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Recently, the 2022 edition of the "China Expert Consensus on Risk Assessment and Management of Panvascular Disease in Patients with Type 2 Diabetes" (hereinafter referred to as the consensus) was released
in four major magazines at the same time: Chinese Journal of Diabetes, Chinese Journal of Health Management, Chinese Journal of Circulation, and Cardiology Plus.
The consensus is led by the Cardiovascular Medicine Branch of the Chinese Medical Doctor Association to organize domestic authoritative scholars in five major fields, including cardiovascular disease, endocrinology, nephrology, neurology and health management, combined with important scientific evidence in this field and the practical experience of clinicians at home and abroad
.
The consensus content covers the epidemiological characteristics, pathophysiological mechanism, multidisciplinary collaborative diagnosis and treatment, risk assessment and management of panvascular disease in T2DM patients, and a total of 21 recommendations can provide systematic and standardized guidance for
the clinical risk assessment and management of panvascular disease in patients with type 2 diabetes.
The consensus applies to doctors
in internal medicine, surgery, general medicine and physical examination who are engaged in clinical work.
Epidemiological status of panvascular disease in patients with T2DM02 Pathophysiological mechanism of panvascular disease in patients with T2DM03
Multidisciplinary collaborative diagnosis and treatment of panvascular disease in T2DM patients04
Risk assessment of panvascular disease in T2DM patients05
Management strategies for panvascular disease in T2DM patients
The consensus highlights the content of early risk assessment of panvascular disease in T2DM patients, that is, the assessment of risk factors, vascular structure and function and target organ damage at least once a year, and emphasizes that the management of panvascular disease in T2DM patients needs to be jointly participated by patients and multidisciplinary physicians, and the control of blood glucose, blood pressure, blood lipids and antiplatelet therapy
are strengthened on the basis of lifestyle intervention.
This article shares
with you the important content of panvascular disease risk assessment in patients with type 2 diabetes.
Patients with T2DM are routinely consulted, physically examined, and general laboratory tests, such as urine routine, liver function, renal function, blood glucose, glycated hemoglobin (HbA1c), insulin, C-peptide, etc.
, and a systematic panvascular disease risk assessment (Table 1) is also carried out to detect subclinical atherosclerosis and target organ damage
at an early stage.
【Recommended】
The systematic evaluation of panvascular disease in patients with T2DM includes, at a minimum, risk factors, vascular structure and function, and target organ damage
.
Table 1: Content of panvascular disease risk assessment in patients with T2DM
The consensus also clarifies the important role of biomarkers in the management of panvascular disease in patients with T2DM, and recommends that myocardial markers (NT-proBNP, hs-cTnT), lipid profile, and renal function indicators be screened
at least once a year at the time of diagnosis and subsequent follow-up in T2DM patients.
NT⁃proBNP: For every 100 pg/mL increase in NT⁃proBNP, 5-year hospitalizations for cardiovascular events increased by 12%
in patients with T2DM.
Intensive cardioprotective therapy in patients with T2DM with NT⁃proBNP>125 pg/mL reduces the risk of hospitalization or death from cardiovascular disease by 65% after 2 years
.
hs⁃cTnT:hs⁃cTnT is a specific and highly sensitive marker of myocardial injury that reflects chronic subclinical myocardial injury
in patients with T2DM.
Patients with T2DM have a significantly higher risk of elevated hs⁃cTnT (≥14 ng/L) than non-diabetic people, and the relative risk of coronary heart disease, heart failure, and all-cause mortality is also significantly increased
over the next 5 years.
【Recommended】
Patients with T2DM are assessed at least once a year at diagnosis and at least one follow-up visit for NT⁃proBNP/BNP and hs⁃cTn
.
If NT⁃proBNP>125 pg/mL or BNP>50 pg/mL or hs⁃cTn is found to exceed the upper limit of the reference value, or if NT⁃proBNP/BNP or hs⁃cTn is elevated through serial monitoring, cardioprotective therapy should be initiated immediately with increased follow-up
Lipid profiles, including total cholesterol, TG, LDL⁃C, HDL⁃C, and ApoB, are assessed at least once a year at the time of diagnosis and subsequent follow-up in patients with T2DM; Lp(a) levels are measured at least once in patients with T2DM after diagnosis; LDL⁃C, non-HDL⁃C, and ApoB were used as the main targets for diagnosis and treatment
.
application value of renal function indicators in the risk assessment and management of panvascular disease in T2DM patients
Urine albumin/creatinine ratio: urinary albumin/creatinine ratio can be measured to reflect urinary albumin excretion, UACR≥ 30 mg/g is positive;
Serum creatinine: used to calculate the estimated glomerular filtration rate (eGFR).
【Recommended】
Patients with T2DM are assessed for UACR and serum creatinine
at least once a year at diagnosis and subsequent follow-up.After the diagnosis of DKD is confirmed in patients with T2DM, the stage of CKD should be further determined based on eGFR and urine albumin levels, the risk of DKD progression should be assessed, and the frequency of
evaluation should be determined.
Note: T2DM is type 2 diabetes; NT⁃proBNP/BNP is N-terminus⁃B-type natriuretic peptide/B-type natriuretic peptide; hs⁃cTnT is highly sensitive cardiac troponin T;; TG is triglycerides, LDL⁃C is LDL cholesterol, HDL⁃C is HDL cholesterol, ApoB is apolipoprotein B; UACR is the urine albumin/creatinine ratio; CKD is chronic kidney disease; DKD is diabetic nephropathy
Source:
[1] Chinese Medical Doctor Association Cardiovascular Medicine Branch, Expert Group of "Chinese Expert Consensus on Risk Assessment and Management of Panvascular Disease in Patients with Type 2 Diabetes".
Expert consensus on risk assessment and management of panvascular disease in patients with type 2 diabetes mellitus (2022 edition)[J].
Chinese Journal of Diabetes,2022,14(10):1017-1034.
[2] Cardiovascular Medicine Branch of Chinese Medical Doctor Association, Expert Group of "Chinese Expert Consensus on Risk Assessment and Management of Panvascular Disease in Patients with Type 2 Diabetes".
Expert consensus on risk assessment and management of panvascular disease in patients with type 2 diabetes mellitus (2022 edition)[J].
Chinese Journal of Health Management,2022,16(10):673-689.
[3] Chinese Medical Doctor Association Cardiovascular Medicine Branch, Expert Group on "Chinese Expert Consensus on Risk Assessment and Management of Panvascular Disease in Patients with Type 2 Diabetes".
Expert consensus on risk assessment and management of panvascular disease in patients with type 2 diabetes mellitus (2022 edition)[J].
Chinese Journal of Circulation,2022,37:0974-1017.
