Guideline for Eexercise Therapy of Type 2 Diabetes Mellitus in China (2024 Edition)

doi:10.12114/j.issn.1007-9572.2024.A0019

Abstract

摘要：

在2型糖尿病（T2DM）患者的综合管理中，运动是生活方式干预的主要形式之一。我国目前仍然缺乏符合中国国情且纳入最新研究证据的T2DM运动治疗指南。为此，国家老年医学中心、中华医学会糖尿病学分会和中国体育科学学会联合组织国内内分泌及代谢病学、运动医学、康复医学、医学营养、老年医学等相关领域专家团队，系统整理了近年来国内外高质量文献，编写了《中国2型糖尿病运动治疗指南（2024版）》，旨在为临床医师、糖尿病教育护士等糖尿病防控人员提供安全、有效的T2DM运动指导。该指南包括T2DM运动治疗的基本原则、急慢性并发症、共患疾病、常用药物、运动时机、运动中血糖监测、运动营养、运动损伤、运动依从性及数字医疗等，共76条推荐意见。该指南具有较强实用性和可操作性，期望能为中国T2DM患者提供科学、规范的运动治疗方案。

关键词: 糖尿病，2型, 运动治疗, 指南

CLC Number:

R 587.1

National Center of Gerontology,Chinese Diabetes Society,China Sport Science Society. Guideline for Eexercise Therapy of Type 2 Diabetes Mellitus in China (2024 Edition)[J]. Chinese General Practice, 2024, 27(30): 3709-3738. DOI: 10.12114/j.issn.1007-9572.2024.A0019.
国家老年医学中心,中华医学会糖尿病学分会,中国体育科学学会. 中国2型糖尿病运动治疗指南（2024版）[J]. 中国全科医学, 2024, 27(30): 3709-3738. DOI: 10.12114/j.issn.1007-9572.2024.A0019.

