management[J]. Endocr Rev, 2017, 38(3):189‑219. DOI: 10.1210/er.2016‑1105.

[920] Liu XX, Zhu XM, Miao Q, et al. Hyperglycemia induced by glucocorticoids in nondiabetic patients: a meta‑analysis[J]. Ann Nutr Metab, 2014, 65(4): 324‑332. DOI:

10.1159/000365892.

[921] Tatalovic M, Lehmann R, Cheetham M, et al. Management of

hyperglycaemia

in

persons

with non‑insulin‑dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review[J]. BMJ Open, 2019, 9(5):e028914. DOI: 10.1136/bmjopen‑2019‑028914.

[922] Khalid JM, Raluy‑Callado M, Curtis BH, et al. Rates and risk of hospitalisation among patients with type 2 diabetes: retrospective cohort study using the UK general practice research database linked to English hospital episode statistics[J]. Int J Clin Pract, 2014, 68(1): 40‑48. DOI: 10.1111/ijcp.12265.

[923] Shi L, Li Y, Xu X, et al. Brown adipose tissue‑derived Nrg4 alleviates endothelial inflammation and atherosclerosis in male mice[J]. Nat Metab, 2022, 4(11):1573‑1590. DOI:

10.1038/s42255‑022‑00671‑0.

[924] 刘敏, 向光大 . 护骨素与糖尿病血管并发症关系研究进展[J].

中国糖尿病杂志 , 2015, 23(3): 281‑283. DOI: 10.3969/j.

issn.1006‑6187.2015.03.026.

[925] 中国人民解放军中部战区总医院, 中华医学会糖尿病分会胰岛素抵抗学组 . 糖尿病合并新型冠状病毒肺炎血糖管理策略的专家建议[J]. 临床内科杂志 , 2020, 37(3):215‑219. DOI: 10.3969/j.issn.1001‑9057.2020.03.024.

[926] Ding Y, Xu X, Meng B, et al. Myeloid‑derived growth factor alleviates non‑alcoholic fatty liver disease alleviates in a manner involving IKKβ/NF‑κB signaling[J]. Cell Death Dis, 2023, 14(6):376. DOI: 10.1038/s41419‑023‑05904‑y.

[927] Beaupere C, Liboz A, Fève B, et al. Molecular mechanisms of glucocorticoid‑induced insulin resistance[J]. Int J Mol Sci, 2021, 22(2):623. DOI: 10.3390/ijms22020623.

[928] Shen Y, Roh HC, Kumari M, et al. Adipocyte glucocorticoid receptor is important in lipolysis and insulin resistance due to exogenous steroids, but not insulin resistance caused by high fat feeding[J]. Mol Metab, 2017, 6(10):1150‑1160. DOI: 10.1016/j.molmet.2017.06.013.

[929] Nakamura H, Fujieda Y, Nakamura A, et al. How should rheumatologists

manage

glucocorticoid‑induced hyperglycemia?[J]. Mod Rheumatol, 2021, 31(3):519‑528. DOI: 10.1080/14397595.2020.1823060.

[930] Perez A, Jansen‑Chaparro S, Saigi I, et al. Glucocorticoid‑induced hyperglycemia[J]. J Diabetes, 2014, 6(1):9‑20. DOI: 10.1111/1753‑0407.12090.

[931] Roberts A, James J, Dhatariya K. Management of

hyperglycaemia and steroid (glucocorticoid) therapy: a guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group[J]. Diabet Med, 2018, 35(8):1011‑1017. DOI: 10.1111/dme.13675.

[932] American Diabetes Association Professional Practice Committee. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes‑2022[J]. Diabetes Care, 2022, 45(Suppl 1): S17‑S38. DOI: 10.2337/dc22‑S002.

[933] 《中国老年型糖尿病防治临床指南》编写组 . 中国老年2型糖尿病防治临床指南(2022年版)[J].中国糖尿病杂志, 2022, 30(1):2‑51. DOI: 10.3969/j.issn.1006‑6187.2022.01.002.

[934] 陈贵言, 赵婷, 胡晓艳, 等 . 应用糖皮质激素的糖尿病患者胰岛素治疗方案探讨 [J]. 中国糖尿病杂志 , 2017, 25(5):407‑410. DOI: 10.3969/j.issn.1006‑6187.2017.05.004.

[935] Anderson RJ, Freedland KE, Clouse RE, et al. The prevalence of comorbid depression in adults with diabetes: a meta‑analysis[J]. Diabetes Care, 2001, 24(6):1069‑1078. DOI: 10.2337/diacare.24.6.1069.

[936] Basiri R, Seidu B, Rudich M. Exploring the interrelationships between diabetes, nutrition, anxiety, and depression: implications for treatment and prevention strategies[J]. Nutrients, 2023, 15(19): 4226. DOI: 10.3390/nu15194226.

[937] Li HQ, Chi S, Dong Q, et al. Pharmacotherapeutic strategies for managing comorbid depression and diabetes[J]. Expert Opin Pharmacother, 2019, 20(13):1589‑1599. DOI: 10.1080/14656566.2019.1622090.

[938] van der Feltz‑Cornelis C, Allen SF, Holt R, et al. Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: systematic review and meta‑analysis[J]. Brain Behav, 2021, 11(2): e01981. DOI:

10.1002/brb3.1981.

[939] Possidente C, Fanelli G, Serretti A, et al. Clinical insights into the cross‑link between mood disorders and type 2 diabetes: a review of longitudinal studies and Mendelian randomisation analyses[J]. Neurosci Biobehav Rev, 2023, 152:105298. DOI: 10.1016/j.neubiorev.2023.105298.

