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Guide: Recently, the "Expert Consensus on Diagnosis and Treatment of Diabetes and Cardiovascular Diseases" was published in the Chinese Journal of Internal Medicine, which provides guidance for the clinical diagnosis and treatment of patients with diabetes and cardiovascular diseases.
Diabetes is the most important comorbidity of cardiovascular disease, and cardiovascular disease is the main cause of death and disability in patients with type 2 diabetes.
In order to standardize the diagnosis and treatment of patients with diabetes and cardiovascular disease, the National Health Commission's Capacity Building and Continuing Education Center organized experts in the fields of cardiology and endocrinology to summarize the research progress and expert experience of relevant disciplines at home and abroad, and formulate this consensus.
The "Consensus" covers important clinical content related to the diagnosis, drug treatment, and risk factor management of diabetes complicated with cardiovascular disease (mainly including atherosclerotic cardiovascular disease and heart failure).
It also targets special populations such as diabetic nephropathy and the elderly ( (>75 years old) and critically ill patients with cardiovascular disease gave specific clinical recommendations.
(The link to the full version of the "Consensus", see the end of the article) 7%, 7%-8%, 8%-9%-Individualized targets for blood glucose in patients with T2DM and CVD.
Regarding the goal of blood glucose control in patients with T2DM and CVD, the "Consensus" The following suggestions are put forward: ➤ Determine individualized glycosylated hemoglobin (HbA1c) control targets based on the patient’s age, course of disease, severity of combined CVD, and risk of hypoglycemia.
Special attention should be paid to prevent hypoglycemia.
➤Age <65 years, course of diabetes <10 years, expected survival time>15 years, no severe CVD [such as heart failure stage A (preclinical heart failure stage), stage B (preclinical heart failure stage) or stage C (clinical heart failure) Failure stage) or only with hypertension and ischemic stroke], the HbA1c control target is recommended to be less than 7%.
➤Diabetes course> 10 years, expected survival time of 5-15 years, with severe CVD (such as combined with ASCVD, heart failure C stage (clinical heart failure stage) or D stage (end-stage heart failure stage) for further treatment (left ventricle) Assistive devices, transplantation)], the HbA1c control target is recommended to be 7% to 8%.
➤For the elderly (>75 years old), the course of diabetes>10 years, and the expected survival time<5 years with severe CVD, the HbA1c control target is 8%-9%, but the direct damage caused by hyperglycemia should be avoided.
130/80mmHg——The blood pressure control target for diabetes combined with CVD is in the blood pressure management chapter of diabetes combined with cardiovascular disease.
The "Consensus" recommends: ➤Diabetes combined with CVD blood pressure reduction target <130/80 mmHg, if it cannot be tolerated, it can be relaxed to <140 /90 mmHg.
➤Diabetes with hypertension, the first choice for antihypertensive drugs is ACEI or ARB.
➤If the blood pressure is ≥160/100 mmHg, higher than the target blood pressure 20/10 mmHg, or the single-agent therapy does not meet the target, combination antihypertensive therapy should be given.
➤Patients with diabetes and coronary heart disease, antihypertensive drugs plus β-blockers.
➤For patients with diabetes and heart failure (HFrEF) with reduced chronic ejection fraction, angiotensin receptor-enkephalinase inhibitor (ARNI), ACEI (ARB can be used for those who cannot tolerate it), β receptors are preferred for blood pressure reduction Blockers and aldosterone receptor antagonists.
➤Home blood pressure monitoring (HBPM) is recommended.
➤Recommended ambulatory blood pressure monitoring (ABPM).
➤Diabetes autonomic neuropathy or hypovolemia, over 70 years old, frail elderly, antihypertensive treatment should pay attention to orthostatic hypotension, and avoid the use of alpha-receptor blockers and diuretics that may aggravate the condition.
