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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">本書は日本糖尿病学会が総力を挙げて編集・執筆したガイドブックで，コンパクトな1冊ながら，糖尿病診療の基本的な考え方から最新情報までをわかりやすくまとめた，充実した内容となっている．内科医はもとより，他科の医師，コメディカルスタッフなどにもご好評いただき，広く活用いただいている．今回の改訂においても，イメグリミンや経口GLP-1受容体作動薬の追加など，2022年3月現在の最新の内容となるようアップデートしている．<br><br>【主な改訂のポイント】<br>◉イメグリミンや経口GLP-1受容体作動薬の追加など，2022年3月現在の最新の薬剤情報にアップデート．<br>◉かかりつけ医から糖尿病や腎臓の専門医・専門医療機関への紹介基準を，図を用いて明確に解説．<br>◉上記だけでなく，低血糖時におけるグルカゴン点鼻粉末剤（バクスミー）の使用，糖尿病医療支援チーム（DiaMAT）設立の動きなど，本書全体にわたって内容をアップデート．</section><section class="preface">はじめに<br><br>　この『糖尿病治療ガイド』は1999年に初版が作製され，以降ほぼ2年おきに改訂され，現在まで20年以上に亘って発行されている．本書は基本的には糖尿病を専門としないが糖尿病の診療に携わっておられる実地医家の先生方や医療スタッフの方に役立つように，現時点での糖尿病診療を行ううえでの標準コンセプトを示すことを目的としている．したがって，本書では，専門的すぎる内容に関しては記載していない．さらには，診療ガイドラインとの整合性を重視しつつも，現時点で必ずしもエビデンスが十分でないことについても，診療上必要なことに関しては，わが国の診療実態等を勘案したうえで専門家のコンセンサスとして掲載していることに留意していただきたい．<br>　本書は，日本糖尿病学会会員から選ばれた委員に加えて，日本医師会から今村聡副会長にも御参画頂いて「“糖尿病治療ガイド」編集委員会”を組織し，著作・編集を行った．<br>　前版である「糖尿病治療ガイド2020-2021」においては，「糖尿病治療の目標」の図，「インスリン非依存状態の治療」の図の改訂に加えて，「病態やライフステージに基づいた治療の実例」の章の新設など，最近の改訂のなかでは大改訂であった．したがって，今回は前版の改訂内容の継続性も考慮し，小改訂にとどめる方針で改訂作業を行った．<br>　この2年で，とくに日本におけるアドボカシー活動は進んだ．それに伴って，本書で用いている言葉の変更も必要ではないかという議論がなされたが，変更にあたって適切な基準がないため，今回，大幅な変更は見送った．おそらくは次回以降に考慮されるべき事項になるのではないかと思われる．この事に関してコラムの記載内容を追加している．さらに，災害時に糖尿病患者を支援する糖尿病医療支援チーム（DiaMAT）の設立に関してもコラム<br>を追加した．また，毎回の改訂と同様に6章「薬物療法」（59～80頁）および付録（140～148頁）において，2022年3月現在の薬剤情報をできるだけ加えた．<br>　それ以外にも，本学会の学術評議員の皆様や日本医師会などからのご意見を基に，必要な修正を加えた．ご協力いただいた皆様に，この場をお借りして厚く御礼を申し上げたい．<br>　本書が，日々進歩している糖尿病治療の理解に役立ち，毎日の診療に一層活用されることを願ってやまない．<br><br>2022年4月<br>「糖尿病治療ガイド」編集委員会</section><section class="indexes">1．糖尿病　疾患の考え方<br>　A．糖尿病とは<br>　B．糖尿病に関する指標<br>　　1．平均血糖値を反映する指標<br>　　2．