[940] Clouse RE, Lustman PJ, Freedland KE, et al. Depression and coronary heart disease in women with diabetes[J]. Psychosom Med, 2003, 65(3): 376‑383. DOI: 10.1097/01.

psy.0000041624.96580.1f.

[941] Lee KW, Ching SM, Devaraj NK, et al. Diabetes in pregnancy and risk of antepartum depression: a systematic review and Meta‑analysis of cohort studies[J]. Int J Environ Res Public Health, 2020, 17(11): 3767. DOI:

10.3390/ijerph17113767.

[942] Maina JG, Balkhiyarova Z, Nouwen A, et al. Bidirectional Mendelian randomization and multiphenotype GWAS show causality and shared pathophysiology between depression and type 2 diabetes[J]. Diabetes Care, 2023, 46(9):1707‑1714. DOI: 10.2337/dc22‑2373.

[943] Huang CJ, Wang SY, Lee MH, et al. Prevalence and incidence of mental illness in diabetes: a national population‑based cohort study[J]. Diabetes Res Clin Pract, 2011,

93(1):

106‑114.

diabres.2011.03.032.

[944] Hasan SS, Clavarino AM, Dingle K, et al. Diabetes mellitus and the risk of depressive and anxiety disorders in Australian women: a longitudinal study[J]. J Womens Health (Larchmt), 2015, 24(11): 889‑898. DOI: 10.1089/

jwh.2015.5210.

[945] Svenningsson I, Björkelund C, Marklund B, et al. Anxiety and depression in obese and normal‑weight individuals with diabetes type 2: a gender perspective[J]. Scand J Caring Sci, 2012, 26(2): 349‑354. DOI: 10.1111/j.1471‑6712.2011.00940.x.

[946] Smith KJ, Béland M, Clyde M, et al. Association of diabetes with anxiety: a systematic review and meta‑analysis[J]. J Psychosom Res, 2013, 74(2): 89‑99. DOI: 10.1016/j.

jpsychores.2012.11.013.

[947] Wild D, von Maltzahn R, Brohan E, et al. A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education[J]. Patient Educ Couns, 2007, 68(1):10‑15. DOI:

10.1016/j.pec.2007.05.003.

[948] Cox DJ, Irvine A, Gonder‑Frederick L, et al. Fear of hypoglycemia: quantification, validation, and utilization[J]. Diabetes Care, 1987, 10(5): 617‑621. DOI: 10.2337/diacare.10.5.617.

[949] Zambanini A, Newson RB, Maisey M, et al. Injection related anxiety in insulin‑treated diabetes[J]. Diabetes Res Clin Pract, 1999, 46(3): 239‑246. DOI: 10.1016/s0168‑8227(99)00099‑6.

[950] Gudala K, Bansal D, Schifano F, et al. Diabetes mellitus and risk of dementia: a meta‑analysis of prospective observational studies[J]. J Diabetes Investig, 2013, 4(6):640‑650. DOI: 10.1111/jdi.12087.

[951] Ohara T, Doi Y, Ninomiya T, et al. Glucose tolerance status and risk of dementia in the community: the Hisayama study[J]. Neurology, 2011, 77(12): 1126‑1134. DOI:

10.1212/WNL.0b013e31822f0435.

[952] Biessels GJ, Staekenborg S, Brunner E, et al. Risk of dementia in diabetes mellitus: a systematic review[J]. Lancet Neurol, 2006, 5(1): 64‑74. DOI: 10.1016/S1474‑4422(05)70284‑2.

[953] Cukierman T, Gerstein HC, Williamson JD. Cognitive decline and dementia in diabetes‑‑systematic overview of prospective observational studies[J]. Diabetologia, 2005, 48(12):2460‑2469. DOI: 10.1007/s00125‑005‑0023‑4.

[954] Hoffman RP. Eating disorders in adolescents with type 1 diabetes. A closer look at a complicated condition[J]. Postgrad Med, 2001, 109(4):67‑69, 73‑74. DOI: 10.3810/pgm.2001.04.910.

[955] Young‑Hyman DL, Davis CL. Disordered eating behavior in individuals with diabetes: importance of context, evaluation, and classification[J]. Diabetes Care, 2010, 33(3):683‑689. DOI: 10.2337/dc08‑1077.

[956] Li C, Ford ES, Zhao G, et al. Prevalence of self‑reported clinically diagnosed sleep apnea according to obesity status in men and women: national health and nutrition examination survey, 2005‑2006[J]. Prev Med, 2010, 51(1):18‑23. DOI: 10.1016/j.ypmed.2010.03.016.

[957] West SD, Nicoll DJ, Stradling JR. Prevalence of obstructive sleep apnoea in men with type 2 diabetes[J]. Thorax, 2006, 61(11):945‑950. DOI: 10.1136/thx.2005.057745.

[958] Resnick HE, Redline S, Shahar E, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study[J]. Diabetes Care, 2003, 26(3): 702‑709. DOI: 10.2337/diacare.26.3.702.

ncbi.

nlm.

nih.

gov/books/NBK555331/pdf/Bookshelf_NBK555331.pdf.

[821] 日本糖尿病学会编著: 糖尿病诊疗ガイドライン2024[M]. 东京:南江堂, 2024.

