本期推荐发表于《中国全科医学》的4篇糖尿病研究相关双语文章，内容涵盖糖尿病相关并发症治疗、糖尿病患者健康管理等，欢迎阅读！
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二甲双胍治疗糖尿病肾病的研究进展
Recent Advances of Metformin in Treatment of Diabetic Nephropathy
【摘要】糖尿病肾病是糖尿病微血管病变常见的并发症之一，可降低糖尿病患者的生活质量，是造成终末期肾衰竭的主要病因。二甲双胍是治疗糖尿病的主要药物之一，在糖尿病肾病治疗中起至关重要的作用。近年来，研究发现二甲双胍不仅可以通过多种机制降低血糖，还可以阻止糖尿病肾病发展为终末期肾衰竭。多项研究发现二甲双胍对于治疗糖尿病肾病具有临床疗效，应根据肾小球滤过率评估患者药物安全性。本文综述了二甲双胍治疗糖尿病肾病的药理作用和作用机制的研究结果，旨在深入了解二甲双胍对糖尿病肾病的治疗作用，为糖尿病肾病的治疗方案提供参考。
【Abstract】Diabetic nephropathy is one of the most common complications of diabetic microangiopathy，which significantly reduces the quality of life of diabetic patients and is the main cause of end-stage renal failure. As one of the main drugs in the treatment of diabetes mellitus，metformin plays a vital role in the treatment of diabetic nephropathy. In recent years，studies have found that metformin can not only lower blood sugar through a variety of mechanisms，but also prevent diabetic kidney disease from developing into end-stage renal failure. Several studies have found that metformin has clinical efficacy in the treatment of diabetic nephropathy，and drug safety in patients should be evaluated by glomerular filtration rate. This review summarizes the results of the clinical effects and mechanism of metformin in the treatment of diabetic nephropathy，aiming to better understand the therapeutic effect of metformin on diabetic nephropathy，and provide reference for the treatment of diabetic nephropathy.
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老年2型糖尿病合并动脉粥样硬化性心血管疾病多重用药管理规范
Management Standards of Polypharmacy in Type 2 Diabetes Combined with Atherosclerotic Cardiovascular Diseases in the Elderly
【摘要】2型糖尿病（T2DM）是老年人常见的慢性病之一，持续的高血糖易损伤全身血管，影响心、肾、眼和神经等器官组织，导致各种并发症的出现。其中，动脉粥样硬化性心血管疾病（ASCVD）是T2DM患者死亡的主要原因，此类患者需要进行降糖、调脂、降压、抗血小板和降低尿蛋白等综合治疗。多重用药对合并多种并发症的老年人有较好的疾病控制作用，但如果应用不合理、不科学，也会带来潜在的药物相互作用和药物不良反应等问题。本文针对老年T2DM合并ASCVD患者多重用药管理进行分析，重点阐述降糖药、降压药、调脂药和抗血小板药等之间的相互作用和注意事项，保证药物使用有效性的前提下提高患者用药的合理性、安全性和规范性，减少不良反应的发生，为临床医师用药提供参考。
【Abstract】Type 2 diabetes mellitus（T2DM） is one of the common chronic diseases among the elderly. Persistent hyperglycemia damages blood vessels throughout the body，affecting organs and tissues such as heart，kidneys，eyes，and nerves，leading to various complications. Atherosclerotic cardiovascular diseases （ASCVD） are the main cause of death in T2DM patients. Such patients need comprehensive treatment such as glucose-lowering，lipid-regulation，antihypertensive，antiplatelet，and urinary protein-lowering treatments. Polypharmacy plays a good role in disease control in older adults with multiple comorbidities，but it also poses a number of problems such as potential drug interactions and adverse drug reactions if applied in an irrational and unscientific manner. This paper analyses the management of polypharmacy in elderly T2DM patients combined with ASCVD，with a particular emphasis on the interactions among hypoglycemic，antihypertensive，lipidregulating，and antiplatelet medications，as well as precautions，so as to improve the rationality，safety and standardization of medication under the premise of ensuring the efficacy of medication，reduce the occurrence of adverse reactions and provide reference for clinicians in the use of drugs.
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价值共创视角下糖尿病社区管理模式实践与思考
Practice and Reflection on Diabetes Community Management Model from the Perspective of Value Co-creation
【摘要】中国是全球糖尿病患病率增长较快的国家之一，也是糖尿病患者最多的国家。《“健康中国2030”规划纲要》明确提出，要进一步防控重大疾病，实施糖尿病防治行动，指导糖尿病患者加强健康管理，延迟或预防糖尿病发生、发展。近20年来，价值共创理论在健康服务领域应用发展较好，不同国家（地区）探索低成本、高效果的方案以预防和控制糖尿病发生，但目前在国内慢性病管理领域较为缺乏。本文基于价值共创视角，以基层社区为研究分析点，进一步总结国内外慢性病管理经验，从主动健康、组织引导、数字技术、激励考核4个方面提出展望，为优化完善基层糖尿病管理的服务体系，建立基于价值共创的多元主体协同参与社区慢性病管理模式，实现慢性病管理的共创、共治、共享提供参考。
【Abstract】China is one of the countries with the fastest growing prevalence of diabetes in the world，and also has the largest number of people with diabetes. The "Health China 2030" plan clearly proposes to further prevent and control major diseases，implement diabetes prevention and control，and guide patients with diabetes to strengthen health management and delay or prevent the development of diabetes. In the past 20 years，value co-creation theory has been well developed in the field of health services，and different countries （regions） have explored programs to prevent and control diabetes at low cost and high effectiveness，but it is currently lacking in the field of chronic disease management in China. Based on the perspective of value co-creation，this paper further summarizes the domestic and international experience of chronic disease management taking community as the research and analysis point，proposes the prospect from four aspects of active health，organizational guidance，digital technology，and incentive assessment，which provides references for optimizing and improving the service system of diabetes management at primary health care，establishing a model of collaborative participation of multiple subjects in community chronic disease management based on value co-creation，and realizing co-creation，co-management and sharing of chronic disease management.