インスリン分泌能の指標<br>　　3．インスリン抵抗性の指標<br>　　4．脂質代謝の指標<br>　C．糖尿病の分類<br>　　1．糖尿病の成因分類<br>　　2．糖尿病における成因（発症機序）と病態（病期）<br><br>2．診　断<br>　A．病歴聴取の注意点<br>　　1．現病歴<br>　　2．既往歴<br>　　3．家族歴<br>　　4．治療歴<br>　　5．病気に関する知識と生活歴<br>　B．身体所見のポイント<br>　　1．皮　膚<br>　　2．眼<br>　　3．口　腔<br>　　4．下　肢<br>　　5．神経系<br>　C．診断のための検査<br>　　1．糖代謝異常の判定区分と判定基準<br>　　2．75gOGTT（75g経口ブドウ糖負荷試験） <br>　D．糖尿病の診断<br>　E．境界型とメタボリックシンドローム（内臓脂肪症候群）<br>　　1．境界型とは<br>　　2．境界型の鑑別<br>　　3．境界型を見出したときの取り扱い<br><br>3．治　療<br>　A．治療目標とコントロール指標<br>　　1．糖尿病治療の目標<br>　　2．コントロールの指標<br>　B．治療方針の立て方<br>　　1．インスリン非依存状態<br>　　2．インスリン依存状態<br>　C．糖尿病療養支援<br>　　1．糖尿病教育<br>　　2．自己管理行動を促進する心理・行動学的方法<br>　　3．心理的問題の扱い方<br>　　4．チーム医療の重要性<br>　D．災害への備えと災害時の対応<br>　　1．災害時の糖尿病の特徴<br>　　2．病院・診療所・医療者レベルでの備えまたは対応<br>　　3．糖尿病患者レベルでの備えまたは対応<br><br>4．食事療法<br>　A．食事療法の進め方<br>　　1．エネルギー摂取量<br>　　2．栄養素の構成<br>　B．食事療法の実際<br>　　1．患者への食事指示<br>　　2．食事療法の評価と指導<br>　　3．食品交換表<br>　C．合併症の予防のために<br><br>5．運動療法<br>　　1．運動療法の進め方<br>　　2．運動の種類<br>　　3．運動の強度<br>　　4．運動時間と頻度<br>　　5．運動の消費エネルギー<br>　　6．運動療法指導上の注意点<br>　　7．運動療法を禁止あるいは制限した方がよい場合<br><br>6．薬物療法<br>　A．経口薬療法および注射薬療法<br>　　1．α‒グルコシダーゼ阻害薬<br>　　2．SGLT2阻害薬<br>　　3．チアゾリジン薬<br>　　4．ビグアナイド薬<br>　　5．イメグリミン<br>　　6．DPP‒4阻害薬<br>　　7．GLP‒1受容体作動薬<br>　　8．スルホニル尿素（SU）薬<br>　　9．速効型インスリン分泌促進薬（グリニド薬）<br>　　10．インスリン療法<br>　　11．配合錠および基礎インスリン製剤とGLP‒1受容体作動薬の配合注射薬<br>　B．その他の薬物療法<br>　　1．糖尿病に合併した高血圧<br>　　2．糖尿病に合併した脂質異常症<br><br>7．糖尿病合併症とその対策<br>　A．糖尿病合併症とは<br>　B．急性合併症<br>　　1．糖尿病性ケトアシドーシス<br>　　2．高浸透圧高血糖状態<br>　　3．感染症<br>　C．慢性合併症<br>　　1．糖尿病網膜症<br>　　2．糖尿病性腎症<br>　　3．糖尿病性神経障害<br>　　4．動脈硬化性疾患<br>　　5．糖尿病性足病変<br>　D．併存疾患（その他の合併症）<br>　　1．骨病変<br>　　2．手の病変<br>　　3．歯周病<br>　　4．認知症<br>　　5．癌<br>　E．合併症の検査<br>　　1．急性合併症のための検査<br>　　2．慢性合併症のための検査<br><br>8．低血糖およびシックデイ<br>　A．低血糖<br>　　1．症　状<br>　　2．高血糖性の昏睡との鑑別<br>　　3．低血糖の誘因<br>　　4．低血糖時の対応<br>　　5．