Figures/Tables 1

References 177

[1]	吴静，郭立新. 中国糖尿病地图[M]. 北京：人民卫生出版社，2022.
[2]	International Diabetes Federation. IDF Diabetes Atlas. 10th ed[EB/OL]. [2024-03-27].
[3]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南（2020年版）[J].中华糖尿病杂志，2021,13(4):315-409. DOI：10.3760/cma.j.cn115791-20210221-00095.
[4]	PENG W, CHEN S, CHEN X，et al. Trends in major non-communicable diseases and related risk factors in China 2002-2019：an analysis of nationally representative survey data[J]. Lancet Reg Health West Pac，2024,43:100809. DOI：10.1016/j.lanwpc.2023.100809.
[5]	PAN X R, LI G W, HU Y H，et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study[J]. Diabetes Care，1997,20(4):537-544. DOI：10.2337/diacare.20.4.537.
[6]	ZHANG L, ZHANG Y, SHEN S，et al. Safety and effectiveness of metformin plus lifestyle intervention compared with lifestyle intervention alone in preventing progression to diabetes in a Chinese population with impaired glucose regulation：a multicentre，open-label，randomised controlled trial[J]. Lancet Diabetes Endocrinol，2023,11(8):567-577. DOI：10.1016/S2213-8587(23)00132-8.
[7]	LINDSTRÖM J, LOUHERANTA A, MANNELIN M，et al. The Finnish diabetes prevention study （DPS）：lifestyle intervention and 3-year results on diet and physical activity[J]. Diabetes Care，2003,26(12):3230-3236. DOI：10.2337/diacare.26.12.3230.
[8]	Diabetes Prevention Program（DPP） Research Group. The diabetes prevention program（DPP）：description of lifestyle intervention[J]. Diabetes Care，2002,25(12):2165-2171. DOI：10.2337/diacare.25.12.2165.
[9]	Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up：the Diabetes Prevention Program Outcomes Study[J]. Lancet Diabetes Endocrinol，2015,3(11):866-875. DOI：10.1016/S2213-8587(15)00291-0.
[10]	潘孝仁，李光伟，胡英华，等. 饮食和运动干预治疗对糖尿病发病率的影响——530例糖耐量低减人群六年前瞻性观察[J].中华内科杂志，1995,34(2):108-112.
[11]	BOWDEN DAVIES K A, SPRUNG V S, NORMAN J A，et al. Physical activity and sedentary time：association with metabolic health and liver fat[J]. Med Sci Sports Exerc，2019,51(6):1169-1177. DOI：10.1249/MSS.0000000000001901.
[12]	STINE J G. Editorial：twenty minutes of moderate-to-vigorous physical activity a day keeps the NAFLD away[J]. Aliment Pharmacol Ther，2022,55(1):116-117. DOI：10.1111/apt.16662.
[13]	中华医学会糖尿病学分会. 中国糖尿病运动治疗指南[M]. 北京：中华医学电子音像出版社，2012.
[14]	中国微循环学会糖尿病与微循环专业委员会，中华医学会糖尿病学分会教育与管理学组，中华医学会内分泌学分会基层内分泌代谢病学组，等. 体医融合糖尿病运动干预专家共识[J].中华糖尿病杂志，2022,14(10):1035-1043. DOI：10.3760/cma.j.cn115791-20220113-00032.
[15]	HU S, LIN C, CAI X，et al. Trends in baseline HbA_1c and body-mass index in randomised placebo-controlled trials of type 2 diabetes from 1987 to 2022：a systematic review and meta-analysis[J]. E Clinical Medicine，2023,57:101868. DOI：10.1016/j.eclinm.2023.101868.
[16]	GBD 2021 Diabetes Collaborators. Global，regional，and national burden of diabetes from 1990 to 2021，with projections of prevalence to 2050：a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet，2023,402(10397):203-234. DOI：10.1016/S0140-6736(23)01301-6.
[17]	HE S, WANG J, SHEN X，et al. Cancer and its predictors in Chinese adults with newly diagnosed diabetes and impaired glucose tolerance（IGT）：a 30-year follow-up of the Da Qing IGT and Diabetes Study[J]. Br J Cancer，2022,127(1):102-108. DOI：10.1038/s41416-022-01758-x.
[18]	BULL F C, AL-ANSARI S S, BIDDLE S，et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour[J]. Br J Sports Med，2020,54(24):1451-1462. DOI：10.1136/bjsports-2020-102955.
[19]	HEISKANEN M A, MOTIANI K K, MARI A，et al. Exercise training decreases pancreatic fat content and improves beta cell function regardless of baseline glucose tolerance：a randomised controlled trial[J]. Diabetologia，2018,61(8):1817-1828. DOI：10.1007/s00125-018-4627-x.