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基于医疗失效模式与效应分析框架的社区2型糖尿病临床惰性形成原因及对策研究
A Study of Root Causes and Countermeasures for Clinical Inertia in Type 2 Diabetes Patients in Community Based on HFMEA Framework
【摘要】背景 自2009年起，社区2型糖尿病（T2DM）健康管理作为国家基本公共卫生服务项目在全国得到推广实施，但由于临床惰性（即发现问题未能及时采取干预措施）的影响，造成患者血糖长期控制效果不佳，因此如何克服临床惰性以提高血糖控制率是优化糖尿病健康管理所面临的一项重要而紧迫的任务。目的 识别社区T2DM健康管理过程中临床惰性发生的关键失效模式，系统分析关键失效模式的发生原因，并提出相应的干预对策措施。方法 立足社区实情，以医疗失效模式与效应分析（HFMEA）框架为指导，通过实地调研、访谈及文献归纳分析法初步明确社区T2DM健康管理流程、临床惰性发生的原因及干预措施。文献检索时间为2020-01-01—2023-06-30。在此基础上，应用德尔菲法，选择16名专家于2022-01-10—02-25期间进行两轮专家咨询，最终确定社区T2DM健康管理过程中临床惰性发生的关键失效模式、发生原因和干预措施。结果 第一轮和第二轮专家权威系数分别为0.791和0.729。最终通过计算风险优先指数（RPN）量化确定了社区T2DM健康管理过程中临床惰性发生的10个关键失效模式，按RPN从大到小，依次为未（及时）胰岛素治疗、未（及时）戒酒、未（及时）常规转诊、未（及时）戒烟、未（及时）紧急转诊、未（及时）三联治疗、未（及时）控制体质量、未（及时）调整膳食结构、未（及时）二联治疗和未（及时）发现低血糖，并从患者、医生及卫生系统层面阐明了关键失效模式形成的根本原因，制定了针对性的干预措施。结论 制定的临床惰性干预措施具有较高的科学性和权威性，为优化社区T2DM健康管理模式奠定了基础。
【Abstract】Background Since 2009，community health management for type 2 diabetes mellitus（T2DM） has been significantly promoted and implemented as a national public health service program. However，the impact of clinical inertia，defined as failure to take timely interventions when therapeutic goals are unmet，hinders the achievement of longterm optimal glycemic control in T2DM patients. Therefore，addressing clinical inertia to improve glycemic control rates is an important and urgent task for optimizing diabetes health management. Objective To identify the key failure modes of clinical inertia in community health management for T2DM，systematically analyze the underlying causes of these failure modes，and propose corresponding intervention measures. Method Based on community realities and guided by the Healthcare Failure Mode and Effect Analysis （HFMEA） framework，a foundational comprehension of community health management processes for T2DM，the root causes of clinical inertia，and prospective intervention measures were obtained through field research，interviews，and literature review. The Delphi method was employed based on this basis to engage 16 experts in two rounds of expert consultation，to delineate the key failure modes，their root causes，and intervention measures concerning clinical inertia in community health management for T2DM. Results The expert authority coefficients for the first and second rounds were 0.791 and 0.729，respectively，ten key failure modes of clinical inertia in community health management for T2DM were quantitatively identified by calculating the Risk Priority Number （RPN） metric and ranked in descending RPN value as follows：untimely insulin treatment，untimely alcohol cessation，untimely routine referral，untimely smoking cessation，untimely emergency referral，untimely triple therapy，untimely weight control，untimely dietary modification，untimely dichotomous therapy，and untimely detection of hypoglycemia. The root causes of these key failure modes were explored from the perspectives of patients，physicians，and the healthcare system，enabling the formulation of targeted intervention measures. Conclusion The devised intervention measures to address clinical inertia exhibit substantial scientific validity and authority，providing a robust foundation for enhancing the community health management model for T2DM.
期刊推荐
《中国全科医学》创刊于1998年，经国家新闻出版署批准，由国家卫生健康委员会主管，中国医院协会、中国全科医学杂志社主办，国内公开出版发行的全科医学学术性刊物。
办刊宗旨：关注全人健康，快速报道全科医学及临床科研成果，推动中国全科医学发展和社区卫生服务工作，在世界范围传播全科医学研究，建立学科科研及学术交流平台。
2024年主要方向：
（1）全科医学/初级卫生保健研究；（2）公共卫生/卫生政策研究；（3）慢病/共病研究；（4）健康公平性研究；（5）心脑血管疾病研究；（6）内分泌与代谢性疾病研究；（7）呼吸系统疾病研究；（8）消化系统疾病研究；（9）肾脏疾病研究；（10）肿瘤研究；（11）中医药发展研究；（12）精神/心理/气候与健康；（13）重点人群健康/医防融合；（14）人工智能与临床研究。
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