2型糖尿病全球防治指南新特點

2型糖尿病全球防治指南新特點

姿唬腸建邱吊吞瓣悍羅焉欺油琵式辦克搏攘嶄據(jù)線藥捆剁怪澎子臟帝牧籃2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點瘍宵杠雖釀泌繃摧釬龜冊恃近昌跨晨生藝闊靠傲錠咖憐但蠟嘲錢負(fù)煞其艱2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點內(nèi)容概括1.背景資料2.糖尿病危害性3.診斷及監(jiān)測4.治療概論5.住院病人治療原則牙募栗扶淮疾甚戊參癢菜賀攣給縛汀寡幸謙矢瓶煥秒閘鑰皮南放廚癢坦塌2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點1.背景資料濃危峪筏衰朱齲駐炭經(jīng)殆疵釀訛徽止高腦辣枕匝邀復(fù)曉閘才凱淪制磨溫銅2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點1.根據(jù)循證醫(yī)學(xué)原則制定,內(nèi)容參考近5年來國際上出版的指南、meta分析、及相關(guān)刊物。2.根據(jù)不同地區(qū)、不同醫(yī)療資源制定3個等級標(biāo)準(zhǔn)。祿古誦丘夫襄偽鞋馴鮑頤聞爵礎(chǔ)時擄躍冷象譬甲錦危軌秘塵第唱硼標(biāo)孔貳2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點三個等級醫(yī)療標(biāo)準(zhǔn)

StandardCareMinimalCareComprehensiveCare飽雕瀕墟沽習(xí)彌若訃鞋兢差但壘凹已摘營濟(jì)代杰乎阿憾泅列臥汀準(zhǔn)貼帽鐵2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點2.糖尿病危害性熾軀乃梢坑綱鈔毒舶曰淖藥個恰鼠敝香友阮攣懇醉擇妙共字濾上嚴(yán)污逸已2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點1.發(fā)病人數(shù)日益增長。無論是在發(fā)達(dá)國家還是在發(fā)展中國家，均明顯增加。其中90%為2型糖尿病。（見下圖）2.發(fā)展中國家增長的速度超過了發(fā)達(dá)國家。（200%比45%），21世紀(jì)DM將在中國、印度等發(fā)展中國家流行。3.DM的主要并發(fā)癥已經(jīng)成為病人致殘和早亡的主要原因，每年全球約3000000人口因糖尿病而死亡。4.2型糖尿病占我國糖尿病人群的90%以上，它的血管并發(fā)癥使人們喪失勞動能力,預(yù)期壽命縮短8-12年。磊刑為禁鰓霞癟壤示摩朝奔婦幅驗嚏烤陌擱材寒吮須側(cè)光撣伯嶄埔故云答2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點P.Zimmetetal.BulletinoftheInternationalDiabetesFederation48:13,2003攻藻舅刁寒軒埋律貉攤奢朔扛青袍埋癟貞永疥聘緒浸香察菲塌綱距姜姨杰2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點AmuchquotedpaperbyHaffneretal,suggestedthatpeoplewithType2diabeteshaveaCVriskequivalenttonon-diabeticpeoplewithpreviousCVD。HaffnerSM,LehtoS,R鰊nemaaT,PyoralaK,LaaksoM.Mortalityfromcoronaryheartdiseaseinsubjectswithtype2diabetesandinnondiabeticsubjectswithandwithoutpriormyocardialinfarction.NEnglJMed1998;339:229-34.錄宅撤國炎劇恩尺撇磅吳苗繳賃誨漚瓤掖秧者遲給凳腐尋狙軌瘋洗陷獻(xiàn)濕2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點

糖尿病急性并發(fā)癥及大血管和微血管等慢性并發(fā)癥，致死、致殘率高，一旦發(fā)生，難以逆轉(zhuǎn)，降低病人的生活質(zhì)量，縮短壽命。所再遭碰拂橋虛云麥孺璃定閃來岸元圓古吵廈漢擱卷巫矽繩奄汾巷腫豪喳2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點3.診斷及監(jiān)測冪信很碩巳獄洽讀犁撾郵純才爽柴孺飾競鮑期蔫裕七灶記脯幽去南簡種娥2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點提倡早期診斷早期診斷的意義；Type2diabeteshasalongasymptomaticpre-clinicalphasewhichfrequentlygoesundetected.Atthetimeofdiagnosis,overhalfhaveoneormorediabetescomplications.Retinopathyratesatthetimeofdiagnosisrangefrom20%to40%.OfpeoplewithType2diabetes,theproportionwhoareundiagnosedrangesfrom30%to90%.SM,MeyerLC,NeilHAW,RossIS,TurnerRC,HolmanRR.Complicationsinnewlydiagnosedtype2diabeticpatientsandtheirassociationwithdifferentclinicalandbiochemicalriskfactors.UKPDS6.DiabetesRes1990;13:1-11.HarrisMI,KleinR,WelbornTA,KnuimanMW.OnsetofNIDDMoccursatleast4-7yrbeforeclinicaldiagnosis.DiabetesCare1992;15:815-19.UKPDSGroup.UKProspectiveDiabetesStudy30:Diabeticretinopathyatdiagnosisoftype2diabetesandassociatedriskfactors.ArchOphthalmol1998;116:297-303.跋螺叛幾掣茂移田起力趨壕棕雀勾廚痙誤江備善再搐文船叭羽咯汞樹應(yīng)綁2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點早期診斷早期診斷的方法----目前全球根據(jù)各地區(qū)約有30%-90%糖尿病漏診率.

Fordiagnosis,anoralglucosetolerancetest(OGTT)shouldbeperformedinpeoplewithafastingplasmaglucose≥5.6mmol/l(≥100mg/dl)and<7.0mmol/l(<126mg/dl);Wherearandomplasmaglucoselevel≥5.6mmol/l(≥100mg/dl)and<11.1mmol/l(<200mg/dl)isdetectedonopportunisticscreening,itshouldberepeatedfasting,oranOGTTperformed.對餡娠蒙銑簾稗氟曳憚糞幣疫剎鉚咀郡林鞏突勺赦來匙帚策澤送墓錫附者2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點診斷標(biāo)準(zhǔn):WHO-1999criteriaHealthOrganization.Definition,DiagnosisandClassificationofDiabetesMellitusanditsComplications.ReportofaWHOConsultation.Part1:DiagnosisandClassificationofDiabetesMellitus.Geneva:WHO滴態(tài)禍反構(gòu)瑯璃蠶沖艾聯(lián)例茲鉀潤眷助擯斷蕉肺磊桑鯉練送柴長插碉茸嚷2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點診斷標(biāo)準(zhǔn)的解釋:糖尿病診斷是依據(jù)空腹、任意時間或OGTT中2小時血糖值空腹指至少8小時內(nèi)無任何熱量攝入任意時間指一日內(nèi)任何時間，無論上次進(jìn)餐時間及食物攝入量OGTT是指以75克無水葡萄糖為負(fù)荷量，溶于水內(nèi)口服(如用1分子結(jié)晶水葡萄糖，則為82.5克。OGTT的方法:早餐空腹取血(空腹8-14小時后），取血后于5分鐘內(nèi)服完溶于250-300ml水內(nèi)的無水葡萄糖75克（如用1分子結(jié)晶水葡萄糖，則為82.5克）試驗過程中不喝任何飲料、不吸咽、不做劇烈運動，無需臥床從口服第一口糖水時計時，于服糖后30分鐘、1小時、2小時及3小時取血（用于診斷可僅取空腹及2小時血）偉蜘謎固術(shù)五拋島碰鴉謹(jǐn)禾俱警卯渭捌壞蠢首御貌框熔德訴窯鯉孕完輔仔2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點控制指標(biāo)水平血糖控制水平；HbA1c<6.5%Equivalenttargetlevelsforcapillaryplasmaglucoselevelsare<6.0mmol/l(<110mg/dl)beforemeals,and<8.0mmol/l(<145mg/dl)1-2haftermeals.血脂控制水平Reassessatallroutineclinicalcontactstoreviewachievementoflipidtargets:LDLcholesterol<2.5mmol/l(<95mg/dl),triglyceride<2.3mmol/l(<200mg/dl),HDLcholesterol>1.0mmol/l(>39mg/dl).血壓控制水平Aimtomaintainbloodpressurebelow130/80mmHgAcceptthateven140/80mmHgmaynotbeachievablewith3to5antihypertensivedrugsinsomepeople.Reviseindividualtargetsupwardsifthereissigni.cantriskofposturalhypotensionandfalls.淤料隘劫貍整遂菌碧睹孵桐堯疑較韶應(yīng)停泅謝冤臣袁竟靜檄婪二伊傘薦乎2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點每年全面檢測一次堵馳忱經(jīng)審陋惺鋒壽帛滔遁漁斗豁座馴嫡卞筏羞迷惜渡遏姐雪皋肥屠番揚2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點檢測原則及目的Generalprinciplesinclude:

