肥胖与糖尿病诊疗体系的对比
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曾祥红，李伟，韩永鹏
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北京中西医结合医院，北京，100039
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摘要：通过文献研究进行肥胖和糖尿病诊疗体系对比，发现：(1) 标准化诊疗规范：《中国2 型糖尿病防治指南》于2004 年首次发布并保持3-5 年更新周期（最新为2024 版），而我国首部国家级《肥胖症诊疗指南（2024 年版）》直至2024 年10 月才颁布，存在20 年发展差距。(2) 诊断标准：糖尿病诊断依赖明确量化指标（如空腹血糖≥ 7.0 mmol/L、糖化血红蛋白≥ 6.5%），而肥胖诊断需综合评估多维度参数（BMI ≥ 28 kg/m2、腰围、体脂率及高血压/ 血脂异常等代谢异常），且存在标准化不足问题（如跨民族BMI 界值未统一）。(3) 治疗方案与药物：糖尿病采用" 五驾马车" 管理模式，涵盖20 余种药物（如二甲双胍、GLP-1 受体激动剂、SGLT-2 抑制剂）及减重手术；肥胖治疗则以生活方式干预为主，仅推荐5 种药物（其中4 种为司美格鲁肽等糖尿病药物转用途），且减重手术适应证严格。(4) 指南更新机制：2017-2024 年间糖尿病指南历经3 次更新，每年纳入逾2000 项新证据；肥胖指南尚处起步阶段，缺乏定期更新机制。(5) 体系差异：糖尿病具备完善的三级预防体系及全额医保覆盖，而肥胖缺乏国家级筛查项目、医保覆盖有限（如司美格鲁肽减重适应证需自费），且公众认知度低、病耻感显著。目前北京协和医院、北京大学人民医院等三甲医院已设立多学科体重管理门诊，但肥胖诊疗体系——尤其是中西医结合体系——仍缺乏权威指南。基于我国卫生健康战略从" 以治病为中心" 向" 以健康为中心" 的转变，亟需加强多学科协作、优化医保政策，构建涵盖预防- 治疗- 康复全流程的中西医结合肥胖管理体系，推动实现从" 疾病治疗" 到" 健康维护" 的战略升级。
关健词：肥胖症；糖尿病；中西医结合
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Comparison of diagnosis and treatment systems forobesity and diabetes
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Xianghong Zeng,Wei Li, Yongpeng Han
Beijing Integrated Traditional Chinese and Western Medicine Hospital, Beijing 100039, China
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Abstract：Through literature research, a comparison of the diagnosis and treatment systems for obesity and diabetes was conducted,and it was found that: (1) Standardized protocols: The Chinese Guidelines for the Prevention and Treatment of Type2 Diabetes was first released in 2004 and has been updated every 3-5 years (latest 2024 version), while China’s first nationalGuidelines for the Diagnosis and Treatment of Obesity (2024 Version) was only issued in October 2024, lagging behind by 20years. (2) Diagnostic criteria: Diabetes diagnosis relies on well-defined, quantifiable biomarkers (e.g., fasting blood glucose ≥7.0mmol/L, glycated hemoglobin ≥6.5%), whereas obesity diagnosis requires comprehensive assessment of multiple indicators (BMI≥28 kg/m2, waist circumference, body fat percentage, and metabolic abnormalities like hypertension/dyslipidemia), with poorstandardization (e.g., ununified BMI cutoffs across ethnicities). (3) Treatment regimens and medications: Diabetes managementadopts a “five-horse carriage” model, including over 20 types of drugs (e.g., metformin, GLP-1 RAs, SGLT-2 inhibitors) andbariatric surgery; in contrast, obesity treatment mainly relies on lifestyle intervention, with only 5 recommended drugs (4 being repurposed diabetes medications like semaglutide) and strict indications for bariatric surgery. (4) Guideline updates: Diabetesguidelines were updated 3 times in 2017-2024 with over 2,000 new pieces of evidence annually, while obesity guidelines are stillin their infancy without a regular update mechanism. (5) Other gaps: Diabetes has a sound three-tiered prevention system andfull medical insurance coverage, whereas obesity lacks national screening programs, has limited insurance coverage (e.g., weightloss indications of semaglutide are self-funded), and suffers from low public awareness and high stigma.Currently, tertiary hospitals in Beijing (e.g., Peking Union Medical College Hospital, Peking University People’s Hospital)have established multi-disciplinary weight management clinics. However, the obesity diagnosis and treatment system—especiallythe integrated traditional Chinese and Western medicine (TCM-WM) system—still lacks authoritative guidelines. In conclusion,to align with China’s health strategy shifting from“ disease-centered treatment” to“ health-centered prevention,” it isimperative to strengthen MDT, optimize medical insurance policies, and construct a comprehensive TCM-WM-based obesitymanagement system covering prevention, treatment, and rehabilitation, thereby promoting the strategic upgrade from“ diseasetreatment” to“ health maintenance.”
Keywords : Obesity; Diabetes Mellitus;; Integrated Traditional Chinese and Western Medicine.
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