[20]	KIRWAN J P, SOLOMON T P, WOJTA D M，et al. Effects of 7 days of exercise training on insulin sensitivity and responsiveness in type 2 diabetes mellitus[J]. Am J Physiol Endocrinol Metab，2009,297(1):E151-156. DOI：10.1152/ajpendo.00210.2009.
[21]	MAGALHÃES J P, MELO X, CORREIA I R，et al. Effects of combined training with different intensities on vascular health in patients with type 2 diabetes：a 1-year randomized controlled trial[J]. Cardiovasc Diabetol，2019,18(1):34. DOI：10.1186/s12933-019-0840-2.
[22]	NAYLOR L H, DAVIS E A, KALIC R J，et al. Exercise training improves vascular function in adolescents with type 2 diabetes[J]. Physiol Rep，2016,4(4):e12713. DOI：10.14814/phy2.12713.
[23]	MOTIANI K K, COLLADO M C, ESKELINEN J J，et al. Exercise training modulates gut microbiota profile and improves endotoxemia[J]. Med Sci Sports Exerc，2020,52(1):94-104. DOI：10.1249/MSS.0000000000002112.
[24]	HU P, LI Y, ZHOU X，et al. Association between physical activity and abnormal glucose metabolism-a population-based cross-sectional study in China[J]. J Diabetes Complications，2018,32(8):746-752. DOI：10.1016/j.jdiacomp.2018.05.021.
[25]	ZHU X, ZHANG F, CHEN J，et al. The effects of supervised exercise training on weight control and other metabolic outcomes in patients with type 2 diabetes：a meta-analysis[J]. Int J Sport Nutr Exerc Metab，2022,32(3):186-194. DOI：10.1123/ijsnem.2021-0168.
[26]	ZHU X, ZHAO L, CHEN J，et al. The effect of physical activity on glycemic variability in patients with diabetes：a systematic review and meta-analysis of randomized controlled trials[J]. Front Endocrinol（Lausanne），2021,12:767152. DOI：10.3389/fendo.2021.767152.
[27]	PI-SUNYER X, BLACKBURN G, BRANCATI F L，et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes：one-year results of the look AHEAD trial[J]. Diabetes Care，2007,30(6):1374-1383. DOI：10.2337/dc07-0048.
[28]	GONG Q, ZHANG P, WANG J，et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance：30-year results of the Da Qing Diabetes Prevention Outcome Study[J]. Lancet Diabetes Endocrinol，2019,7(6):452-461. DOI：10.1016/S2213-8587(19)30093-2.
[29]	KANALEY J A, COLBERG S R, CORCORAN M H，et al. Exercise/physical activity in individuals with type 2 diabetes：a consensus statement from the American College of Sports Medicine[J]. Med Sci Sports Exerc，2022,54(2):353-368. DOI：10.1249/MSS.0000000000002800.
[30]	YANG X, LI J, HU D，et al. Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population：the China-PAR project（prediction for ASCVD risk in China）[J]. Circulation，2016,134(19):1430-1440. DOI：10.1161/CIRCULATIONAHA.116.022367.
[31]	DUVIVIER B M, SCHAPER N C, HESSELINK M K，et al. Breaking sitting with light activities vs structured exercise：a randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes[J]. Diabetologia，2017,60(3):490-498. DOI：10.1007/s00125-016-4161-7.
[32]	LITTLE J P, GILLEN J B, PERCIVAL M E，et al. Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes[J]. J Appl Physiol （1985），2011,111(6):1554-1560. DOI：10.1152/japplphysiol.00921.2011.
[33]	ARMSTRONG M J, RABI D M, SOUTHERN D A，et al. Clinical utility of pre-exercise stress testing in people with diabetes[J]. Can J Cardiol，2019,35(2):185-192. DOI：10.1016/j.cjca.2018.11.007.
[34]	中国医药卫生文化协会心血管健康与科学运动分会. 运动相关心血管事件风险的评估与监测中国专家共识[J].中国循环杂志，2022,37(7):659-668. DOI：10.3969/j.issn.1000-3614.2022.07.002.
[35]	JAYEDI A, EMADI A, SHAB-BIDAR S. Dose-dependent effect of supervised aerobic exercise on HbA（1c） in patients with type 2 diabetes：a meta-analysis of randomized controlled trials[J]. Sports Med，2022,52(8):1919-1938. DOI：10.1007/s40279-022-01673-4.
[36]	TIPTON C M. Historical perspective：the antiquity of exercise，exercise physiology and the exercise prescription for health[J]. World Rev Nutr Diet，2008,98:198-245. DOI：10.1159/000152989.
[37]	YATES T, HAFFNER S M, SCHULTE P J，et al. Association between change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance （NAVIGATOR trial）：a cohort analysis[J]. Lancet，2014,383(9922):1059-1066. DOI：10.1016/S0140-6736(13)62061-9.
[38]	PALUCH A E, BAJPAI S, BASSETT D R，et al. Daily steps and all-cause mortality：a meta-analysis of 15 international cohorts[J]. Lancet Public Health，2022,7(3):e219-228. DOI：10.1016/S2468-2667(21)00302-9.
[39]	LEE I M, SHIROMA E J, KAMADA M，et al. Association of step volume and intensity with all-cause mortality in older women[J]. JAMA Intern Med，2019,179(8):1105-1112. DOI：10.1001/jamainternmed.2019.0899.
[40]	JAYEDI A, ZARGAR M S, EMADI A，et al. Walking speed and the risk of type 2 diabetes：a systematic review and meta-analysis[J]. Br J Sports Med，2024,58(6):334-342. DOI：10.1136/bjsports-2023-107336.
[41]	GUNNAR B. The Borg CR Scales® Folder[EB/OL]. [2024-03-27].
[42]	PESTA D H, GONCALVES R, MADIRAJU A K，et al. Resistance training to improve type 2 diabetes：working toward a prescription for the future[J]. Nutr Metab（Lond），2017,14:24. DOI：10.1186/s12986-017-0173-7.
[43]	DUNSTAN D W, DALY R M, OWEN N，et al. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes[J]. Diabetes Care，2002,25(10):1729-1736. DOI：10.2337/diacare.25.10.1729.
[44]	KOBAYASHI Y, LONG J, DAN S，et al. Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes：a randomised controlled trial[J]. Diabetologia，2023,66(10):1897-1907. DOI：10.1007/s00125-023-05958-9.
[45]	ISHIGURO H, KODAMA S, HORIKAWA C，et al. In search of the ideal resistance training program to improve glycemic control and its indication for patients with type 2 diabetes mellitus：a systematic review and meta-analysis[J]. Sports Med，2016,46(1):67-77. DOI：10.1007/s40279-015-0379-7.
[46]	BEHM D G, GRANACHER U, WARNEKE K，et al. Minimalist training：is lower dosage or intensity resistance training effective to improve physical fitness? A narrative review[J]. Sports Med，2024,54(2):289-302. DOI：10.1007/s40279-023-01949-3.
[47]	FEATHERSTONE J F, HOLLY R G, AMSTERDAM E A. Physiologic responses to weight lifting in coronary artery disease[J]. Am J Cardiol，1993,71(4):287-292. DOI：10.1016/0002-9149(93)90792-b.
[48]	PAN B, GE L, XUN Y Q，et al. Exercise training modalities in patients with type 2 diabetes mellitus：a systematic review and network meta-analysis[J]. Int J Behav Nutr Phys Act，2018,15(1):72. DOI：10.1186/s12966-018-0703-3.
[49]	CHURCH T S, BLAIR S N, COCREHA M S，et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes：a randomized controlled trial[J]. JAMA，2010,304(20):2253-2262. DOI：10.1001/jama.2010.1710.
[50]	MUKHERJI A B, LU D, QIN F，et al. Effectiveness of a community-based structured physical activity program for adults with type 2 diabetes：a randomized clinical trial[J]. JAMA Netw Open，2022,5(12):e2247858. DOI：10.1001/jamanetworkopen.2022.47858.
[51]	UMPIERRE D, RIBEIRO P A, KRAMER C K，et al. Physical activity advice only or structured exercise training and association with HbA_1c levels in type 2 diabetes：a systematic review and meta-analysis[J]. JAMA，2011,305(17):1790-1799. DOI：10.1001/jama.2011.576.
[52]	BOULÉ N G, HADDAD E, KENNY G P，et al. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus：a meta-analysis of controlled clinical trials[J]. JAMA，2001,286(10):1218-1227. DOI：10.1001/jama.286.10.1218.