[822] Mathiesen ER, Alibegovic AC, Corcoy R, et al. Insulin degludec versus insulin detemir, both in combination with insulin aspart, in the treatment of pregnant women with type 1 diabetes (EXPECT): an open‑label, multinational, randomised, controlled, non‑inferiority trial[J]. Lancet Diabetes Endocrinol, 2023, 11(2): 86‑95. DOI: 10.1016/S2213‑8587(22)00307‑2.

[823] Picón‑César MJ, Molina‑Vega M, Suárez‑Arana M, et al. Metformin for gestational diabetes study: metformin vs insulin in gestational diabetes: glycemic control and obstetrical and perinatal outcomes: randomized prospective trial[J]. Am J Obstet Gynecol, 2021, 225(5):

517.e1‑e17. DOI: 10.1016/j.ajog.2021.04.229.

[824] Feig DS, Zinman B, Asztalos E, et al. Determinants of small for gestational age in women with type 2 diabetes in pregnancy: who should receive metformin? [J]. Diabetes Care, 2022, 45(7):1532‑1539. DOI: 10.2337/dc22‑0013.

[825] Given JE, Loane M, Garne E, et al. Metformin exposure in first trimester of pregnancy and risk of all or specific congenital anomalies: exploratory case‑control study[J]. BMJ, 2018, 361:k2477. DOI: 10.1136/bmj.k2477.

[826] Feig DS, Donovan LE, Zinman B, et al. Metformin in women with type 2 diabetes in pregnancy (MiTy): a multicentre,

international,

randomised, placebo‑controlled trial[J]. Lancet Diabetes Endocrinol, 2020, 8(10): 834‑844. DOI: 10.1016/S2213‑8587(20)

[959] de Groot M, Golden SH, Wagner J. Psychological conditions in adults with diabetes[J]. Am Psychol, 2016,

71(7):552‑562. DOI: 10.1037/a0040408.

[960] OuYang H, Chen B, Abdulrahman AM, et al. Associations between gestational diabetes and anxiety or depression: a systematic review[J]. J Diabetes Res, 2021, 2021:

9959779. DOI: 10.1155/2021/9959779.

[961] de Groot M, Crick KA, Long M, et al. Lifetime duration of depressive disorders in patients with type 2 diabetes[J]. Diabetes Care, 2016, 39(12): 2174‑2181. DOI: 10.2337/dc16‑1145.

[962] Rubin RR, Ma Y, Marrero DG, et al. Elevated depression symptoms, antidepressant medicine use, and risk of developing diabetes during the diabetes prevention program[J]. Diabetes Care, 2008, 31(3): 420‑426. DOI:

10.2337/dc07‑1827.

[963] Lustman PJ, Griffith LS, Clouse RE. Depression in adults with diabetes. Results of 5‑yr follow‑up study[J]. Diabetes Care, 1988, 11(8): 605‑612. DOI: 10.2337/diacare.11.8.605.

[964] Khaledi M, Haghighatdoost F, Feizi A, et al. The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta‑analysis on huge number of observational studies[J]. Acta Diabetol, 2019, 56(6):631‑650. DOI: 10.1007/s00592‑019‑01295‑9.

[965] Haghighatdoost F, Azadbakht L. Dietary treatment options for depression among diabetic patient, focusing on macronutrients[J]. J Diabetes Res, 2013, 2013:421832. DOI: 10.1155/2013/421832.

[966] Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses[J]. N Engl J Med, 2010, 363(27): 2611‑2620. DOI: 10.1056/NEJMoa1003955.

[967] Li C, Ford ES, Zhao G, et al. Undertreatment of mental health problems in adults with diagnosed diabetes and serious psychological distress: the behavioral risk factor surveillance system, 2007[J]. Diabetes Care, 2010, 33(5):1061‑1064. DOI: 10.2337/dc09‑1515.

[968] Rauwerda NL, Tovote KA, Peeters A, et al. WHO‑5 and BDI‑Ⅱ are acceptable screening instruments for depression in people with diabetes[J]. Diabet Med, 2018, 35(12):1678‑1685. DOI: 10.1111/dme.13779.

[969] Janssen EP, Köhler S, Stehouwer CD, et al. The patient health questionnaire‑9 as a screening tool for depression in individuals with type 2 diabetes mellitus: the Maastricht study[J]. J Am Geriatr Soc, 2016, 64(11):e201‑e206. DOI: 10.1111/jgs.14388.

[970] Kotyśko M, Frankowiak J. Psychometric characteristics of the Center for Epidemiologic Studies Depression Scale‑Revised in a population of Polish university students[J]. PLoS One, 2023, 18(9): e0290536. DOI:

10.1371/journal.pone.0290536.

[971] Abbas Q, Latif S, Ayaz Habib H, et al. Cognitive behavior therapy for diabetes distress, depression, healthanxiety, quality of life and treatment adherence among patients with type‑Ⅱ diabetes mellitus: a randomized control trial[J]. BMC Psychiatry, 2023, 23(1): 86. DOI: 10.1186/s12888‑023‑04546‑w.

[972] Gonder‑Frederick LA, Schmidt KM, Vajda KA, et al. Psychometric properties of the hypoglycemia fear survey‑Ⅱ for adults with type 1 diabetes[J]. Diabetes Care, 2011, 34(4):801‑806. DOI: 10.2337/dc10‑1343.

[973] Cox DJ, Gonder‑Frederick L, Polonsky W, et al. Blood

glucose awareness training (BGAT‑2): long‑term benefits[J]. Diabetes Care, 2001, 24(4): 637‑642. DOI: 10.2337/diacare.24.4.637.

