糖尿病神经病变:2017 年美国糖尿病协会立场声明(精华)

2016-12-27 07:00 来源:丁香园 作者:王新军
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● Optimize glucose control as early as possible to prevent or delay the development of distal symmetric polyneuropathy and cardiovascular autonomic neuropathy in people with type 1 diabetes. A

尽早优化血糖控制以预防或延缓 1 型糖尿病患者的远端对称性多神经病变和心血管自主神经病变的发展。A

● Optimize glucose control to prevent or slow the progression of distal symmetric polyneuropathy in people with type 2 diabetes. B

优化血糖控制,以预防或延缓 2 型糖尿病患者远端对称性多神经病变的进展。B

● Consider a multifactorial approach targeting glycemia among other risk factors to prevent cardiovascular autonomic neuropathy in people with type 2 diabetes. C

考虑包括控制血糖等多种危险因素的多种方法,以预防 2 型糖尿病患者的心血管自主神经病变。 C

● All patients should be assessed for distal symmetric polyneuropathy starting at diagnosis of type 2 diabetes and 5 years after the diagnosis of type 1 diabetes and at least annually thereafter. B

所有患者应该在诊断 2 型糖尿病时和诊断 1 型糖尿病 5 年后评估远端对称性多神经病变,以后至少每年筛查 1 次。B

● Consider screening patients with prediabetes who have symptoms of peripheral neuropathy. B

具有周围神经病变症状的糖尿病前期患者考虑筛查远端对称性多神经病变。B

● Assessment should include a careful history and either temperature or pinprick sensation (small-fiber function) and vibration sensation using a 128-Hz tuning fork (large-fiber function). All patients should have an annual 10-g monofilament testing to assess for feet at risk for ulceration and amputation. B

评估应包括仔细询问历史、温度觉或针刺觉(小纤维功能)和使用 128-Hz 音叉评估振动觉(大纤维功能)。 所有患者应每年进行 10 克单丝测试评估足溃疡和截肢的风险。B

● Electrophysiological testing or referral to a neurologist is rarely needed for screening, except in situations where the clinical features are atypical, the diagnosis is unclear, or a different etiology is suspected. Atypical features include motor greater than sensory neuropathy, rapid onset, or asymmetrical presentation. B

很少需要电生理检查或转诊到神经病学医师筛查,除非在临床特征不典型、诊断不清或怀疑其他病因时。非典型特征包括运动神经病变比感觉神经病变更严重、快速发作或表现不对称。 B

●Tight glucose control targeting near-normal glycemia in patients with type 1 diabetes dramatically reduces the incidence of distal symmetric polyneuropathy and is recommended for distal symmetric polyneuropathy prevention in type 1 diabetes. A

1 型糖尿病患者严格控制血糖接近正常可显著降低远端对称性多神经病变的发生率,并且建议用于 1 型糖尿病中的远端对称性多神经病的预防。A

● In patients with type 2 diabetes with more advanced disease and multiple risk factors and comorbidities, intensive glucose control alone is modestly effective in preventing distal symmetric polyneuropathy and patient-centered goals should be targeted. B

在患有晚期疾病和多种危险因素及合并症的 2 型糖尿病患者中,仅仅强化血糖控制在防止远端对称性多神经病方面效果有限,应该制定以患者为中心的目标。B

●Lifestyle interventions are recommended for distal symmetric polyneuropathy prevention in patients with prediabetes/metabolic syndrome and type 2 diabetes. B

建议糖尿病前期/代谢综合征和 2 型糖尿病患者进行生活方式干预预防远端对称性多神经病变。B

● Consider either pregabalin or duloxetine as the initial approach in the symptomatic treatment for neuropathic pain in diabetes. A

考虑首选普瑞巴林或度洛西汀治疗糖尿病神经性疼痛的症状。A

● Gabapentin may also be used as an effective initial approach, taking into account patients』 socioeconomic status, comorbidities, and potential drug interactions. B

加巴喷丁也是用于初始治疗的有效方法,应考虑患者的社会经济地位、合并症和潜在的药物相互作用。B

● Although not approved by the U.S. Food and Drug Administration, tricyclic antidepressants are also effective for neuropathic pain in diabetes but should be used with caution given the higher risk of serious side effects. B

尽管没有被美国食品和药物管理局(FDA)批准,三环类抗抑郁药对于糖尿病神经性疼痛也是有效的,但是由于具有较高的严重副作用的风险,应当谨慎使用。B

● Given the high risks of addiction and other complications, the use of opioids, including tapentadol or tramadol, is not recommended as first- or second-line agents for treating the pain associated with DSPN. E