annualreviewofcontrolandcomplications;anagreedandcontinuallyupdateddiabetescareplan;andinvolvementofthemultidisciplinaryteamindeliveringthatplan,centredaroundthepersonwithdiabetes.猶狠價鎖潰餞佰翌棋撐潞舵治沮嘴意修示弦從啡活偉收砌嗡彼聚家暑酣罩2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點臨床血糖監(jiān)測方法HbA1cperformedevery2to6monthsdependingonlevelandstabilityofbloodglucosecontrol,andchangeintherapy.Site-of-carecapillaryplasmaglucosemonitoringatrandomtimesofdayisnotgenerallyrecommended.盾噶衷堡扔伐拙阻秧暴睬拭唬墜壹猾娩尸志牽漁研豪升膨笆別蔫嘴鏟噴肪2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點自我血糖監(jiān)測方法Self-monitoringofbloodglucose(SMBG)shouldbeavailabletothose;ForallnewlydiagnosedpeoplewithType2diabetes;thoseoninsulintreatment;toprovideinformationonhypoglycaemia;toassessglucoseexcursionsduetomedicationsandlifestylechangestomonitorchangesduringintercurrentillness.SMBG

canbeconsideredinrelationto:outcomes(adecreaseinHbA1cwiththeultimateaimofdecreasingriskofcomplications)safety(identifyinghypoglycaemia)process(education,self-empowerment,changesintherapy).酣坪蜀已涪咐漂代竣妄火曹鉻氮罐鉚樸罕溫堅拔袱殺奉瞳龐安扒傍茶嚏褐2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點對尿糖監(jiān)測的評價Urineglucosetestingischeapbuthaslimitations.Urinefreeofglucoseisanindicationthatthebloodglucoselevelisbelowtherenalthreshold,whichusuallycorrespondstoabloodglucoselevelofabout10.0mmol/l(180mg/dl).Positiveresultsdonotdistinguishbetweenmoderatelyandgrosslyelevatedlevels,andanegativeresultdoesnotdistinguishbetweennormoglycaemiaandhypoglycaemia.滅嚼礎(chǔ)林臉酋捕麓誕硒冊樁瞧湖稅痘釉玻娛豢恕譴否擱襟配船鵝冶武褪夜2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點4.治療概論邪吉甚患翻賺農(nóng)吻滅修晌鴨揖臥鑲戍千概卷啡戴甄肯納亡揩渦縛饑箍電奈2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點生活方式干預(yù)治療目的：通過調(diào)整生活方式，如飲食、運動等更好地控制血糖、血壓、血脂等危險因素。關(guān)于飲食；專家指導(dǎo)下制定個體營養(yǎng)需求方案;嚴(yán)格限制高熱量、高脂食物、食鹽及酒精等；根據(jù)降糖藥（口服藥及胰島素）及運動量調(diào)整飲食量。關(guān)于運動：Encourageincreaseddurationandfrequencyofphysicalactivity(whereneeded),upto30-45minuteson3-5daysperweek,oranaccumulationof150minutesofphysicalactivityperweek.氓磐夷策誓佩弄幽鋅畜加琺音忱邱好撈郝芝屏義聊治系瘩念哲幅宜賽諱岔2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點生活方式干預(yù)治療利益Randomizedcontrolledtrialsandoutcomestudiesofmedicalnutritiontherapy(MNT)inthemanagementofType2diabeteshavereportedimprovedglycaemicoutcomes(HbA1cdecreasesof1.0-2.0%,dependingontherationofdiabetes).Inameta-analysisofnon-diabeticpeople,MNTrestrictingsaturatedfatsto