[974] de Groot M, Shubrook JH, Hornsby WG Jr, et al. Program ACTIVE Ⅱ : outcomes from a randomized, multistate community‑based depression treatment for rural and urban adults with type 2 diabetes[J]. Diabetes Care, 2019, 42(7):1185‑1193. DOI: 10.2337/dc18‑2400.

[975] Varela‑Moreno E, Anarte‑Ortiz MT, Jodar‑Sanchez F, et al. Economic evaluation of a web application implemented in primary care for the treatment of depression in patients with type 2 diabetes mellitus: multicenter randomized controlled trial[J]. JMIR Mhealth Uhealth, 2024, 12:e55483. DOI: 10.2196/55483.

[976] American Diabetes Association. Standards of medical care in diabetes‑‑2012[J]. Diabetes Care, 2012, 35(Suppl 1):S11‑S63. DOI: 10.2337/dc12‑s011.

[977] Li S, Yang D, Zhou X, et al. Neurological and metabolic related pathophysiologies and treatment of comorbid diabetes with depression[J]. CNS Neurosci Ther, 2024, 30(4):e14497. DOI: 10.1111/cns.14497.

[978] Vancampfort D, Correll CU, Galling B, et al. Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‑analysis[J]. World Psychiatry, 2016, 15(2):166‑174. DOI: 10.1002/wps.20309.

[979] Lee MK, Lee SY, Sohn SY, et al. Type 2 diabetes and its association with psychiatric disorders in young adults in South Korea[J]. JAMA Netw Open, 2023, 6(6): e2319132. DOI: 10.1001/jamanetworkopen.2023.19132.

[980] Huo L, Lu X, Wu F, et al. Diabetes in late‑life schizophrenia: prevalence, factors, and association with clinical symptoms[J]. J Psychiatr Res, 2021, 132: 44‑49. DOI: 10.1016/j.jpsychires.2020.09.026.

[981] Holt RI, Mitchell AJ. Diabetes mellitus and severe mental illness: mechanisms and clinical implications[J]. Nat Rev Endocrinol, 2015, 11(2): 79‑89. DOI: 10.1038/nrendo.2014.203.

[982] Rohde C, Köhler‑Forsberg O, Nierenberg AA, et al. Pharmacological treatment of bipolar disorder and risk of diabetes mellitus: a nationwide study of 30, 451 patients[J]. Bipolar Disord, 2023, 25(4): 323‑334. DOI: 10.1111/bdi.13308.

[983] Slama L, Barrett BW, Abraham AG, et al. Risk for incident diabetes is greater in prediabetic men with HIV than without HIV[J]. AIDS, 2021, 35(10): 1605‑1614. DOI:

10.1097/QAD.0000000000002922.

[984] Magagnoli J, Pereira F, Narendran S, et al. Anti‑HIV drugs reduce risk of prediabetes and progression to type 2 diabetes in HIV‑infected patients[J]. MedComm Futur Med, 2023, 2(2):e37. DOI: 10.1002/mef2.37.

[985] Schambelan M, Benson CA, Carr A, et al. Management of metabolic complications associated with antiretroviral therapy for HIV‑1 infection: recommendations of an International AIDS Society‑USA panel[J]. J Acquir Immune Defic Syndr, 2002, 31(3): 257‑275. DOI:

10.1097/00126334‑200211010‑00001.

[986] Monroe AK, Glesby MJ, Brown TT. Diagnosing and managing diabetes in HIV‑infected patients: current concepts[J]. Clin Infect Dis, 2015, 60(3): 453‑462. DOI:

10.1093/cid/ciu779.

[987] Kajogoo VD, Amogne W, Medhin G. New onset type 2 diabetes mellitus risks with integrase strand transfer inhibitors‑based regimens: a systematic review and meta‑analysis[J]. Metabol Open, 2023, 17: 100235. DOI:

10.1016/j.metop.2023.100235.

[988] Mulindwa F, Kamal H, Castelnuovo B, et al. Association between integrase strand transfer inhibitor use with insulin resistance and incident diabetes mellitus in persons living with HIV: a systematic review and meta‑analysis[J]. BMJ Open Diabetes Res Care, 2023, 11(1):e003136. DOI: 10.1136/bmjdrc‑2022‑003136.

[989] 叶润华, 李静, 姚仕堂, 等 . 德宏傣族景颇族自治州抗病毒治疗的HIV/AIDS糖尿病患病率及其相关因素分析[J].中华流行病学杂志, 2019, 40(6):654‑659. DOI: 10.3760/cma.j.

issn.0254‑6450.2019.06.010.

[990] Taramasso L, Squillace N, Ricci E, et al. Incident diabetes in course of antiretroviral therapy[J]. AIDS, 2023, 37(8):1269‑1276. DOI: 10.1097/QAD.0000000000003548.

[991] American Diabetes Association. 1. Improving care and promoting health in populations: standards of medical care in diabetes‑2020[J]. Diabetes Care, 2020, 43(Suppl 1):S7‑S13. DOI: 10.2337/dc20‑S001.

[992] 赵晓龙, 陈军, 张仁芳, 等 . HIV感染者合并糖尿病的风险与管理 [J]. 中国艾滋病性病 , 2023, 29(9): 1053‑1058. DOI:

10.13419/j.cnki.aids.2023.09.25.

[993] Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity[J]. Circulation, 2009, 120(16): 1640‑1645. DOI: 10.1161/CIRCULATIONAHA.109.192644.

