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[ADA2007]Robert A. Rizza教授现场专访:ADA2007最新指南

作者:idiabetes 2007/6/24 15:55:00    加入收藏

Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic and Foundation

A:记者   BRobert  A.  Rizza

International diabetes: First of all, the most important thing I suppose our readers want to know is the feature of this year’s meeting of American Diabetes Association, and are there any differences from the former annual meetings? Are there any breaking progress on research and clinical practice in the field of diabetes?
Rizza: The meetings over the years slowly evolved to having a combination of both review symposium as well as new abstracts, so called oral abstract poster. So a balance between new sciences versus reviews. More and more reviews so that you can get an overview of the entire area whereas there is also individual presentations—the 15-minute mini-presentation talking about the new sciences. And so, I think it’s been much more balanced for the last couple of years.
International diabetes: And, the second question: Would you please explain the reason for revising ADA’s clinical practice recommendations this year? Does it update yearly?
Rizza: Yeah, the clinical practice recommendations updated yearly by the American Diabetes Association’s clinical practice committee. What the clinical practice committee tries to do is to look at the evidence—if there is any new evidence, any new clinical trials and any new information that would tell us that one of the, or another of the recommendations needs to be changed. So that happens generally in the fall and it publishes in January. But you know the recommendations have been fairly standard for some time now. The real challenge is not to change the recommendations, but the real challenge is to get people—our practitioners, your practitioners around the world to assure everybody with diabetes is receiving all of the recommendations.
International diabetes: What’s the major revisions on this year’s version?
Rizza: That’s actually what I should know, because this year looking at, if I could remember correctly, looking in from last January, there are not so many changes. We have for years, you know, more or less have much the same blood pressure goals, the hemoglobin goals, the cholesterol goals, so I think that’s pretty much been stable. So I don’t think there are many major changes.
International diabetes: Any update?
Rizza: Just some minor changes, minor update about possibly use of … Probably the major thing that happened is that this year, the American Diabetes Association came up with a treatment algorithm, which has been a debate that for a person with type II: what drug would you start, and what to change? So that was published this year as part of the consensus group. And the basic is just starting with metformin for most patients with type II, and if not achieving goals we add sulfonylurea, or if not achieving goals we add insulin, or if not achieving goals perhaps we add thiazolidinedione. Of course this has been a sort of debate for some period of time and suggesting that the bottom line is that you start with metformin. Probably early use of insulin is a benefit for many, many people. Many people benefit from sulfonylureas. The real question has always been when should we add thiazolidinedione, the consensus was in a subset of people perhaps, but mostly metformin is the first-line drug. And then the debate continues on whether sulfonylureas should be second-line drug.
International diabetes: So the early intervention includes metformin besides life style change?
Rizza: Right. Another part of the algorithm points out when to start it. So if your goal with Hemoglobin A1c is near normal, it’s possible, and the absence of hyperglycemia, and if the HbA1c is starting at very high, 10, 12, metformin is unlikely to a benefit. So you may want to start with some other way. On the other hand, if you start with your HbA1c of 7.5, then you may find metformin beneficial. Again, the clinical judgement comes in carrying out the clinical time when you use, you know, how your patient is, which drug to use. Those guidelines were, I think, only algorithm.

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