生活方式之基础治疗
1、The principles of lifestyle management are as for Standard care.
生活方式治疗之原则同标准治疗。
2、Offer basic nutrition guidelines (healthy food choices) for improved glycaemic control.
提供基本的饮食指南（健康食物选择），改善患者的血糖控制。
3、Advise on ways to reduce energy intake (carbohydrate, fat, alcohol as appropriate).
提供减少能量摄入（碳水化合物、脂肪和酒精是比较合适的）方法的建议
4、Provide nutritional counselling from someone with training in nutrition therapy, around the time of diagnosis, then as assessed as being necessary, or more often as required or requested.
在诊断不久即从受过营养治疗训练的人那里获得营养方面的咨询，在需要时进行评估，必要时可以增加评估的频度。
5、Advise and encourage participation in regular physical activity.
建议和鼓励患者参加常规的体力活动。
生活方式之标准治疗
1、Advise people with Type 2 diabetes that lifestyle modifi cation, by changing patterns of eating and physical activity, can be effective in controlling many of the adverse risk factors found in the condition.
建议2型糖尿病患者进行生活方式的调整，改变饮食习惯和体力活动，可以有效改善多种危险因素。
2、Provide access to a dietitian (nutritionist) or other health-care professional trained in the principles of nutrition, at or around the time of diagnosis, offering one initial consultation with two or three follow-up sessions,individually or in groups.
在诊断当时或不久就与一位饮食学家（营养学家）或者其他受过饮食方面训练的医疗专业人员取得联系，分别就单独的或者综合2－3次随访来获得一个最初的咨询意见。
3、Provide ongoing counselling and assessment yearly as a routine, or more
often as required or requested, and when changes in medication are made.
将每年的跟踪咨询和评估形成常规，如果需要调整药物或者有必须需要时增加其频度。
4、Individualize advice on food/meals to match needs, preferences, and culture.
根据每个人的具体需要，代谢参数和文化来提供个体化的饮食建议。
5、 Advise control of foods with high amounts of sugars, fats or alcohol.
建议控制高糖，高脂或高酒精饮食。
6、 Integrate drug therapy, where needed, into the individual’s chosen lifestyle.
需要的时候将药物治疗列入个体的生活方式选择的考虑因素中。
7、For people choosing to use fixed insulin regimens, advise consistent carbohydrate intake at meals. For these people, as well as those on flexible meal-time + basal insulin regimens, offer education on assessment of carbohydrate content of different types of foods.
对于那些选择应用胰岛素制剂的人群，建议他们在餐时摄入定量的碳水化合物.对于这些患者和进餐时间灵活＋基础胰岛素制剂的患者，都需要给予相应的不同食物碳水化合物含量评估的教育。
8、 Provide advice on the use of foods in the prevention and management of hypoglycaemia where appropriate.
适当的时候都应给予应用预防和治疗低血糖的食物的建议。
9、Introduce physical activity gradually, based on the individual’s willingness and ability, and setting individualized and specific goals.
根据各人的意愿和能力逐步介绍体力活动，并制定个体化和特定的目标。
10、Encourage increased duration and frequency of physical activity (where needed), up to 30-45 minutes on 3-5 days per week, or an accumulation of 150 minutes of physical activity per week.
需要时鼓励增加体力活动的时间和频率，可以增加到每周运动3－5天，每次30－45分钟，或者一周累积体力活动时间达到150分钟。
11、Provide guidelines for adjusting medications (insulin) and/or addingcarbohydrate for physical activity.
给予在体力活动的同时调整药物（胰岛素）和/或增加碳水化合物的指南。
12、 Both nutrition therapy and physical activity training should be incorporated into more broadly based diabetes self-management training programmes (see Education).
营养治疗和体力活动训练都应当归入到涉及面更广泛的糖尿病自我管理训练计划中（参见“运动”部分）
13、For weight reduction in people with Type 2 diabetes who are obese, it may sometimes be appropriate to consider weight loss medications as adjunct therapy.
对于肥胖2型糖尿病人群的降低体重治疗来说，有时把降低体重药物视为辅助治疗方式可能是恰当的。
口服降糖药物治疗
1、监测指标：
⑴最好的指标是HbA1c
循证依据：
UKPDS研究
DCCT研究
——HbA1c与糖尿病并发症直接相关。
推荐参考文献（个人看法）：
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998 Sep 12;352(9131):837-53
The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus New England Journal of Medicine Volume 329:977-986 September 30, 1993 Number 14
⑵监测血糖
血糖的监测包括餐前血糖和餐后血糖。在一些没有条件检测HbA1c的地区，最低要求是监测血糖。
2、控制目标：
HbA1c<6.5%
3、降糖药物的选择：
⑴一线治疗药物——二甲双胍
循证依据：
UKPDS之二甲双胍亚组研究
参考文献（个人推荐）：
Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group.Lancet. 1998 Sep 12;352(9131):854-65
二甲双胍治疗组心肌梗死率下降39％，并且有统计学意义。其他治疗药物虽然也可以引起心肌梗死发生率的下降，但是没有统计学意义。
应用方法：
在2型糖尿病药物治疗中，除外有肾功能减退时，二甲双胍做为首选治疗。在治疗过程中应监测肾功能，避免发生乳酸酸中毒。
⑵二线治疗药物——磺脲类药物
磺脲类药物的心血管保护作用不如二甲双胍。
二甲双胍无效时加用磺脲类药物。
对于瘦型患者，应用磺脲类药物做为一线药物。
⑶关于噻唑烷二酮类药物
噻唑烷二酮类药物目前多应用于代谢综合征。
噻唑烷二酮类药物不做为2型糖尿病首选治疗的原因：
①噻唑烷二酮类药物改善HbA1c效果与二甲双胍和磺脲类药物相当，并无优势。
②噻唑烷二酮可以降低心血管风险，但是未达到统计学意义。降低心肌梗死、中风、各种原因引起的死亡等糖尿病二级终点事件的水平与磺脲类药物和胰岛素相当，但是不及二甲双胍。
②噻唑烷二酮还有可能加重心衰的危险。
循证依据：
PROactive研究
参考文献（个人推荐）：
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. Lancet. 2005 Oct 8;366(9493):1279-89.