[994] 祝之明 .代谢综合征病因探索与临床实践[M]. 北京:人民军医出版社, 2005.

[995] 中华医学会糖尿病学分会 . 中国 2 型糖尿病防治指南(2020 年版) ( 下) [J]. 中国实用内科杂志 , 2021, 41(9):757‑784. DOI: 10.19538/j.nk2021090106.

[996] Harrison S, Couture P, Lamarche B. Diet quality, saturated fat and metabolic syndrome[J]. Nutrients, 2020, 12(11):

3232. DOI: 10.3390/nu12113232.

[997] Alkhulaifi F, Darkoh C. Meal timing, meal frequency and metabolic syndrome[J]. Nutrients, 2022, 14(9):1719. DOI:

10.3390/nu14091719.

[998] Myers J, Kokkinos P, Nyelin E. Physical activity, cardiorespiratory fitness, and the metabolic syndrome[J]. Nutrients, 2019, 11(7):1652. DOI: 10.3390/nu11071652.

[999] 中国成人血脂异常防治指南修订联合委员会 . 中国成人血脂异常防治指南(2016 年修订版)[J]. 中华心血管病杂志 , 2016, 44(10): 833‑853. DOI: 10.3760/cma. j.

issn.0253‑3758.2016.10.005.

[1000] Lian F, Ni Q, Shen Y, et al. International traditional Chinese medicine guideline for diagnostic and treatment principles of diabetes[J]. Ann Palliat Med, 2020, 9(4):2237‑2250. DOI: 10.21037/apm‑19‑271.

[1001] 中华中医药学会 . 中医糖尿病临床诊疗指南[M]. 北京: 中国中医药出版社, 2020.

[1002] 中华中医药学会糖尿病基层防治专家指导委员会 . 国家糖尿病基层中医防治管理指南(2022)[J]. 中医杂志 , 2022, 63(24): 2397‑2414. DOI: 10.13288/j. 11‑2166/

r.2022.24.017.

[1003] 逄冰, 倪青 . 经方在糖尿病治疗中的应用[J].中国中药杂志, 2019, 44(18): 3895‑3898. DOI: 10.19540/j. cnki.

cjcmm.20190416.504.

[1004] Gao X, Shang J, Liu H, et al. A Meta‑analysis of the clinical efficacy of TCM decoctions made from formulas in the Liuwei Dihuang Wan categorized formulas in treating diabetic nephropathy proteinuria[J]. Evid Based Complement Alternat Med, 2018, 2018: 2427301. DOI:

10.1155/2018/2427301.

[1005] Zhou B, Zhang G, Guo W, et al. Xiaoke Decoction in treatment of type Ⅱ diabetes: a Meta‑analysis[J]. Chin Herb Med, 2022, 14(1): 130‑141. DOI: 10.1016/j.

chmed.2021.08.004.

[1006] Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus[J]. Metabolism, 2008, 57(5):712‑717. DOI: 10.1016/j.metabol.2008.01.013.

[1007] Zhang Y, Li X, Zou D, et al. Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine[J]. J Clin Endocrinol Metab, 2008, 93(7):2559‑2565. DOI: 10.1210/jc.2007‑2404.

[1008] Lan J, Zhao Y, Dong F, et al. Meta‑analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension[J]. J Ethnopharmacol, 2015, 161: 69‑81. DOI: 10.1016/j.

jep.2014.09.049.

[1009] Harrison SA, Gunn N, Neff GW, et al. A phase 2, proof of concept, randomised controlled trial of berberine ursodeoxycholate in patients with presumed non‑alcoholic steatohepatitis and type 2 diabetes[J]. Nat Commun, 2021, 12(1): 5503. DOI: 10.1038/s41467‑021‑25701‑5.

[1010] Cheng L, Meng XB, Lu S, et al. Evaluation of hypoglycemic efficacy of tangningtongluo formula, a traditional Chinese Miao medicine, in two rodent animal models[J]. J Diabetes Res, 2014, 2014:745419. DOI: 10.1155/2014/745419.

[1011] Cheng L, Song J, Li G, et al. Effects of the Tangningtongluo formula as an alternative strategy for diabetics via upregulation of insulin receptor substrate‑1[J]. Mol Med Rep, 2017, 16(1):703‑709. DOI: 10.3892/mmr.2017.6679.

[1012] Wang N, Zhang C, Xu Y, et al. OMICs approaches‑assisted identification of macrophages‑derived MIP‑1γ as the therapeutic target of botanical products TNTL in diabetic retinopathy[J]. Cell Commun Signal, 2019, 17(1):81. DOI:

10.1186/s12964‑019‑0396‑5.

[1013] Cai Z, Hu X, Gui L, et al. Study on the therapeutic effect and mechanism of Tangningtongluo Tablet on diabetic mice[J]. J Diabetes Complications, 2023, 37(8): 108523. DOI: 10.1016/j.jdiacomp.2023.108523.

[1014] Ren Y, Hu X, Qi M, et al. Tangningtongluo Tablet ameliorates pancreatic damage in diabetic mice by inducing autophagy and inhibiting the PI3K/Akt/mTOR signaling pathway[J]. Int Immunopharmacol, 2024, 142(Pt A):113032. DOI: 10.1016/j.intimp.2024.113032.

[1015] 仝小林 . 糖尿病中医药临床循证实践指南[M]. 北京: 科学出版社, 2016.

