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背景在世界范围内,2型糖尿病(T2DM)以及其相关并发症的流行率导致社会经济负担越来越高。目标本指南旨在提供以循证医学为基础的2型糖尿病预防建议。方法欧洲多学科联盟对目前采用SIGN标准对2型糖尿病患者进行筛查和干预有效性评估的研究进行系统性回顾。结果肥胖和久坐生活方式属于主要的可控风险因素。年龄和种族属于不可控风险因素。病例发现,应该采取分步进行(step-wise)的程序使用风险问卷调查和OGTT。糖耐量减低和/或空腹血糖受损者属于高危人群,应该区分优先次序给予强化干预。在高危成人人群,生活方式干预可延缓2型糖尿病的发生。这需要社会各团体支持以创造利于提高健康的环境。保持减重效果(体重下降≥5%)可降低风险。目前,二甲双胍(metformin)、阿卡波糖(acarbose)和奥利司他(orlistat)考虑用于预防糖尿病的二线治疗。在儿童青少年和贫困人群,应该采用针对性的有计划的特殊途径,提高糖尿病预防的认识,进而改变生活方式。获得社会支持的饮食和体育锻炼的生活方式干预更有效。成本效益分析应该纳入社会视角。结论在高危人群,生活方式干预是有成本效益的,应该融入经评估的护理模型。有效的预防计划基于持久的政府倡议,包括宣传、社区支持、财政和立法方面的支持、民营部门以及新闻媒体的参与。
Background Worldwide, the prevalence of type 2 diabetes (T2DM) and its associated complications has led to increasing socio-economic burdens. Objectives The purpose of this guideline is to provide advice on the prevention of type 2 diabetes based on evidence-based medicine. Methods A European multidisciplinary coalition systematically reviewed the current studies that used the SIGN criteria for screening and assessing the effectiveness of interventions in patients with type 2 diabetes. Results Obesity and sedentary lifestyle are the major controllable risk factors. Age and ethnicity are uncontrollable risk factors. The case was found to be a step-wise procedure using a risk questionnaire and OGTT. Patients with impaired glucose tolerance and / or impaired fasting glucose are at high risk and should be prioritized for intensive intervention. In high-risk adult populations, lifestyle interventions can delay the onset of type 2 diabetes. This requires the support of all sectors of society to create an environment conducive to health promotion. Maintaining weight loss (weight loss ≥ 5%) reduces the risk. Currently, metformin, acarbose and orlistat are considered for second-line therapy for the prevention of diabetes. In children and adolescents and poor people, targeted and planned special approaches should be adopted to raise awareness of diabetes prevention and thus change the way of life. Life-style interventions for socially supported diets and physical activity are more effective. Cost-benefit analysis should be integrated into the social perspective. Conclusion In high-risk groups, lifestyle interventions are cost-effective and should be integrated into the assessed care model. Effective prevention programs are based on enduring government initiatives that include advocacy, community support, financial and legislative support, the private sector and the media.