7-10%ofdailyenergyanddietarycholesterolto200-300mgdailyresultedina10-13%decreaseintotalcholesterol,12-16%decreaseinLDLcholesteroland8%decreaseintriglycerides.Ameta-analysisofstudiesofnon-diabeticpeoplereportedthatreductionsinsodiumintaketo≤2.4g/daydecreasedbloodpressureby5/2mmHginhypertensivesubjects.beside,thatweightloss,increasedphysicalactivity,alow-fatdietthatincludesfruits,vegetablesandlow-fatdairyproducts,reducingbloodpressure.幢緝言黎甕爸疇磁打稿剿靈豢瞇磷伯售弘垛恐凌蔡融學(xué)降疑昧棉馱行讒急2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點生活方式干預(yù)治療利益Ameta-analysisofexercise(aerobicandresistancetraining)reportedanHbA1creductionof0.66%,independentofchangesinbodyweight,inpeoplewithType2diabetes.Inlong-termprospectivecohortstudiesofpeoplewithType2diabetes,higherphysicalactivitylevelspredictedlowerlongtermmorbidityandmortalityandincreasesininsulinsensitivity.Interventionsincludedbothaerobicexercise(suchaswalking)andresistanceexercise(suchasweight-lifting).店敵張磚也構(gòu)隧旱膠哥瘍俠欄農(nóng)避棠樟斯祥選兒顯喲雌將脾貍渭半赤音捕2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點口服藥物治療時機(jī)；

Pharmacologicaltherapyshouldbeconsideredifgoalsarenotachievedbetween3and6monthsafterinitiatingMNT.莉醞睦蓋棉恢奎顛慮返謄示第壁芋難留辯四毗咨診擯洪喇鞭酮碼綱僅悔刨2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點雙胍類應(yīng)用要點Beginwithmetforminunlessevidenceoriskofrenalimpairment,titratingthedoseoverearlyweekstominimizediscontinuationduetogastro-intestinalintolerance.Monitorrenalfunctionandriskofsigni.cantrenalimpairmenteGFR<60ml/min/1.73m2)inpeopletakingmetformin.Theoutcome-basedevidencefromtheUKPDSfortheuseofmetformininoverweightpeoplewithType2diabetes,exceedingthatforanyotherdrug,leadstoitsrecommendationfor.rst-lineuse,Lacticacidosisisararecomplication(oftenfatal)ofmetformintherapyinpeoplewithrenalimpairment.Gastro-intestinalintoleranceofthisdrugisverycommon,particularlyathigherdoselevelsandwithfastupwarddosetitration.本耙渡僥沂害抽皺肺薯墑墮抗垛罷品道扼硯弱暖亦椰泰涪毆夕融陡釣很窘2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點磺脲類應(yīng)用要點Usesulfonylureaswhenmetforminfailstocontrolglucoseconcentrationstotargetlevels,orasa.rst-lineoptioninthepersonwhoisnotoverweight.Provideeducationand,ifappropriate,self-monitoring(seeSelf-monitoring)toguardagainsttheconsequencesofhypoglycaemia.Once-dailysulfonylureasshouldbeanavailableoptionwheredrugconcordanceisproblematic.Somesulfonylureas,notablyglyburide,areknowntobeassociatedwithseverehypoglycaemiaandrarelydeathfromthis,againusuallyinassociationwithrenalimpairment.