Lipid management of diabetes complicated with CVD——Differentiated management according to ASCVD risk stratification "Consensus" recommends: All diabetic patients should first undergo risk stratification of atherosclerotic cardiovascular disease (ASCVD) (Table 1), and adopt Corresponding treatment goals.
Table 1 Diabetic patients with atherosclerotic cardiovascular disease (ASCVD) risk stratification 1.
Blood lipid testing and treatment goals "Consensus" recommendations: ➤ It is recommended that patients with diabetes test fasting blood lipid levels: total cholesterol (TC), triglycerides (TG) ), high-density lipoprotein cholesterol (HDL-C), LDL-C, non-HDL-C, apolipoprotein B (ApoB).
➤Blood lipid target for patients with diabetes and ASCVD at very high risk: LDL-C is reduced by at least 50% from baseline, and LDL-C is less than 1.
4 mmo/L (55 mg/dl).
The secondary target is non-HDL-C<2.
0 mmol/L (80 mg/dl).
➤Blood lipid goals for high-risk patients with diabetes and ASCVD: LDL-C is reduced by at least 50% from baseline, and LDL-C is less than 1.
8 mmo/L (70 mg/dl).
The secondary target is non-HDL-C<2.
6 mmol/L (100 mg/dl).
➤Blood lipid target for patients with diabetes mellitus and cardiovascular disease between 20 and 39 years old: LDL-C target <2.
6 mmol/L (<100 mg/dl), secondary target is non-HDL-C <3.
4 mmol/L (130 mg/ dl).
2.
Lipid-lowering treatment methods "Consensus" recommendations: ➤ It is recommended that all diabetics adopt a healthy life>
If the life>
➤It is recommended to use moderate-intensity statins as the first choice for lipid-lowering therapy.
➤When statins cannot make LDL-C reach the standard, it is recommended to use ezetimibe in combination.
➤When statins combined with ezetimibe cannot make LDL-C reach the target, if the patient is at a very high risk of CVD, it is recommended to combine proprotein convertase subtilisin 9 (PCSK9) inhibitors (Iloyuumab, Aliciyudan) anti).
➤For CVD high-risk/very high-risk patients, on the basis of strict life>
➤For CVD high-risk/very high-risk patients, on the basis of strict life>
➤It is not recommended to use gemfibrozil in combination with statins.
Choice of first-line hypoglycemic drugs for patients with T2DM combined with CVD (Figure 1) Figure 1 T2DM combined with CVD hypoglycemic drugs treatment path 1.
First-line hypoglycemic drugs for patients with T2DM combined with CVD "Consensus" recommendations: ➤If there is no contraindication or intolerance, It is recommended that metformin be the first-line hypoglycemic drug for patients with T2DM and CVD, but it is not recommended for patients with acute and decompensated heart failure.
➤If metformin has contraindications or intolerance, GLP-1RA or SGLT-2i with evidence of cardiovascular protection is recommended as a first-line hypoglycemic agent.
➤If there are contraindications or intolerances to GLP-1RA or SGLT-2i, it is recommended to use α-glycosidase inhibitor or dipeptidyl peptidase 4 inhibitor (DPP-4i) as the first-line hypoglycemic agent, but it is not recommended to combine heart effort Saxagliptin is used in patients with exhausted T2DM.
2.
Optimal plan for combined treatment with hypoglycemic drugs for patients with T2DM and CVD The "Consensus" recommends: ➤For patients with T2DM and CVD, regardless of the baseline HbA1c or individualized HbA1c target value, it is recommended to combine with metformin with evidence of cardiovascular benefit Hypoglycemic drugs.
➤Patients with T2DM and ASCVD may give priority to combining GLP-1RA (liraglutide, dulaglutide) or SGLT-2i (enpagliflozin, canagliflozin), which have been proven to bring cardiovascular benefits.
Reduce cardiovascular events.
➤Patients with T2DM and heart failure should first consider the combined use of SGLT-2i, including dapagliflozin, empagliflozin, and canagliflozin to reduce the risk of heart failure hospitalization.