[1016] 中国中西医结合学会, 中华中医药学会, 中华医学会 . 2 型糖 尿 病 中 西 医 结 合 诊 疗 指 南 [EB/OL]. (2023‑05‑31)[2024‑11‑27].

cacm.

org.

cn/wp‑content/uploads/2023/06/2%E5%9E%

8B%E7%B3%96%E5%B0%BF% E7%97%85%E4%B8%AD%

E8%A5%BF% E5%8C% BB% E7%BB% 93%E5%90%88%E8%AF% 8A% E7%96%97%E6%8C% 87%E5%8D%

97.pdf.

[1017] 中华中医药学会基层糖尿病防治专家指导委员会, 中华中医药学会糖尿病分会, 杨叔禹 . 糖尿病"三师共管"诊疗模式应 用 指 南 (2024 版) [J]. 中 医 杂 志 , 2024, 65(19):2056‑2061. DOI: 10.13288/j.11‑2166/r.2024.19.017.

[1018] Ji H, Zhao X, Chen X, et al. Jinlida for diabetes prevention in impaired glucose tolerance and multiple metabolic abnormalities: the FOCUS randomized clinical trial[J]. JAMA Intern Med, 2024, 184(7): 727‑735. DOI: 10.1001/jamainternmed.2024.1190.

[1019] Lian F, Li G, Chen X, et al. Chinese herbal medicine Tianqi reduces progression from impaired glucose tolerance to diabetes: a double‑blind, randomized, placebo‑controlled, multicenter trial[J]. J Clin Endocrinol Metab, 2014, 99(2):648‑655. DOI: 10.1210/jc.2013‑3276.

[1020] Pang B, Zhang Y, Liu J, et al. Prevention of type 2 diabetes with the Chinese herbal medicine Tianqi capsule: a systematic review and meta‑analysis[J]. Diabetes Ther, 2017,

8(6):

1227‑1242.

s13300‑017‑0316‑x.

[1021] Wang H, Guo L, Shang H, et al. JinqiJiangtang tablets for pre‑diabetes: a randomized, double‑blind and placebo‑controlled clinical trial[J]. Sci Rep, 2017, 7(1):

11190. DOI: 10.1038/s41598‑017‑11583‑5.

[1022] Tan Y, Liu S, Huang M, et al. Efficacy and safety of Gegen Qinlian decoction in the treatment of type Ⅱ diabetes mellitus: a systematic review and meta‑analysis of randomized clinical trials[J]. Front Endocrinol (Lausanne), 2023, 14: 1316269. DOI: 10.3389/fendo.2023.1316269.

[1023] Gao Z, Zhang W, He L, et al. Double‑blinded, randomized clinical trial of Gegen Qinlian decoction pinpoints Faecalibacterium as key gut bacteria in alleviating hyperglycemia[J]. Precis Clin Med, 2024, 7(1): pbae003. DOI: 10.1093/pcmedi/pbae003.

[1024] Tong XL, Wu ST, Lian FM, et al. The safety and effectiveness of TM81, a Chinese herbal medicine, in the treatment of type 2 diabetes: a randomized double‑blind placebo‑controlled trial[J]. Diabetes Obes Metab, 2013, 15(5):448‑454. DOI: 10.1111/dom.12051.

[1025] Tian J, Lian F, Yang L, et al. Evaluation of the Chinese herbal medicine Jinlida in type 2 diabetes patients based on stratification: results of subgroup analysis from a 12‑week trial[J]. J Diabetes, 2018, 10(2): 112‑120. DOI:

10.1111/1753‑0407.12559.

[1026] Lian F, Jin D, Bao Q, et al. Effectiveness of traditional Chinese medicine Jinlida granules as an add‑on therapy for type 2 diabetes: a system review and meta‑analysis of randomized controlled trials[J]. J Diabetes, 2019, 11(7):540‑551. DOI: 10.1111/1753‑0407.12877.

[1027] Pan J, Xu Y, Chen S, et al. The effectiveness of traditional Chinese medicine Jinlida granules on glycemic variability in newly diagnosed type 2 diabetes: a double‑blinded, randomized trial[J]. J Diabetes Res, 2021, 2021:6303063. DOI: 10.1155/2021/6303063.

[1028] Zhao X, Liu L, Liu J. Treatment of type 2 diabetes mellitus using the traditional Chinese medicine Jinlida as an add‑on medication: a systematic review and meta‑analysis of randomized controlled trials[J]. Front

Endocrinol (Lausanne), 2022, 13:1018450. DOI: 10.3389/fendo.2022.1018450.

[1029] Kang X, Sun Y, Duan Y, et al. Jinlida granules combined with metformin improved the standard‑reaching rate of blood glucose and clinical symptoms of patients with type 2 diabetes: secondary analysis of a randomized controlled trial[J]. Front Endocrinol (Lausanne), 2023, 14: 1142327. DOI: 10.3389/fendo.2023.1142327.

[1030] Gu Y, Xu X, Wang Z, et al. Chromium‑containing traditional Chinese medicine, Tianmai Xiaoke tablet, for newly diagnosed type 2 diabetes mellitus: a meta‑analysis and systematic review of randomized clinical trials[J]. Evid Based Complement Alternat Med, 2018, 2018: 3708637. DOI: 10.1155/2018/3708637.

[1031] Li RL, Dong TW, Wei JG, et al. Meta‑analysis of the therapeutic effect of Shenqi Jiangtang granule on type 2 diabetes mellitus[J]. Evid Based Complement Alternat Med, 2020, 2020:5754823. DOI: 10.1155/2020/5754823.