[53]	ABATE M, SCHIAVONE C, PELOTTI P，et al. Limited joint mobility in diabetes and ageing：recent advances in pathogenesis and therapy[J]. Int J Immunopathol Pharmacol，2010,23(4):997-1003. DOI：10.1177/039463201002300404.
[54]	JAYAWARDENA R, RANASINGHE P, CHATHURANGA T，et al. The benefits of yoga practice compared to physical exercise in the management of type 2 diabetes mellitus：a systematic review and meta-analysis[J]. Diabetes Metab Syndr，2018,12(5):795-805. DOI：10.1016/j.dsx.2018.04.008.
[55]	CHUDYK A, PETRELLA R J. Effects of exercise on cardiovascular risk factors in type 2 diabetes：a meta-analysis[J]. Diabetes Care，2011,34(5):1228-1237. DOI：10.2337/dc10-1881.
[56]	CHAPMAN A, MEYER C, RENEHAN E，et al. Exercise interventions for the improvement of falls-related outcomes among older adults with diabetes mellitus：a systematic review and meta-analyses[J]. J Diabetes Complications，2017,31(3):631-645. DOI：10.1016/j.jdiacomp.2016.09.015.
[57]	SNOWLING N J, HOPKINS W G. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients：a meta-analysis[J]. Diabetes Care，2006,29(11):2518-2527. DOI：10.2337/dc06-1317.
[58]	BORROR A, ZIEFF G, BATTAGLINI C，et al. The effects of postprandial exercise on glucose control in individuals with type 2 diabetes：a systematic review[J]. Sports Med，2018,48(6):1479-1491. DOI：10.1007/s40279-018-0864-x.
[59]	MORRISON S, COLBERG S R, MARIANO M，et al. Balance training reduces falls risk in older individuals with type 2 diabetes[J]. Diabetes Care，2010,33(4):748-750. DOI：10.2337/dc09-1699.
[60]	MORRISON S, SIMMONS R, COLBERG S R，et al. Supervised balance training and wii fit-based exercises lower falls risk in older adults with type 2 diabetes[J]. J Am Med Dir Assoc，2018,19(2):185.e7-e13. DOI：10.1016/j.jamda.2017.11.004.
[61]	YOUNG L H, WACKERS F J, CHYUN D A，et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes：the DIAD study：a randomized controlled trial[J]. JAMA，2009,301(15):1547-1555. DOI：10.1001/jama.2009.476.
[62]	VAN DER BERG J D, STEHOUWER C D, BOSMA H，et al. Associations of total amount and patterns of sedentary behaviour with type 2 diabetes and the metabolic syndrome：the Maastricht Study[J]. Diabetologia，2016,59(4):709-718. DOI：10.1007/s00125-015-3861-8.
[63]	COOPER A J, BRAGE S, EKELUND U，et al. Association between objectively assessed sedentary time and physical activity with metabolic risk factors among people with recently diagnosed type 2 diabetes[J]. Diabetologia，2014,57(1):73-82. DOI：10.1007/s00125-013-3069-8.
[64]	DEMPSEY P C, LARSEN R N, SETHI P，et al. Benefits for type 2 diabetes of interrupting prolonged sitting with brief bouts of light walking or simple resistance activities[J]. Diabetes Care，2016,39(6):964-972. DOI：10.2337/dc15-2336.
[65]	《运动处方中国专家共识（2023）》专家组. 运动处方中国专家共识（2023）[J].中国运动医学杂志，2023,42(1):3-13. DOI：10.3969/j.issn.1000-6710.2023.01.001.
[66]	HOLMSTRUP M, FAIRCHILD T, KESLACY S，et al. Multiple short bouts of exercise over 12-h period reduce glucose excursions more than an energy-matched single bout of exercise[J]. Metabolism，2014,63(4):510-519. DOI：10.1016/j.metabol.2013.12.006.
[67]	LI S, LEAR S A, RANGARAJAN S，et al. Association of sitting time with mortality and cardiovascular events in high-income，middle-income，and low-income countries[J]. JAMA Cardiol，2022,7(8):796-807. DOI：10.1001/jamacardio.2022.1581.
[68]	OPPERT J M, BELLICHA A, VAN BAAK M A，et al. Exercise training in the management of overweight and obesity in adults：synthesis of the evidence and recommendations from the European Association for the Study of Obesity Physical Activity Working Group[J]. Obes Rev，2021,22 (Suppl 4):e13273. DOI：10.1111/obr.13273.