If SGLT-2i has contraindications, consider combining GLP-1RA.
➤If there are contraindications or intolerances to the use of metformin, GLP-1RA and SGLT-2i, after fully evaluating the drug specificity and patient factors (including blood sugar, weight, risk of hypoglycemia, liver and kidney function, etc.
), you can choose α -Glucosidase inhibitors, DPP-4i, pioglitazone, and sulfonylureas drugs with different hypoglycemic mechanisms for combined therapy.
➤If combined with heart failure, it is not recommended to combine thiazolidinedione drugs and saxagliptin.
If there are contraindications or intolerances to the above drug applications, it is recommended to combine basal insulin.
The choice of hypoglycemic drugs for patients with T2DM combined with CVD and CKD (Figure 2) "Consensus" recommends: ➤If the patient has no contraindications and can tolerate it, it is recommended that metformin be the initial medication for patients with T2DM combined with CVD and CKD.
➤It is recommended to combine SGLT-2i or GLP-1RA with evidence of cardiac and renal benefits on the basis of metformin.
➤If the blood glucose of the above-mentioned combination therapy still does not meet the target, you can further choose a combination medication plan with different mechanisms of action or initiate insulin therapy according to the patient's heart and kidney function, blood sugar, weight and other conditions.
➤If there are contraindications or intolerances to metformin, SGLT-2i or GLP-1RA with evidence of cardiac and renal benefit is recommended as a first-line hypoglycemic agent.
➤Insulin therapy is recommended for CKD 3b~5 patients.
If the patient refuses insulin therapy, try to choose oral hypoglycemic drugs that are not excreted by the kidneys and have no effect on the heart.
Figure 2 T2DM combined with CVD with CKD hypoglycemic drug treatment route Note: ➤ If the patient has ASCVD with CKD, it is recommended to combine SCLT-2i (enpagliflozin, canagliflozin) or GLP-1RA (liraglutide, liraglutide, Dulaglutide); ➤If the patient has heart failure with CKD, it is recommended to combine SCLT-2i (canagliflozin, dapagliflozin, empagliflozin); ➤linagliptin and rosiglitazone are used for There is no need to adjust the dose for patients with CKD stage 1-5, but saxagliptin and thiazolidinediones increase the risk of heart failure, and should be avoided in patients with heart failure.
The "Consensus" recommendations for insulin use in patients with T2DM and CVD: ➤ When there are obvious symptoms of hyperglycemia, ketosis or hyperglycemia hypertonic state, stress, and blood sugar still not up to the standard after treatment with life>
➤For ACS patients with severe hyperglycemia (random blood glucose> 10 mmol/L), insulin-based hypoglycemic therapy is recommended, and individualized blood glucose control goals are determined according to the specific conditions of the patients.
ACS patients avoid hypoglycemia and control hyperglycemia Blood sugar is equally important.
For patients undergoing coronary artery bypass grafting, oral hypoglycemic drugs are not recommended during the perioperative period, and insulin therapy should be used.
➤Insulin therapy is associated with increased body weight and risk of hypoglycemia.
For T2DM patients with heart failure, it is recommended to use other hypoglycemic drugs that have clear benefits for heart failure.
➤Currently, there is no evidence-based medical evidence to confirm which insulin initial treatment plan is better.
Most national and regional guidelines recommend the initial use of basal insulin, including insulin glargine, insulin deglubber, and insulin detemir.
If blood sugar control is not up to standard, insulin can be added during meals.
The insulin initiation and adjustment plan is shown in Figure 3.
Figure 3 Insulin initiation and adjustment plan management of people with special diabetes 1.
Blood glucose management for patients with critical cardiovascular disease T2DM "Consensus" recommendations: ➤ Strengthening blood glucose monitoring and controlling blood glucose at 7.
8-10.
