• 四川大學(xué)華西醫(yī)院老年科,成都,610041;

目的 　借助循證醫(yī)學(xué)的方法為初診老年2型糖尿病患者確定治療目標(biāo)及治療方案.
方法 　在充分評(píng)估患者情況后,提出臨床問(wèn)題,從Cochrane圖書館(2003年第3期)、Medline(PubMed網(wǎng)站1990年1月～2003年2月)、和http://sumsearch.uthsca.edu/searchform4.htm上進(jìn)行檢索.檢索主題詞為:diabetes mellitus non-insulin-dependent; self-monitor of blood glucose; micro- and macro-vascular complications;sulphonylureas; insulin; aspirin; metformin; acarbose; self-monitor of blood glucose; older patient; hypertension management; Lipid management; RCT; human; meta-analysis;systmatic review.
結(jié)果 　共檢索出與不同問(wèn)題相關(guān)的隨機(jī)對(duì)照試驗(yàn)112篇,系統(tǒng)評(píng)價(jià)或Meta-分析24篇.通過(guò)對(duì)檢索結(jié)果進(jìn)行分析,為患者制定了合理的治療方案.經(jīng)1年隨訪證實(shí),該方案適合患者.
結(jié)論 　采用循證治療的方法,為初治的老年2型糖尿病患者確定合理的治療目標(biāo)和治療方案,可有效提高治療效果.

引用本文： 王雙,董碧蓉,李峻. 1例初診老年2型糖尿病患者的循證治療. 中國(guó)循證醫(yī)學(xué)雜志, 2004, 04(4): 278-281. doi: 復(fù)制

1. ［1］UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) [J]. Lancet, 1998:352(9131) :837-853.
2. ［2］America Diabetes Association. Standards of medical care for patients with diabetes mellitus [ J ]. Diabetes Care, 2003; 26(Suppl. 1 ) : s33-s50.
3. ［3］Coster S, Gulliford MC, Seed PT, Powrie J K, Swaminathan R. Self-monitoring in Type 2 diabetes mellitus: a meta-analysis[J ]. Diabetic Medicine, 2000; 17 ( 11 ) :755-761.
4. ［4］Norris SL, Engelgau MM, Narayan KM. Effectiveness of self management training in type 2 diabetes: a systematic review of randomized controlled trials [ J ]. Diabetes Care, 2001 ;24 ( 3 ):561-587.
5. ［5］Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M.Mortality from coronary heart diasease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior mycardial infarction [ J ]. N Engl J Med, 1998; 339 ( 4 ): 229-234.
6. ［6］Larosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: A meta-analysis of randomized controlled trials[J]. JAMA, 1999; 282(24) :2 340-2 346.
7. ［7］Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes[J]. JAMA, 2002; 288(4): 462-467.
8. ［8］Schrier RW , Estacio RO , Esler A , Mehler P . Effects of aggressive blood presure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes [ J ]. Kidney Int, 2002; 61(3): 1 086-1 097.
9. ［9］United Kingdom Prospective Diabetes Study 7. Response of fasting plasma glucose to diet therapy in newly presenting type 2 diabetic patients, UKPDS Group [ J ]. Metbolism, 1990; 39(9) :905-912.
10. ［10］United Kingdom Prospective Diabetes Study 24. A 6-year,randomized, controlled trial comparing sulfonylurea, insulin,and mefformin therapy in patients with newly diagnosed type 2 diabetes that could not be controlled with diet therapy. UK Prospective Diabetes Study Group[J]. Ann Intern Med, 1998;128(3) :165-175.
11. ［11］Simonson DC, Kourides IA, Feinglos M, Shamoon H, Fischette CT. Efficacy, safety, and dose-response characteristics of glipizide gastrointestinal therapeutic system on glycemic control and insulin secretion in NIDDM. Results of two multicenter,randomized, placebo-controlled clinical trials . The Glipizide Gastrointestinal Therapeutic System Study Group [ J ]. Diabetes Care, 1997; 20(4) :597-606.
12. ［12］Rosenstock J , Samols E , Muchmore DB , Schneider J .Glimepiride, a new once-daily sulfonylurea. A double-blind placebo-controlled study of NIDDM patients. Glimepiride Study Group[J]. Diabetes Care, 1996; 19(11) :1 194-1 199.