再発予防<br>　B．シックデイ<br>　　1．シックデイとは<br>　　2．シックデイ対応の原則<br>　　3．入院加療が早急に必要な場合<br><br>9．ライフステージごとの糖尿病<br>　 A．小児・思春期における糖尿病<br>　　1．1型糖尿病<br>　　2．2型糖尿病<br>　 B．妊娠と糖尿病<br>　 C．高齢者の糖尿病<br><br>10．専門医に依頼すべきポイント<br>　 A．糖尿病専門医に依頼する場合<br>　　1．血糖コントロール不良<br>　　2．教育入院<br>　　3．慢性合併症<br>　　4．急性合併症<br>　　5．手術・化学療法<br>　B．他科専門医に依頼する場合<br>　　1．眼　科<br>　　2．腎臓内科<br>　　3．神経内科，皮膚科，外科<br>　　4．循環器科<br>　　5．泌尿器科<br>　　6．整形外科<br>　　7．精神科，心療内科<br>　　8．歯　科<br>　　9．感染症<br>　C．地域連携，医療連携<br><br>11．病態やライフステージに基づいた治療の実例<br>　診断と初期治療<br>　〔症例1〕境界型のときからの生活習慣改善が重要<br>　〔症例2〕糖尿病を初めて指摘された肥満患者への対応<br>　〔症例3〕認知症が疑われる糖尿病患者における初期治療方針<br>　〔症例4〕劇症1型糖尿病を疑うとき<br>　〔症例5〕小児における尿糖陽性<br>　〔症例6〕妊娠糖尿病の診断となったとき<br>　定期受診における薬剤調整と指導<br>　〔症例7〕治療強化前の注意点<br>　〔症例8〕定期通院中で血糖コントロール良好患者には減薬も考える<br>　〔症例9〕グリニド薬（またはSU薬）＋α‒GIで治療中の患者の低血糖にはブドウ糖を<br>　〔症例10〕SU薬投与中の患者にDPP‒4阻害薬・SGLT2阻害薬を追加するときにはSU薬減量を<br>　〔症例11〕SU薬投与中の高齢者には低血糖に注意<br>　〔症例12〕高齢者で長年高用量SU薬を使用している患者への治療見直し<br>　〔症例13〕定期治療中の糖尿病患者の血糖が急に悪化したら<br>　〔症例14〕著明な高血糖の治療時には血糖降下の速度にも配慮を<br>　〔症例15〕緩徐進行1型糖尿病患者だとわかったときには<br>　〔症例16〕1型糖尿病患者におけるSGLT2阻害薬投与の可否<br>　〔症例17〕定期受診患者におけるフットケア<br>　併存症を持つ患者における治療<br>　〔症例18〕心不全治療中の糖尿病患者にはSGLT2阻害薬の処方を検討<br>　〔症例19〕心血管疾患既往者に対しては血糖だけではなく脂質も厳重に管理<br>　〔症例20〕腎機能低下患者には投薬内容の見直しを<br>　〔症例21〕腎機能低下患者における降圧薬の選択は，尿検査結果によって異なる<br>　〔症例22〕NAFLDを合併した2型糖尿病<br>　〔症例23〕肝硬変に伴う血糖上昇<br>　〔症例24〕インスリン療法が必要であるが自己注射できない認知症患者<br>　〔症例25〕癌化学療法中の糖尿病患者の血糖コントロールが増悪したとき<br>　特殊な状況における対応<br>　〔症例26〕シックデイにおける対応<br>　〔症例27〕インスリン依存の1型糖尿病における体調不良<br>　〔症例28〕糖尿病治療中断患者が久しぶりに受診したら，治療の見直しを<br>　〔症例29〕検査・治療による絶食の際の対応<br>　〔症例30〕周術期の血糖コントロール<br>　〔症例31〕妊娠前の血糖管理<br><br>付　録<br>　特定健診・特定保健指導の進め方─糖尿病予防の立場から<br>　自己検査用グルコース測定器一覧表<br>　血糖降下薬一覧表<br>　インスリン製剤および主なペン型注入器一覧表<br>　参考書<br><br>索　引</section></article>
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