以及Lancet. 2006 Jan 7;367(9504)上的多篇comment
⑶关于阿卡波糖
阿卡波糖在中国应用广泛，但是综合评价阿卡波糖本身并无特别优势，降低HbA1c效果很小，且在流行病学研究中，患者常常由于耐受不了胃肠道副作用而停用。
随附上一副2型糖尿病口服降糖药物应用流程图：
口服降糖药物之标准治疗：
1、Begin oral glucose-lowering drugs when lifestyle interventions alone are unable to maintain blood glucose control at target levels (see Glucose control levels). Maintain support for lifestyle measures throughout the periods of use of these drugs.
Consider each initiation or dose increase of an oral glucose-lowering drug as a trial, monitoring the response in 2-6 months.
当生活方式干预不能够将血糖控制在目标水平（参见血糖控制一节）时开始应用口服降糖药物。在应用药物期间也要维持生活方式治疗。
将每种降糖药物的起始应用或者加量都视为一次试验，在2－6月内监测药物反应。
2、Begin with metformin unless evidence or risk of renal impairment, titrating the dose over early weeks to minimize discontinuation due to gastro-intestinal intolerance. Monitor renal function and risk of signifi cant renal impairment (eGFR <60 ml/min/1.73 m2) in people taking metformin.
如果没有肾脏受损或有受损危险的情况下，起始应用二甲双胍治疗。在最初的几周调整剂量，将由于胃肠道不适引起的停药减小到最少。在接受二甲双胍治疗的人群中监测肾脏功能和发生明显肾功能受损(eGFR <60 ml/min/1.73 m2)危险。
3、Use sulfonylureas when metformin fails to control glucose concentrations to target levels, or as a fi rst-line option in the person who is not overweight. Choose a drug of low cost, but exercise caution if hypoglycaemia may be a problem to the individual, including through renal impairment. Provide education and, if appropriate, self-monitoring (see Self-monitoring) to guard against the consequences of hypoglycaemia.
Once-daily sulfonylureas should be an available option where drug concordance is problematic. Rapid-acting insulin secretagogues may be useful as an alternative to sulfonylureas in some insulin-sensitive people with fl exible lifestyles.
在应用二甲双胍不能将血糖水平控制在目标值时应用磺脲类药物，或者在非超重人群中，磺脲类药物可以做为一线选择。选择低价药物，但是要注意的是，如果个体有发生低血糖的危险（包括由于肾脏损害引起的），运动则要谨慎。给予糖尿病教育，如果在适当的情况下，自我监测（见自我监测节）可以减少低血糖及其后续事件的发生。
如果有药物依从性的问题时，一日一次的磺脲类药物是个比较合适的选择。在那些生活方式比较灵活的胰岛素敏感个体中，应用速效胰岛素促泌剂来代替磺脲类药物会比较有用。
4、Use a PPAR-γ agonist (thiazolidinedione) when glucose concentrations are not controlled to target levels, adding it:
——to metformin as an alternative to a sulfonylurea, or
——to a sulfonylurea where metformin is not tolerated, or
——to the combination of metformin and a sulfonylurea.
Be alert to the contra-indication of cardiac failure, and warn the person with diabetes of the possibility of development of signifi cant oedema.
在血糖水平没有控制在目标值时应用PPAR-γ促效剂（噻唑烷二酮）
——噻唑烷二酮＋二甲双胍组合替代噻唑烷二酮＋磺脲类组合 或
——二甲双胍不能耐受时用一种磺脲类药物＋噻唑烷二酮 或
——二甲双胍＋一种磺脲类＋噻唑烷二酮组合
5、Use α-glucosidase inhibitors as a further option. They may also have a role in
some people intolerant of other therapies.
α-糖苷酶抑制剂做为进一步的选择。在不能耐受其他药物的患者中它们可能也有作用。
6、Step up doses, and add other oral glucose-lowering drugs, at frequent intervals until blood glucose control is at target levels. Consider whether the rate of deterioration suggests insulin therapy will be needed early despite such measures.
间隔一段时间逐步增加药物剂量以及联用其他降糖药物，直至血糖达标。还需要考虑血糖水平恶化的速率，决定是否需要早期联合应用胰岛素治疗。