13. ［13］Effect of intensive blood-glucose control with metformin on complications in over weight patients with type 2 diabetes( UKPDS 34) . UK Prospective Diabetes Study [ J ]. Lancet,1998; 352(9131 ) :854-865.
14. ［14］Chiasson JL, Josse RG, Hunt JA, Palmason C, Rodger NW,Ross SA, R yan EA, Tan MH, Wolever TM. The efficacy of acarbose in the treatment of patients with non-insulindependent diabetes mellitus. A multicenter controlled clinical trial[J]. Ann Intern Med,1994; 121(12) :928-935.
15. ［15］Holman RR, Cull CA, Turner RC. A randomized doubleblind trial of acarbose in type 2 diabetes shows improved glycemic control over 3 years (U. K. Prospective Diabetes Study 44) [J]. Diabetes Care, 1999; 22(6): 960-964.
16. ［16］Inzucchi SE. Oral antihyperglycemic therapy for type 2 diabetes scientific review[J]. JAMA, 2002; 287 (3) :360-372.
17. ［17］Harpaz D, Gottlieb S, GraffE. Effects of aspirin treatment on survival in non-insulin-dependent diabetic patients with coronary artery disease. Is raeli Bezafibrate Infarction Prevention Study Group[J]. Am J Med, 1998;105(6) :494-499.
18. ［18］Johnson ES, Lanes SF, Wentworth CE 3rd, Satterfield MH,Abebe BL, Dicker LW. A metaregression analysis of the doseresponse effect of aspirin on stroke [ J ]. Arch Intern Med,1999; 159(11) :1 248-1 253.
19. ［19］de Gaetano G. Low-dose aspirin and vitamin E in people at cardiovascular risk: A randomised trial in general practice.Collaborative Group of the Pri-mary Prevention Project [J].Lancet, 2001 ;357(9 250) :89-95.
20. ［20］Hebert PR, Hennekens CH. An overview of the 4 randomized trials of as-pirin therapy in the primary revention of vascular disease[J]. Arch Intern Med, 2000;160(20) :3 123-3 127.
21. ［21］Antiplatelet Trialists’Collaboration. Collaborative overview of ran-domised trials of antiplatelet therapy-I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients [ J ]. BM J,1994 ;308(6 921 ) :81-106.
22. ［22］American Diabetes Association. Aspirin therapy in diabetes.Diabetes Care [ J ], 2002; 25 ( supple 1 ): s78-79.
23. ［23］Stewart R, Liolitsa D. Type 2 diabetes mellitus, cognitive impairment and dementia[J]. Diabet Med, 1999; 16 (2) :93-112.
24. ［24］Meneilly GS, Cheung E, Tessier D, Yakura C, Tuokko H.The effect of improved glycemic control on cognitive functions in the elderly patient with diabetes [ J ] J Geron-tol, 1993; 48(4) :M117-M121.
  1. 1. ［1］UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) [J]. Lancet, 1998:352(9131) :837-853.
  2. 2. ［2］America Diabetes Association. Standards of medical care for patients with diabetes mellitus [ J ]. Diabetes Care, 2003; 26(Suppl. 1 ) : s33-s50.
  3. 3. ［3］Coster S, Gulliford MC, Seed PT, Powrie J K, Swaminathan R. Self-monitoring in Type 2 diabetes mellitus: a meta-analysis[J ]. Diabetic Medicine, 2000; 17 ( 11 ) :755-761.
  4. 4. ［4］Norris SL, Engelgau MM, Narayan KM. Effectiveness of self management training in type 2 diabetes: a systematic review of randomized controlled trials [ J ]. Diabetes Care, 2001 ;24 ( 3 ):561-587.
  5. 5. ［5］Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M.Mortality from coronary heart diasease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior mycardial infarction [ J ]. N Engl J Med, 1998; 339 ( 4 ): 229-234.
  6. 6. ［6］Larosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: A meta-analysis of randomized controlled trials[J]. JAMA, 1999; 282(24) :2 340-2 346.
  7. 7. ［7］Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes[J]. JAMA, 2002; 288(4): 462-467.
  8. 8. ［8］Schrier RW , Estacio RO , Esler A , Mehler P . Effects of aggressive blood presure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes [ J ]. Kidney Int, 2002; 61(3): 1 086-1 097.