鉴于成瘾和其他并发症的风险较高,不推荐使用阿片类药物包括他喷他多或曲马多作为治疗与远端对称性多神经病变(DSPN)相关疼痛的一线或二线药物。E

● Tests assessing gait and balance may be considered in people with distal symmetric polyneuropathy to evaluate the risk of falls. E

在远端对称性多神经病变患者,可以考虑评估步态和平衡的测试,以评估跌倒的风险。E

● Consider treatment with duloxetine, pregabalin, and gabapentin to improve quality of life in patients with neuropathic pain. C

考虑使用度洛西汀、普瑞巴林和加巴喷丁治疗以改善神经性疼痛患者的生活质量。C

● Assess the effects of distal symmetric polyneuropathy on quality of life to improve adherence and response to neuropathic pain treatment. E

评估远端对称性多神经病变对生活质量的影响,以提高对神经性疼痛治疗的依从性和反应。E

● Symptoms and signs of autonomic neuropathy should be assessed in patients with microvascular and neuropathic complications. E

应该在患有微血管病变和神经病变并发症的患者,评估自主神经病变的症状和体征。E

● In the presence of symptoms or signs of cardiovascular autonomic neuropathy, tests excluding other comorbidities or drug effects/ interactions that could mimic  ardiovascular autonomic neuropathy should be performed. E

存在心血管自主神经病的症状或体征的情况下,应进行相关检查排除其它合并症或可出现类似心血管自主神经病变的药物效应/相互作用。E

● Consider assessing symptoms and signs of cardiovascular autonomic neuropathy in patients with hypoglycemia unawareness. C

考虑评估无感知性低血糖患者的心血管自主神经病变的症状和体征。C

● Optimize glucose control as early as possible to prevent or delay the development of cardiovascular autonomic neuropathy in people with type 1 diabetes. A

尽早优化血糖控制以预防或延缓 1 型糖尿病患者的心血管自主神经病变的发展。A

● Consider a multifactorial approach targeting glycemia among other risk factors to prevent cardiovascular autonomic neuropathy in people with type 2 diabetes. C

考虑针对等多种高血糖等多种危险因素的治疗方法,以预防 2 型糖尿病患者的心血管自主神经病变。C

● Consider lifestyle modifications to improve cardiovascular autonomic neuropathy in patients with prediabetes. C

考虑改善生活方式以改善糖尿病前期患者的心血管自主神经病变。C

● Evaluate for gastroparesis in people with diabetic neuropathy, retinopathy, and/or nephropathy by assessing for symptoms of unexpected glycemic variability, early satiety, bloating, nausea, and vomiting. C

通过评估意外血糖变异、早饱、腹胀、恶心和呕吐的症状,评估糖尿病性神经病变、视网膜病变和/或糖尿病肾病患者的胃轻瘫。C

● Exclusion of other causes documented to alter gastric emptying, such as use of opioids or glucagonlike peptide 1 receptor agonists and organic gastric outlet obstruction, is needed before performing specialized testing for gastroparesis. C

在进行专门的胃轻瘫测试之前,需要排除其他改变胃排空的原因,例如使用阿片类药物或胰高血糖素样肽 1 受体激动剂和器质性胃出口阻塞。C

● To test for gastroparesis, either measure gastric emptying with scintigraphy of digestible solids at 15-min intervals for 4 h after food intake or use a 13C-octanoic acid breath test. B

为检查胃轻瘫,在食物摄入后以 15 分钟间隔连续 4 小时用可消化的固体闪烁扫描法进行胃排空试验或使用 13C-辛酸呼气试验。B

● Consider short-term metoclopramide in the treatment of diabetic gastroparesis. E

考虑短期甲氧氯普胺治疗糖尿病性胃轻瘫。E

● Consider screening men with other forms of diabetic neuropathy annually for erectile dysfunction with simple questions about a patient’s libido and ability to reach and maintain an erection. C

应用询问患者的性欲和达到并维持勃起能力等简单问题,筛查具有其他形式糖尿病性神经病变的男性患者的勃起功能障碍。C

● Consider screening patients with other forms of diabetic neuropathy for lower urinary tract symptoms and female sexual dysfunction in the presence of recurrent urinary tract infections using targeted questioning regarding symptoms, such as nocturia, pain during intercourse, and others. E

存在反复尿路感染的糖尿病神经病变的患者,考虑询问特定症状(例如夜尿、性交疼痛和其他症状),筛查下尿路症状和女性性功能障碍。E

(注:原文共 19 页,内容较多,本文仅翻译了其执行纲要部分,如要了解更多内容,请阅读原文)

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