0 mmol/L can benefit critically ill patients .
➤If blood glucose continues to exceed 10.
0 mmol/L, insulin therapy should be initiated.
➤Persons susceptible to hypoglycemia can determine individualized blood sugar control goals based on the patient's clinical and comorbid conditions.
➤It is strongly recommended to give intravenous insulin infusion to control blood sugar.
Insulin dosage should be adjusted according to the results of hourly blood glucose monitoring, and severe hypoglycemia should be avoided.
➤It is recommended to use a rapid blood glucose meter for frequent capillary blood glucose monitoring.
At present, CGM has insufficient data on clinical prognosis, safety, or cost-effectiveness, and it is not recommended for use in critical care at the moment.
2.
The medication characteristics of elderly (>75 years old) T2DM patients with CVD The "Consensus" recommends: ➤The risk of hypoglycemia in elderly patients with T2DM is increased.
Hypoglycemia with CVD may lead to more serious consequences.
Hypoglycemia is recommended for hypoglycemic drugs.
Low drugs, such as metformin, α-glycosidase inhibitor, DPP-4i, SGLT-2i, GLP-1RA, etc.
➤The blood glucose target of elderly T2DM patients should be reasonably relaxed, but all patients should avoid symptoms or acute complications of hyperglycemia due to hyperglycemia.
➤The choice of hypoglycemic drugs for elderly patients with T2DM needs to be selected according to the patient's diabetes development stage, the current blood sugar level, and individual characteristics.
When choosing hypoglycemic drugs, the safety of the drug and the prevention of acute complications of diabetes need to be selected.
Disease as a priority factor.
Full version of the consensus link: http://rs.
yiigle.
com/CN112138202105/1317500.
htm Reference materials: National Health Commission Capacity Building and Continuing Education Center, Sun Yihong, Chen Kang, Chen Xin, etc.
Diabetic patients with cardiovascular disease Expert consensus on diagnosis and treatment[J].
Chinese Journal of Internal Medicine,2021, 60(5): 421-437.
DOI: 10.
3760/cma.
j.
cn112138-20201208-00999.
Diabetes is the most important comorbidity of cardiovascular disease, and cardiovascular disease is the main cause of death and disability in patients with type 2 diabetes.
In order to standardize the diagnosis and treatment of patients with diabetes and cardiovascular disease, the National Health Commission's Capacity Building and Continuing Education Center organized experts in the fields of cardiology and endocrinology to summarize the research progress and expert experience of relevant disciplines at home and abroad, and formulate this consensus.
The "Consensus" covers important clinical content related to the diagnosis, drug treatment, and risk factor management of diabetes complicated with cardiovascular disease (mainly including atherosclerotic cardiovascular disease and heart failure).
It also targets special populations such as diabetic nephropathy and the elderly ( (>75 years old) and critically ill patients with cardiovascular disease gave specific clinical recommendations.
(The link to the full version of the "Consensus", see the end of the article) 7%, 7%-8%, 8%-9%-Individualized targets for blood glucose in patients with T2DM and CVD.
Regarding the goal of blood glucose control in patients with T2DM and CVD, the "Consensus" The following suggestions are put forward: ➤ Determine individualized glycosylated hemoglobin (HbA1c) control targets based on the patient’s age, course of disease, severity of combined CVD, and risk of hypoglycemia.
Special attention should be paid to prevent hypoglycemia.
➤Age <65 years, course of diabetes <10 years, expected survival time>15 years, no severe CVD [such as heart failure stage A (preclinical heart failure stage), stage B (preclinical heart failure stage) or stage C (clinical heart failure) Failure stage) or only with hypertension and ischemic stroke], the HbA1c control target is recommended to be less than 7%.
➤Diabetes course> 10 years, expected survival time of 5-15 years, with severe CVD (such as combined with ASCVD, heart failure C stage (clinical heart failure stage) or D stage (end-stage heart failure stage) for further treatment (left ventricle) Assistive devices, transplantation)], the HbA1c control target is recommended to be 7% to 8%.
