摘要
《糖尿病患者体重管理专家共识(2024版)》强调了体重管理在糖尿病治疗中的重要性,提出了基于循证医学的分层管理模式。共识指出,中国成人糖尿病患者中超重/肥胖比例高达60%~70%,肥胖显著增加心血管及微血管并发症风险。因此,共识首次提出“体重与代谢共管”理念,明确体重管理为糖尿病治疗核心目标。超重/肥胖与糖尿病患病率显著相关,且腹型肥胖在中国人群中尤为突出。肥胖是糖尿病的重要危险因素,BMI每增加1,糖尿病风险上升约5%。中国人群相比西方更易出现腹型肥胖,代谢风险高。共识提出了体重管理的分层干预策略,包括目标分层与个性化设定、分层干预路径及药物干预新进展。短期减重目标为BMI≥24者3~6个月减重5%~10%,特殊人群如老年患者目标放宽。药物干预方面,GLP-1受体激动剂、双靶点药物等展现出良好减重效果。对于特殊人群,如老年糖尿病患者、妊娠期糖尿病及肌少性肥胖患者,共识给出了具体管理要点。老年患者需避免过度减重导致肌少症,妊娠期糖尿病需控制孕期增重,肌少性肥胖需综合干预。共识还强调了多学科协作模式的重要性,通过三级预防体系、智慧化管理及护士作为个案管理者的角色,实现闭环管理。同时,针对护理实践中的挑战,提出了教育策略创新、技术赋能及政策支持等优化建议。通过多学科协作、技术赋能及政策支持等手段,实现精准化、数字化、全域化的体重管理模式。
Objective The Expert Consensus on Weight Management in Diabetes Mellitus(Version 2024)emphasises the importance of weight management in diabetes treatment and proposes a stratified management model based on evidence-based medicine.The consensus points out that the proportion of overweight/obesity Chinese diabetes adults was 60%~70%,and obesity highly increases the risk of cardiovascular and microvascular complications.Therefore,the consensus for the first time puts forward the concept of‘co-management of weight and metabolism,weight management is the core goal of diabetes treatment.Overweight/obesity is significantly associated with the prevalence of diabetes,and abdominal obesity is particularly prominent in the Chinese population.Obesity is an important risk factor for diabetes,and for every 1 increase in BMI,the risk of diabetes rises by about 5%.Chinese populations are more likely to have abdominal obesity and high metabolic risk compared to the West countries.The consensus proposes a tiered intervention strategy for weight management,including goal stratification and individualised setting,tiered intervention pathways and new advances in pharmacological intervention.The short-term weight loss goal is 5%~10%weight loss in 3~6 months for those with BMI≥24,and the goal is relaxed for special populations such as elderly patients.In terms of pharmacological intervention,GLP-1 agonists and dual-targeting drugs have shown good results in weight loss.For special groups,such as elderly patients with diabetes,gestational diabetes and sarcopenic obesity,the consensus gives specific management points.Elderly patients need to avoid excessive weight loss leading to sarcopenia,gestational diabetes need to control weight gain during pregnancy,and sarcopenic obesity need comprehensive intervention.The consensus also emphasised the importance of a multidisciplinary collaborative model to achieve closed-loop management through a three-tier prevention system,intelligent management and the role of the nurse as a case manager.Meanwhile,optimisation suggestions such as innovation in education strategies,technology empowerment and policy support were proposed to address the challenges in nursing practice.Through multidisciplinary collaboration,technological empowerment and policy support,a precise,digital and global weight management model can be achieved.
作者
李小珍
蓝盈盈
王章安
黄冬清
谈佳
陈丽平
谢伟玲
黄锡岚
蒋茜茜
曹译丹
LI Xiaozhen;LAN Yingying;WANG Zhang'an;HUANG Dongqing;TAN Jia;CHEN Liping;XIE Weiling;HUANG Xilan;JIANG Qianqian;CAO Yidan(Guangxi Academy of Medical Sciences/Guangxi Zhuang Autonomous Region People's Hospital,Nanning 530021,China)
出处
《护理实践与研究》
2025年第10期1430-1434,共5页
Nursing Practice and Research
基金
广西科技厅自然科学基金项目(编号:2023GXNSFBA026187)
广西卫健委课题(编号:Z-A20240013)
广西中医药管理局课题(编号:GXZYA20250207)。
关键词
糖尿病
体重管理
循证护理
分层干预
代谢获益
Diabetes mellitus
Weight management
Evidence-based care
Stratified intervention
Metabolic benefit