[1032] Li T, Li H, Wu Y, et al. Efficacy and safety of Shenqi Jiangtang granules plus oral hypoglycemic agent in patients with type 2 diabetes mellitus: a protocol for systematic review and meta‑analysis of 15 RCTs[J]. Medicine (Baltimore), 2021, 100(5): e23578. DOI:

10.1097/MD.0000000000023578.

[1033] Chan CC, Zhang HW, Chan K, et al. Xiaoke Pill ( 消渴丸) and anti‑diabetic drugs: a review on clinical evidence of possible herb‑drug interactions[EB/OL]. [2024‑11‑27]. https://www.sci‑hub.st/10.1007/s11655‑015‑2106‑5.

[1034] Qu L, Liang X, Tian G, et al. Efficacy and safety of Mulberry Twig Alkaloids tablet for the treatment of type 2 diabetes: a multicenter, randomized, double‑blind, double‑dummy, and parallel controlled clinical trial[J]. Diabetes Care, 2021, 44(6):1324‑1333. DOI: 10.2337/dc20‑2109.

[1035] Meng Z, Xu C, Liu H, et al. Effects of mulberry twig alkaloids(Sangzhi alkaloids) and metformin on blood glucose fluctuations in combination with premixed insulin‑treated patients with type 2 diabetes[J]. Front Endocrinol (Lausanne), 2023, 14:1272112. DOI: 10.3389/fendo.2023.1272112.

[1036] 中国中西医结合学会内分泌专业委员会 . 渴络欣胶囊治疗糖尿病肾脏疾病临床应用专家共识[J].中国中西医结合杂志 , 2020, 40(8): 979‑984. DOI: 10.7661/j.

cjim.20200225.067.

[1037] Zhang W, Zhou J, Wang C, et al. Efficacy and safety of Keluoxin capsule in combination with Western medicine for diabetic kidney disease: a systematic review and meta‑analysis[J]. Front Pharmacol, 2022, 13: 1052852. DOI: 10.3389/fphar.2022.1052852.

[1038] Chen YZ, Gong ZX, Cai GY, et al. Efficacy and safety of Flos Abelmoschus manihot (Malvaceae) on type 2 diabetic nephropathy: a systematic review[J]. Chin J Integr Med, 2015, 21(6):464‑472. DOI: 10.1007/s11655‑014‑1891‑6.

[1039] An W, Huang Y, Chen S, et al. Efficacy and safety of Huangkui capsule for diabetic nephropathy: a protocol for systematic review and meta‑analysis[J]. Medicine (Baltimore), 2021, 100(42): e27569. DOI: 10.1097/MD.0000000000027569.

[1040] Zhao J, Tostivint I, Xu L, et al. Efficacy of combined Abelmoschus manihot and Irbesartan for reduction of albuminuria in patients with type 2 diabetes and diabetic kidney disease: a multicenter randomized double‑blind

parallel controlled clinical trial[J]. Diabetes Care, 2022, 45(7):e113‑e115. DOI: 10.2337/dc22‑0607.

[1041] Lian F, Wu L, Tian J, et al. The effectiveness and safety of a danshen‑containing Chinese herbal medicine for diabetic retinopathy:

randomized,

double‑blind, placebo‑controlled multicenter clinical trial[J]. J Ethnopharmacol, 2015, 164: 71‑77. DOI: 10.1016/j.

jep.2015.01.048.

[1042] Luo XX, Duan JG, Liao PZ, et al. Effect of qiming granule on retinal blood circulation of diabetic retinopathy: a multicenter clinical trial[J]. Chin J Integr Med, 2009, 15(5):384‑388. DOI: 10.1007/s11655‑009‑0384‑5.

[1043] Zhang Y, Shi M, Peng D, et al. QiMing granules for diabetic retinopathy: a systematic review and meta‑analysis of randomized controlled trials[J]. Front Pharmacol, 2024, 15:1429071. DOI: 10.3389/fphar.2024.1429071.

[1044] Zhang Y, Jin D, Duan Y, et al. Efficacy of Mudan granule (combined with methylcobalamin) on type 2 diabetic peripheral neuropathy: study protocol for a double‑blind, randomized,

placebo‑controlled,

parallel‑arm, multi‑center trial[J]. Front Pharmacol, 2021, 12: 676503. DOI: 10.3389/fphar.2021.676503.

[1045] Khalil M, Power N, Graham E, et al. The association between sleep and diabetes outcomes‑a systematic review[J]. Diabetes Res Clin Pract, 2020, 161: 108035. DOI: 10.1016/j.diabres.2020.108035.

[1046] Asgharnezhad M, Joukar F, Fathalipour M, et al. Gastrointestinal symptoms in patients with diabetes mellitus and non‑diabetic: a cross‑sectional study in north of Iran[J]. Diabetes Metab Syndr, 2019, 13(3):2236‑2240. DOI: 10.1016/j.dsx.2019.05.028.

[1047] Hackett RA, Steptoe A. Type 2 diabetes mellitus and psychological stress‑a modifiable risk factor[J]. Nat Rev Endocrinol, 2017, 13(9): 547‑560. DOI: 10.1038/nrendo.2017.64.

[1048] 国家食品药品监督管理局 . 关于印发中药注册管理补充规定的通知 [EB/OL]. (2008‑01‑07) [2024‑11‑27]. https://baike. baidu. com/item/% E4%B8%AD% E8%8D% AF%E6%B3%A8%E5%86%8C% E7%AE% A1%E7%90%86%E8%A1%A5%E5%85%85%E8%A7%84%E5%AE%9A/3390912?fr=ge_ala.