➤For the elderly (>75 years old), the course of diabetes>10 years, and the expected survival time<5 years with severe CVD, the HbA1c control target is 8%-9%, but the direct damage caused by hyperglycemia should be avoided.
130/80mmHg——The blood pressure control target for diabetes combined with CVD is in the blood pressure management chapter of diabetes combined with cardiovascular disease.
The "Consensus" recommends: ➤Diabetes combined with CVD blood pressure reduction target <130/80 mmHg, if it cannot be tolerated, it can be relaxed to <140 /90 mmHg.
➤Diabetes with hypertension, the first choice for antihypertensive drugs is ACEI or ARB.
➤If the blood pressure is ≥160/100 mmHg, higher than the target blood pressure 20/10 mmHg, or the single-agent therapy does not meet the target, combination antihypertensive therapy should be given.
➤Patients with diabetes and coronary heart disease, antihypertensive drugs plus β-blockers.
➤For patients with diabetes and heart failure (HFrEF) with reduced chronic ejection fraction, angiotensin receptor-enkephalinase inhibitor (ARNI), ACEI (ARB can be used for those who cannot tolerate it), β receptors are preferred for blood pressure reduction Blockers and aldosterone receptor antagonists.
➤Home blood pressure monitoring (HBPM) is recommended.
➤Recommended ambulatory blood pressure monitoring (ABPM).
➤Diabetes autonomic neuropathy or hypovolemia, over 70 years old, frail elderly, antihypertensive treatment should pay attention to orthostatic hypotension, and avoid the use of alpha-receptor blockers and diuretics that may aggravate the condition.
Lipid management of diabetes complicated with CVD——Differentiated management according to ASCVD risk stratification "Consensus" recommends: All diabetic patients should first undergo risk stratification of atherosclerotic cardiovascular disease (ASCVD) (Table 1), and adopt Corresponding treatment goals.
Table 1 Diabetic patients with atherosclerotic cardiovascular disease (ASCVD) risk stratification 1.
Blood lipid testing and treatment goals "Consensus" recommendations: ➤ It is recommended that patients with diabetes test fasting blood lipid levels: total cholesterol (TC), triglycerides (TG) ), high-density lipoprotein cholesterol (HDL-C), LDL-C, non-HDL-C, apolipoprotein B (ApoB).
➤Blood lipid target for patients with diabetes and ASCVD at very high risk: LDL-C is reduced by at least 50% from baseline, and LDL-C is less than 1.
4 mmo/L (55 mg/dl).
The secondary target is non-HDL-C<2.
0 mmol/L (80 mg/dl).
➤Blood lipid goals for high-risk patients with diabetes and ASCVD: LDL-C is reduced by at least 50% from baseline, and LDL-C is less than 1.
8 mmo/L (70 mg/dl).
The secondary target is non-HDL-C<2.
6 mmol/L (100 mg/dl).
➤Blood lipid target for patients with diabetes mellitus and cardiovascular disease between 20 and 39 years old: LDL-C target <2.
6 mmol/L (<100 mg/dl), secondary target is non-HDL-C <3.
4 mmol/L (130 mg/ dl).
2.
Lipid-lowering treatment methods "Consensus" recommendations: ➤ It is recommended that all diabetics adopt a healthy life>
If the life>
➤It is recommended to use moderate-intensity statins as the first choice for lipid-lowering therapy.
➤When statins cannot make LDL-C reach the standard, it is recommended to use ezetimibe in combination.
➤When statins combined with ezetimibe cannot make LDL-C reach the target, if the patient is at a very high risk of CVD, it is recommended to combine proprotein convertase subtilisin 9 (PCSK9) inhibitors (Iloyuumab, Aliciyudan) anti).
