欧洲糖尿病研究协会成人低血糖评价与治疗

EvaluationandManagementofAdultHypoglycemicDisorders:AnEndocrineSocietyClinicalPracticeGuidelineGUIDELINESCLINICALTheEndocrineSociety’sTheEndocrineSociety8401ConnecticutAvenue,Suite900ChevyChase,MD20815301.941.0200:AmericanDiabetesAssociation,EuropeanAssociationfortheStudyofDiabetes,andEuropeanSocietyofEndocrinologyAffiliations:WashingtonUniversitySchoolofMedicine(P.E.C.),St.Louis,Missouri;MassachusettsGeneralHospitalandHarvardMedicalSchool(L.A.),Boston,Massachusetts;BartsandtheLondonSchoolofMedicine,QueenMaryUniversityofLondon(A.B.G.),London,UnitedKingdom;UniversityofSheffield(S.R.H.),Sheffield,UnitedKingdom;UniversityofMinnesota(E.R.S.),Minneapolis,Minnesota;andMayoClinic(V.M.M.,F.J.S.),Rochester,MinnesotaDisclaimerStatement:ClinicalPracticeGuidelinesaredevelopedtobeofassistancetoendocrinologistsbyprovidingguidanceandrecommendationsforparticularareasofpractice.TheGuidelinesshouldnotbeconsideredinclusiveofallproperapproachesormethods,orexclusiveofothers.TheGuidelinescannotguaranteeanyspecificoutcome,nordotheyestablishastandardofcare.TheGuidelinesarenotintendedtodictatethetreatmentofaparticularpatient.Treatmentdecisionsmustbemadebasedontheindependentjudgmentofhealthcareprovidersandeachpatient’sindividualcircumstances.TheEndocrineSocietymakesnowarranty,expressorimplied,regardingtheGuidelinesandspecificallyexcludesanywarrantiesofmerchantabilityandfitnessforaparticularuseorpurpose.TheSocietyshallnotbeliablefordirect,indirect,special,incidental,orconsequentialdamagesrelatedtotheuseoftheinformationcontainedherein.Evidence-basedreviewsforthisguidelinewerepreparedundercontractwithTheEndocrineSociety.FirstpublishedintheJournalofClinicalEndocrinology&Metabolism,March2009,94(3):709-728©TheEndocrineSociety,2009CommercialReprintInformationForinformationonreprintrequestsofmorethan101andcommercialreprintscontact:MennaBurgessReprintSalesSpecialistCadmusProfessionalCommunicationsPhone:410.819.3960Fax:[phone]Email:[e-mail]ionForinformationonreprintsof100andfewer,completetheguidelineorderformandreturnusingoneofthefollowingmethods:Mail:TheEndocrineSocietyc/oBankofAmericaP.O.Box630721Baltimore,MD21263-0721Fax:[phone]Email:[e-mail]&CorrespondencesTheEndocrineSocietyAttn:Government&PublicAffairsDepartment8401ConnecticutAvenue,Suite900ChevyChase,MD20815Phone:[phone]Email:[e-mail]:’sClinicalPracticeGuidelinesortodownloadthecompleteversionofthisguideline,visit:AnEndocrineSocietyClinicalPracticeGuidelineGUIDELINESCLINICALTheEndocrineSociety’sTableofContentsSummaryofRecommendations.................................................................4MethodofDevelopmentofEvidence-BasedRecommendations.......................................5WorkupforaHypoglycemicDisorder............................................................6EvaluationandManagementofHypoglycemiainPersonsWithoutDiabetesMellitus.....................7EvaluationandManagementofHypoglycemiainPersonsWithDiabetesMellitus......................15References................................................................................26OrderForm...............................................................................35ReprintInformation,Questions&Correspondences..................................InsideBackCoverObjective:Theaimistoprovideguidelinesfortheevaluationandmanagementofadultswithhypoglycemicdisorders,includingthosewithdiabetesmellitus.Participants:TheTaskForcewascomposedofachair,selectedbytheClinicalGuidelinesSubcommittee(CGS)ofTheEndocrineSociety,fiveadditionalexperts,onemethodologist,andamedicalwriter.TheTaskForcereceivednocorporatefundingorremuneration.Evidence:UsingtherecommendationsoftheGradingofRecommendations,Assessment,DevelopmentandEvaluation(GRADE)system,thequalityofevidenceisgradedverylow(),low(),moderate(),orhigh().ConsensusProcess:Consensuswasguidedbysystematicreviewsofevidenceanddiscussionsduringonegroupmeeting,severalconferencecalls,ande-mailcommunications.ThedraftspreparedbythetaskforcewiththehelpofamedicalwriterwerereviewedsuccessivelybyTheEndocrineSociety’sCGS,ClinicalAffairsCoreCommittee(CACC),AmericanDiabetesAssociation,EuropeanAssociationfortheStudyofDiabetes,theEuropeanSocietyofEndocrinology,andtheSociety’sCouncil.TheversionapprovedbytheCGSandCACCwasplacedonTheEndocrineSociety’sWebsiteforcommentsbymembers.Ateachstageofreview,theTaskForcereceivedwrittencommentsandincorporatedneededchanges.Conclusions:WerecommendevaluationandmanagementofhypoglycemiaonlyinpatientsinwhomWhipple’striad—symptoms,signs,orbothconsistentwithhypoglycemia,alowplasmaglucoseconcentration,andresolutionofthosesymptomsorsignsaftertheplasmaglucoseconcentrati