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?

《国际糖尿病》：首先，我想我们的读者最希望了解的就是本次美国糖尿病协会年会的特点，这次会议和以往的年会有什么区别吗？在糖尿病的研究和临床实践方面有没有什么突破性进展呢？

 

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.

Rizza：这些年来，美国糖尿病协会年会的形式逐渐进展成为由两个部分组成，包括对以往文献的综述及新发表文献的摘要。也就是说它是一种新进展和综述旧文献之间的平衡。会上不但有越来越多的综述，这样你可以高屋建瓴地了解整个领域，也有个人报告－—15分钟的小报告介绍新进展。所以，我认为这些年来大会越来越注重这二者之间的平衡了。

 

 

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?

《国际糖尿病》：您能否给我们解释一下美国糖尿病协会今年修订临床实践建议的原因呢？这个建议是否每年更新呢？

 

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.

Rizza：是的，临床实践推荐方案是由美国糖尿病协会的临床实践委员会负责每年更新的。临床实践委员会的任务就是关注医学证据的进展——是否有新的证据发表、是否有新的临床试验开展、是否出现了一些新的信息，这些信息告诉我们建议中的某一条需要修改了。一般这些新的进展会在1月份发表，目前的ADA推荐方案有相当长一段时间没有变化了，这件事情真正的挑战之处不在于如何修改推荐方案，而在于如何让我们国家的医生、让全世界的医生都能够真正做到保证每一名糖尿病患者的方案都遵循推荐方案。

 

International diabetes: What’s the major revisions on this year’s version?

《国际糖尿病》：今年的推荐方案主要有哪些改动之处呢？

 

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.

Rizza：如果我没记错的话，跟去年1月份（的推荐方案）比起来，（今年的推荐方案）没有太多的变化。你也知道，这么些年来，我们的血压目标、血红蛋白目标、胆固醇目标基本都相同，所以我认为推荐方案一直是比较稳定的。我认为没有太多大的变化。

 

International diabetes: Any update?

《国际糖尿病》：有什么最新进展吗？

 

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.

Rizza：只有一些小的变化，有一些小的进展是关于药物用法方面的。今年最主要的变化就是美国糖尿病协会提出了一个治疗流程，而对于2型糖尿病患者的治疗流程方面一直存在争议：一开始应该用什么药？（血糖控制不好的话）换用何种药物？上述治疗流程也是用药评议小组今年将要公布的结论之一。具体说来就是对于大多数2型糖尿病患者起始治疗用药一般都选择二甲双胍，如果用二甲双胍治疗还不能使患者的血糖达到目标水平的话，我们可以加用磺酰脲类降糖药，或者可以加用胰岛素，或者加用噻唑烷二酮类降糖药。当然，一段时间以来对这个问题有一定争议。二甲双胍可以作为最初的治疗药物；早期使用胰岛素治疗可能对很多人都有益处；磺酰脲类降糖药对很多人也有好处。问题在于我们是否应该加用噻唑烷二酮类降糖药。目前得出的结论是，对大多数患者而言，二甲双胍都是一线用药，但磺酰脲类降糖药是否应该作为二线药物还存在争议。

 

International diabetes: So the early intervention includes metformin besides life style change?

《国际糖尿病》：所以除了生活方式改变以外二甲双胍治疗也应该作为早期干预的手段？

 

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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