➤For CVD high-risk/very high-risk patients, on the basis of strict life>
➤For CVD high-risk/very high-risk patients, on the basis of strict life>
➤It is not recommended to use gemfibrozil in combination with statins.
Choice of first-line hypoglycemic drugs for patients with T2DM combined with CVD (Figure 1) Figure 1 T2DM combined with CVD hypoglycemic drugs treatment path 1.
First-line hypoglycemic drugs for patients with T2DM combined with CVD "Consensus" recommendations: ➤If there is no contraindication or intolerance, It is recommended that metformin be the first-line hypoglycemic drug for patients with T2DM and CVD, but it is not recommended for patients with acute and decompensated heart failure.
➤If metformin has contraindications or intolerance, GLP-1RA or SGLT-2i with evidence of cardiovascular protection is recommended as a first-line hypoglycemic agent.
➤If there are contraindications or intolerances to GLP-1RA or SGLT-2i, it is recommended to use α-glycosidase inhibitor or dipeptidyl peptidase 4 inhibitor (DPP-4i) as the first-line hypoglycemic agent, but it is not recommended to combine heart effort Saxagliptin is used in patients with exhausted T2DM.
2.
Optimal plan for combined treatment with hypoglycemic drugs for patients with T2DM and CVD The "Consensus" recommends: ➤For patients with T2DM and CVD, regardless of the baseline HbA1c or individualized HbA1c target value, it is recommended to combine with metformin with evidence of cardiovascular benefit Hypoglycemic drugs.
➤Patients with T2DM and ASCVD may give priority to combining GLP-1RA (liraglutide, dulaglutide) or SGLT-2i (enpagliflozin, canagliflozin), which have been proven to bring cardiovascular benefits.
Reduce cardiovascular events.
➤Patients with T2DM and heart failure should first consider the combined use of SGLT-2i, including dapagliflozin, empagliflozin, and canagliflozin to reduce the risk of heart failure hospitalization.
If SGLT-2i has contraindications, consider combining GLP-1RA.
➤If there are contraindications or intolerances to the use of metformin, GLP-1RA and SGLT-2i, after fully evaluating the drug specificity and patient factors (including blood sugar, weight, risk of hypoglycemia, liver and kidney function, etc.
), you can choose α -Glucosidase inhibitors, DPP-4i, pioglitazone, and sulfonylureas drugs with different hypoglycemic mechanisms for combined therapy.
➤If combined with heart failure, it is not recommended to combine thiazolidinedione drugs and saxagliptin.
If there are contraindications or intolerances to the above drug applications, it is recommended to combine basal insulin.
The choice of hypoglycemic drugs for patients with T2DM combined with CVD and CKD (Figure 2) "Consensus" recommends: ➤If the patient has no contraindications and can tolerate it, it is recommended that metformin be the initial medication for patients with T2DM combined with CVD and CKD.
➤It is recommended to combine SGLT-2i or GLP-1RA with evidence of cardiac and renal benefits on the basis of metformin.
➤If the blood glucose of the above-mentioned combination therapy still does not meet the target, you can further choose a combination medication plan with different mechanisms of action or initiate insulin therapy according to the patient's heart and kidney function, blood sugar, weight and other conditions.
➤If there are contraindications or intolerances to metformin, SGLT-2i or GLP-1RA with evidence of cardiac and renal benefit is recommended as a first-line hypoglycemic agent.
➤Insulin therapy is recommended for CKD 3b~5 patients.
If the patient refuses insulin therapy, try to choose oral hypoglycemic drugs that are not excreted by the kidneys and have no effect on the heart.
Figure 2 T2DM combined with CVD with CKD hypoglycemic drug treatment route Note: ➤ If the patient has ASCVD with CKD, it is recommended to combine SCLT-2i (enpagliflozin, canagliflozin) or GLP-1RA (liraglutide, liraglutide, Dulaglutide); ➤If the patient has heart failure with CKD, it is recommended to combine SCLT-2i (canagliflozin, dapagliflozin, empagliflozin); ➤linagliptin and rosiglitazone are used for There is no need to adjust the dose for patients with CKD stage 1-5, but saxagliptin and thiazolidinediones increase the risk of heart failure, and should be avoided in patients with heart failure.