  9. 9. ［9］United Kingdom Prospective Diabetes Study 7. Response of fasting plasma glucose to diet therapy in newly presenting type 2 diabetic patients, UKPDS Group [ J ]. Metbolism, 1990; 39(9) :905-912.
  10. 10. ［10］United Kingdom Prospective Diabetes Study 24. A 6-year,randomized, controlled trial comparing sulfonylurea, insulin,and mefformin therapy in patients with newly diagnosed type 2 diabetes that could not be controlled with diet therapy. UK Prospective Diabetes Study Group[J]. Ann Intern Med, 1998;128(3) :165-175.
  11. 11. ［11］Simonson DC, Kourides IA, Feinglos M, Shamoon H, Fischette CT. Efficacy, safety, and dose-response characteristics of glipizide gastrointestinal therapeutic system on glycemic control and insulin secretion in NIDDM. Results of two multicenter,randomized, placebo-controlled clinical trials . The Glipizide Gastrointestinal Therapeutic System Study Group [ J ]. Diabetes Care, 1997; 20(4) :597-606.
  12. 12. ［12］Rosenstock J , Samols E , Muchmore DB , Schneider J .Glimepiride, a new once-daily sulfonylurea. A double-blind placebo-controlled study of NIDDM patients. Glimepiride Study Group[J]. Diabetes Care, 1996; 19(11) :1 194-1 199.
  13. 13. ［13］Effect of intensive blood-glucose control with metformin on complications in over weight patients with type 2 diabetes( UKPDS 34) . UK Prospective Diabetes Study [ J ]. Lancet,1998; 352(9131 ) :854-865.
  14. 14. ［14］Chiasson JL, Josse RG, Hunt JA, Palmason C, Rodger NW,Ross SA, R yan EA, Tan MH, Wolever TM. The efficacy of acarbose in the treatment of patients with non-insulindependent diabetes mellitus. A multicenter controlled clinical trial[J]. Ann Intern Med,1994; 121(12) :928-935.
  15. 15. ［15］Holman RR, Cull CA, Turner RC. A randomized doubleblind trial of acarbose in type 2 diabetes shows improved glycemic control over 3 years (U. K. Prospective Diabetes Study 44) [J]. Diabetes Care, 1999; 22(6): 960-964.
  16. 16. ［16］Inzucchi SE. Oral antihyperglycemic therapy for type 2 diabetes scientific review[J]. JAMA, 2002; 287 (3) :360-372.
  17. 17. ［17］Harpaz D, Gottlieb S, GraffE. Effects of aspirin treatment on survival in non-insulin-dependent diabetic patients with coronary artery disease. Is raeli Bezafibrate Infarction Prevention Study Group[J]. Am J Med, 1998;105(6) :494-499.
  18. 18. ［18］Johnson ES, Lanes SF, Wentworth CE 3rd, Satterfield MH,Abebe BL, Dicker LW. A metaregression analysis of the doseresponse effect of aspirin on stroke [ J ]. Arch Intern Med,1999; 159(11) :1 248-1 253.
  19. 19. ［19］de Gaetano G. Low-dose aspirin and vitamin E in people at cardiovascular risk: A randomised trial in general practice.Collaborative Group of the Pri-mary Prevention Project [J].Lancet, 2001 ;357(9 250) :89-95.
  20. 20. ［20］Hebert PR, Hennekens CH. An overview of the 4 randomized trials of as-pirin therapy in the primary revention of vascular disease[J]. Arch Intern Med, 2000;160(20) :3 123-3 127.
  21. 21. ［21］Antiplatelet Trialists’Collaboration. Collaborative overview of ran-domised trials of antiplatelet therapy-I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients [ J ]. BM J,1994 ;308(6 921 ) :81-106.
  22. 22. ［22］American Diabetes Association. Aspirin therapy in diabetes.Diabetes Care [ J ], 2002; 25 ( supple 1 ): s78-79.
  23. 23. ［23］Stewart R, Liolitsa D. Type 2 diabetes mellitus, cognitive impairment and dementia[J]. Diabet Med, 1999; 16 (2) :93-112.
  24. 24. ［24］Meneilly GS, Cheung E, Tessier D, Yakura C, Tuokko H.The effect of improved glycemic control on cognitive functions in the elderly patient with diabetes [ J ] J Geron-tol, 1993; 48(4) :M117-M121.