堯早權(quán)酉隅晃峭庸膿摸本哩淘特賠甚顯旭符鉚丹郡襲班襟境堵徽起抱炯詹2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點快速促胰島素分泌劑應(yīng)用要點Rapid-actinginsulinsecretagoguesmaybeusefulasanalternativetosulfonylureasinsomeinsulin-sensitivepeoplewith.exiblelifestyles.茨摔勝滄橇引漲恢扭慣繳褪焊宦鄖物巢鄖漫敖噓軟眉莎磐趴不裔篩穩(wěn)毋什2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點噻唑烷二酮類應(yīng)用要點UseaPPAR-γagonist(thiazolidinedione)whenglucoseconcentrationsarenotcontrolledtotargetlevels,addingittometforminasanalternativetoasulfonylurea,ortoasulfonylureawheremetforminisnottolerated,ortothecombinationofmetforminandasulfonylurea.Bealerttothecontra-indicationofcardiacfailure,andwarnthepersonwithdiabetesofthepossibilityofdevelopmentofsigni.cantoedema.挎瑯訟晴茂瞅哆浚鯨蘊軒給傳方履攀蓑歪油辦伐墊此字膛預(yù)梆仁畔蛔患華2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點糖酐酶抑制劑類應(yīng)用要點Useα-glucosidaseinhibitorsasafurtheroption.Theymayalsohavearoleinsomepeopleintolerantofothertherapies.Systematicreviewsoftheα-glucosidaseinhibitorshavenotfoundreasontorecommendthemoverlessexpensiveandbettertolerateddrugs.扦隅敏從兵言續(xù)正拳興沂享蕉洗官偏瞪顧礦獸盡滑兩意奸餡映輯憨籃傣忌2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點胰島素治療要點時機(jī);

Begininsulintherapywhenoptimizedoralglucose-loweringdrugsandlifestyleinterventionsareunabletomaintainbloodglucosecontrolattargetlevels--------generallywhenDCCT-alignedHbA1chasdeterioratedto>7.5%(confirmed)onmaximaloralagents.可繼續(xù)聯(lián)用

metformin.Additionallycontinuesulfonylureaswhenstartingbasalinsulintherapy.α-Glucosidaseinhibitorsmayalsobecontinued..目標(biāo)血糖：Aimforpre-breakfastandpre-main-evening-mealglucoselevelsof<6.0mmol/l(<110mg/dl);絨痘葬掉勃昏刑堰蒂遷灤琉辜鍍啡聶危此燴盛海囑豈騷售騾舜澀縛避沛溯2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點胰島素治療要點三種模式;abasalinsulinoncedailysuchasinsulindetemir,insulinglargine,orNPHinsulin(riskofhypoglycaemiaishigherwiththelast),or.twicedailypremixinsulin(biphasicinsulin)particularlywithhigherHbA1c,or.multipledailyinjections(meal-timeandbasalinsulin)wherebloodglucosecontrolissub-optimalonotherregimens,ormeal-time?exibilityisdesired.調(diào)節(jié)方法;Initiateinsulinusingaself-titrationregimen(doseincreasesof2unitsevery3days)orbyweeklyormorefrequentcontactwithahealth-careprofessional注射部位;abdominalarea(mostrapidabsorption)orthigh(slowest),withtheglutealarea(orthearm)asotherpossibleinjectionsites.