The "Consensus" recommendations for insulin use in patients with T2DM and CVD: ➤ When there are obvious symptoms of hyperglycemia, ketosis or hyperglycemia hypertonic state, stress, and blood sugar still not up to the standard after treatment with life>
➤For ACS patients with severe hyperglycemia (random blood glucose> 10 mmol/L), insulin-based hypoglycemic therapy is recommended, and individualized blood glucose control goals are determined according to the specific conditions of the patients.
ACS patients avoid hypoglycemia and control hyperglycemia Blood sugar is equally important.
For patients undergoing coronary artery bypass grafting, oral hypoglycemic drugs are not recommended during the perioperative period, and insulin therapy should be used.
➤Insulin therapy is associated with increased body weight and risk of hypoglycemia.
For T2DM patients with heart failure, it is recommended to use other hypoglycemic drugs that have clear benefits for heart failure.
➤Currently, there is no evidence-based medical evidence to confirm which insulin initial treatment plan is better.
Most national and regional guidelines recommend the initial use of basal insulin, including insulin glargine, insulin deglubber, and insulin detemir.
If blood sugar control is not up to standard, insulin can be added during meals.
The insulin initiation and adjustment plan is shown in Figure 3.
Figure 3 Insulin initiation and adjustment plan management of people with special diabetes 1.
Blood glucose management for patients with critical cardiovascular disease T2DM "Consensus" recommendations: ➤ Strengthening blood glucose monitoring and controlling blood glucose at 7.
8-10.
0 mmol/L can benefit critically ill patients .
➤If blood glucose continues to exceed 10.
0 mmol/L, insulin therapy should be initiated.
➤Persons susceptible to hypoglycemia can determine individualized blood sugar control goals based on the patient's clinical and comorbid conditions.
➤It is strongly recommended to give intravenous insulin infusion to control blood sugar.
Insulin dosage should be adjusted according to the results of hourly blood glucose monitoring, and severe hypoglycemia should be avoided.
➤It is recommended to use a rapid blood glucose meter for frequent capillary blood glucose monitoring.
At present, CGM has insufficient data on clinical prognosis, safety, or cost-effectiveness, and it is not recommended for use in critical care at the moment.
2.
The medication characteristics of elderly (>75 years old) T2DM patients with CVD The "Consensus" recommends: ➤The risk of hypoglycemia in elderly patients with T2DM is increased.
Hypoglycemia with CVD may lead to more serious consequences.
Hypoglycemia is recommended for hypoglycemic drugs.
Low drugs, such as metformin, α-glycosidase inhibitor, DPP-4i, SGLT-2i, GLP-1RA, etc.
➤The blood glucose target of elderly T2DM patients should be reasonably relaxed, but all patients should avoid symptoms or acute complications of hyperglycemia due to hyperglycemia.
➤The choice of hypoglycemic drugs for elderly patients with T2DM needs to be selected according to the patient's diabetes development stage, the current blood sugar level, and individual characteristics.
When choosing hypoglycemic drugs, the safety of the drug and the prevention of acute complications of diabetes need to be selected.
Disease as a priority factor.
Full version of the consensus link: http://rs.
yiigle.
com/CN112138202105/1317500.
htm Reference materials: National Health Commission Capacity Building and Continuing Education Center, Sun Yihong, Chen Kang, Chen Xin, etc.
Diabetic patients with cardiovascular disease Expert consensus on diagnosis and treatment[J].
Chinese Journal of Internal Medicine,2021, 60(5): 421-437.
DOI: 10.
3760/cma.
j.
cn112138-20201208-00999.