[1049] 全国人民代表大会 . 中华人民共和国中医药法[EB/OL]. (2016‑12‑25)[2024‑11‑27]. http://www.npc.gov.cn/npc/c2/c238/201905/t20190521_282003.html.

[1050] 国家药品监督管理局 . 总局办公厅公开征求《中药经典名方复方制剂简化注册审批管理规定(征求意见稿)》及申报资 料 要 求 ( 征 求 意 见 稿) 意 见 [EB/OL]. (2017‑10‑09) [2024‑11‑27]. https://www. nmpa. gov. cn/xxgk/zhqyj/zhqyjyp/20171009175201197.html.

[1051] 国家中医药管理局 . 古代经典名方目录(第一批) [EB/OL]. (2018‑04‑13) [2024‑11‑27]. https://www. gov.

cn/zhengce/zhengceku/2018‑12/31/content_5429153.

[1052] Chen C, Liu J, Sun M, et al. Acupuncture for type 2 diabetes mellitus: a systematic review and meta‑analysis of randomized controlled trials[J]. Complement Ther Clin Pract, 2019, 36: 100‑112. DOI: 10.1016/j.

ctcp.2019.04.004.

[1053] Li SQ, Chen JR, Liu ML, et al. Effect and safety of acupuncture for type 2 diabetes mellitus: a systematic review and meta‑analysis of 21 randomised controlled trials[J]. Chin J Integr Med, 2022, 28(5): 463‑471. DOI:

10.1007/s11655‑021‑3450‑2.

[1054] Li X, Liu Y, Jing Z, et al. Effects of acupuncture therapy in diabetic neuropathic pain: a systematic review and meta‑analysis[J]. Complement Ther Med, 2023, 78:

102992. DOI: 10.1016/j.ctim.2023.102992.

[1055] Hoerder S, Habermann IV, Hahn K, et al. Acupuncture in diabetic peripheral neuropathy‑neurological outcomes of the randomized acupuncture in diabetic peripheral neuropathy trial[J]. World J Diabetes, 2023, 14(12):1813‑1823. DOI: 10.4239/wjd.v14.i12.1813.

[1056] Shin KM, Lee S, Lee EY, et al. Electroacupuncture for painful diabetic peripheral neuropathy: a multicenter, randomized, assessor‑blinded, controlled trial[J]. Diabetes Care, 2018, 41(10): e141‑e142. DOI: 10.2337/dc18‑1254.

[1057] Fu Q, Yang H, Zhang L, et al. Traditional Chinese medicine foot bath combined with acupoint massage for the treatment of diabetic peripheral neuropathy: a systematic review and meta‑analysis of 31 RCTs[J]. Diabetes Metab Res Rev, 2020, 36(2):e3218. DOI: 10.1002/dmrr.3218.

[1058] Liu X, Miller YD, Burton NW, et al. The effect of Tai Chi on health‑related quality of life in people with elevated blood glucose or diabetes: a randomized controlled trial[J]. Qual Life Res, 2013, 22(7): 1783‑1786. DOI: 10.1007/s11136‑012‑0311‑7.

[1059] Liu X, Zhu H, Peng Y, et al. Twenty‑four week Taichi training improves pulmonary diffusion capacity and glycemic control in patients with type 2 diabetes mellitus[J]. PLoS One, 2024, 19(4):e0299495. DOI: 10.1371/journal.pone.0299495.

[1060] Chen Y, Qin J, Tao L, et al. Effects of Tai Chi Chuan on cognitive function in adults 60 years or older with type 2 diabetes and mild cognitive impairment in China: a randomized clinical trial[J]. JAMA Netw Open, 2023, 6(4):e237004. DOI: 10.1001/jamanetworkopen.2023.7004.

[1061] Kong L, Ren J, Fang S, et al. Effects of traditional Chinese mind‑body exercise‑Baduanjin for type 2 diabetes on psychological well‑being: a systematic review and meta‑analysis[J]. Front Public Health, 2022, 10: 923411. DOI: 10.3389/fpubh.2022.923411.

[1062] Luo X, Zhao M, Zhang Y, et al. Effects of baduanjin exercise on blood glucose, depression and anxiety among patients with type Ⅱ diabetes and emotional disorders: a meta‑analysis[J]. Complement Ther Clin Pract, 2023, 50:

101702. DOI: 10.1016/j.ctcp.2022.101702.

相关指南

• 中国成人2型糖尿病合并心肾疾病患者降糖药物临床应用专家共识 · 内分泌与代谢 2020
• 中国老年糖尿病诊疗指南(2021年版) · 内分泌与代谢 2021
• 中国老年2型糖尿病胰岛素抵抗诊疗专家共识（2022版） · 内分泌与代谢 2022
• 中国寒冷地区2型糖尿病患者管理多学科专家共识 · 内分泌与代谢 2023
• 中国2型糖尿病防治指南(2020年版) · 内分泌与代谢 2021
• 2型糖尿病基层诊疗指南(实践版·2019) · 内分泌与代谢 2019
• 糖尿病肾脏疾病中西医结合诊疗指南(2023版) · 内分泌与代谢 2023
• 钠-葡萄糖共转运蛋白2抑制剂联合二甲双胍治疗2型糖尿病专家共识 · 内分泌与代谢 2023