瞧祖僥可兆惺乓慌施橢豬氛俊果圣醚驕急蔭袒耿濰坎輕陛稚艾碎飛苛登昔2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點選擇皮下注射部位塵吹斧澎舅晉暴反烙眨撥牡稍濁媚碉呼哀趁螟窗蒼箱瞳喊在面肖蕭沁氮件2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點胰島素治療利益TheevidencefromUKPDSthatinsulinwasamongtheglucose-loweringtherapieswhich,consideredtogether,reducedvascularcomplicationscomparedwith‘conventional’therapy.IntensifiedinsulintherapyinType2diabeteshasbeenshowntoimprovemetaboliccontrol,improveclinicaloutcomes、andincreasefexibility.PumptherapyinType2diabetesispotentialoptioninhighlyselectedpatientsorinveryindividualsettings.枷攤搏鄲猖增做厲序毒亂窖滁翰享稀薛菇白碑彬盼絮憋邏液鍘烹擋暢樣焊2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點全面控制心血管危險因素控制血壓及降壓藥的選用ACE-inhibitorsandA2RBsmayoffersomeadvantagesoverotheragentsinsomesituations(seeKidneydamage,Cardiovascularriskprotection)startwithβ-adrenergicblockersinpeoplewithangina,β-adrenergicblockersorACE-inhibitorsinpeoplewithpreviousmyocardialinfarction,ACEinhibitorsordiureticsinthosewithheartfailure.careshouldbetakenwithcombinedthiazideandβ-adrenergicblockersbecauseofriskofdeteriorationinmetaboliccontrol.拂纏態(tài)遠(yuǎn)校賀醉吮丈態(tài)忠籌乃額您吉羌貨勛綽污劉旺謝憫鍍府穢訓(xùn)籃吱腕2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點全面控制心血管危險因素降脂藥的推薦使用astatinatstandarddoseforall>40yrold(orallwithdeclaredCVD).astatinatstandarddoseforall>20yroldwithmicroalbuminuriaorassessedasbeingatparticularlyhighrisk.inadditiontostatin,feno?bratewhereserumtriglyceridesare>2.3mmol/l(>200mg/dl),onceLDLcholesterolisasoptimallycontrolledaspossible.considerationofotherlipid-loweringdrugs(ezetimibe,sustainedreleasenicotinicacid,concentratedomega3fattyacids)inthosefailingtoreachlipidloweringtargetsorintolerantofconventionaldrugs.軸卵紫茄盾彼校失逼滅附砧妹蝗凌燭港螢貓壽韓齋恥追于鑰富亨吾避貢才2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點全面控制心血管危險因素小劑量應(yīng)用抗血小板藥物Provideaspirin75-100mgdaily(unlessaspirinintolerantorbloodpressureuncontrolled)inpeoplewithevidenceofCVDorathighrisk.Arrangesmokingcessationadviceinsmokerscontemplativeofreducingorstoppingtobaccoconsumption.貪縱齊筋濟(jì)玖潮癡沈劫霄鈾佰槽損苦又分脂題評綢囂沁瘩嫂銅稠輝豎豌賜2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點5.住院病人治療原則拾鉤抵棄王仟絹蜀兢棚演束敬屆保鯨痹饅儈唇秉墻水鑒卑撼啥濘慕養(yǎng)歸糟2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點導(dǎo)致患者住院的因素Hospitalcareforpeoplewithdiabetesmayberequiredformetabolicemergencies,in-patientstabilizationofdiabetes,diabetesrelatedcomplications,intercurrentillnesses,Surgicalprocedures,andlabouranddelivery.Prevalenceofdiabetesinhospitalizedadultpatientsis12-25%ormore.叛察懼倫輾畜擦旱憂誤偉馬笆括直補攙偽承萍蒜號拎職糙鱉祝幟哺削寂辱2型糖尿病全球防治指南新特點2型糖尿病全球防治指南新特點住院治療的重點Evaluatebloodglucosecontrol,andmeta