糖尿病指南CKD.ppt

A Balanced Approach to Nurtrition in CKD with or without Diabetes: Macronutrient Composition and Mineral Content III. CLINICAL PRACTICE RECOMMENDATIONS CLINICAL PRACTICE RECOMMENDATION 1: MANAGEMENT OF ALBUMINURIA IN NORMOTENSIVE PATIENTS WITH DIABETES AND ALBUMINURIA AS A SURROGATE MARKER Treatments that lower urinary albumin excretion may slow progression of diabetic kidney disease (DKD) and improve clinical outcomes, even in the absence of hypertension. 1.1 Normotensive people with diabetes and macroalbuminuria should be treated with an ACE inhibitor or an ARB. (C) 1.2 Treatment with an ACE inhibitor or an ARB may be considered in normotensive people with diabetes and microalbuminuria. (C) 1.3 Albuminuria reduction may be considered a treatment target in DKD. (C) CLINICAL PRACTICE RECOMMENDATION 2: MULTIFACETED APPROACH TO INTERVENTION IN DIABETES AND CHRONICKIDNEY DISEASE Multiple risk factors are managed concurrently in patients with diabetes and CKD, and the incremental effects of treating each of these risk factors appear to add up to substantial clinical benefits. 2.1 The care of people with diabetes and CKD should incorporate a multifaceted approach to intervention that includes instruction in healthy behaviors and treatments to reduce risk factors. (C) 2.2 Target BMI for people with diabetes and CKD should be within the normal range(18.5-24.9 kg/m2). (C) CLINICAL PRACTICE RECOMMENDATION 4: BEHAVIORAL SELF-MANAGEMENT IN DIABETES AND CHRONIC KIDNEY DISEASE Behavioral self-management in diabetes and CKD is particularly challenging because of the intensive nature of the diabetes regimen. Education alone is not sufficient to promote and sustain healthy behavior change, particularly with such a complex regimen. 4.1 Self-management strategies should be key components of a multifaceted treatment plan with attention to multiple behaviors:(C) ● Monitoring and treatment of glycemia ● Blood pressure ● Nutrition ● Smoking cessation ● Exercise ● Adher