[69]	GRACE A, CHAN E, GIALLAURIA F，et al. Clinical outcomes and glycaemic responses to different aerobic exercise training intensities in typeⅡdiabetes：a systematic review and meta-analysis[J]. Cardiovasc Diabetol，2017,16(1):37. DOI：10.1186/s12933-017-0518-6.
[70]	GILLEN J B, LITTLE J P, PUNTHAKEE Z，et al. Acute high-intensity interval exercise reduces the postprandial glucose response and prevalence of hyperglycaemia in patients with type 2 diabetes[J]. Diabetes Obes Metab，2012,14(6):575-577. DOI：10.1111/j.1463-1326.2012.01564.x.
[71]	American College of Sports Medicine. ACSM运动测试与运动处方指南. 王正珍，译. 10版[M]. 北京：北京体育大学出版社，2019.
[72]	KARSTOFT K, WINDING K, KNUDSEN S H，et al. The effects of free-living interval-walking training on glycemic control，body composition，and physical fitness in type 2 diabetic patients：a randomized，controlled trial[J]. Diabetes Care，2013,36(2):228-236. DOI：10.2337/dc12-0658.
[73]	NIEUWOUDT S, FEALY C E, FOUCHER J A，et al. Functional high-intensity training improves pancreatic β-cell function in adults with type 2 diabetes[J]. Am J Physiol Endocrinol Metab，2017,313(3):E314-320. DOI：10.1152/ajpendo.00407.2016.
[74]	COLBERG S R, SIGAL R J, YARDLEY J E，et al. Physical activity/exercise and diabetes：a position statement of the American Diabetes Association[J]. Diabetes Care，2016,39(11):2065-2079. DOI：10.2337/dc16-1728.
[75]	MITRANUN W, DEEROCHANAWONG C, TANAKA H，et al. Continuous vs interval training on glycemic control and macro-and microvascular reactivity in type 2 diabetic patients[J]. Scand J Med Sci Sports，2014,24(2):e69-76. DOI：10.1111/sms.12112.
[76]	HOLLEKIM-STRAND S M, BJØRGAAS M R, ALBREKTSEN G，et al. High-intensity interval exercise effectively improves cardiac function in patients with type 2 diabetes mellitus and diastolic dysfunction：a randomized controlled trial[J]. J Am Coll Cardiol，2014,64(16):1758-1760. DOI：10.1016/j.jacc.2014.07.971.
[77]	TSANG T, ORR R, LAM P，et al. Effects of Tai Chi on glucose homeostasis and insulin sensitivity in older adults with type 2 diabetes：a randomised double-blind sham-exercise-controlled trial[J]. Age Ageing，2008,37(1):64-71. DOI：10.1093/ageing/afm127.
[78]	XIANG G D, WANG Y L. Regular aerobic exercise training improves endothelium-dependent arterial dilation in patients with impaired fasting glucose[J]. Diabetes Care，2004,27(3):801-802. DOI：10.2337/diacare.27.3.801.
[79]	QIU J, YANG J, LU M，et al. Chinese compilation of physical activities in healthy adults aged 18-64：Categories and metabolic intensities[J]. Sports Med Health Sci，2022,4(3):160-171. DOI：10.1016/j.smhs.2022.06.004.
[80]	LEE M S, JUN J H, LIM H J，et al. A systematic review and meta-analysis of tai chi for treating type 2 diabetes[J]. Maturitas，2015,80(1):14-23. DOI：10.1016/j.maturitas.2014.09.008.
[81]	CHAN A, CHAIR S Y, LEE D，et al. Tai Chi exercise is more effective than brisk walking in reducing cardiovascular disease risk factors among adults with hypertension：a randomised controlled trial[J]. Int J Nurs Stud，2018,88:44-52. DOI：10.1016/j.ijnurstu.2018.08.009.
[82]	WANG C, SCHMID C H, IVERSEN M D，et al. Comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis：a randomized trial[J]. Ann Intern Med，2016,165(2):77-86. DOI：10.7326/M15-2143.
[83]	LI F, HARMER P, FITZGERALD K，et al. Tai chi and postural stability in patients with Parkinson's disease[J]. N Engl J Med，2012,366(6):511-519. DOI：10.1056/NEJMoa1107911.
[84]	WANG C, SCHMID C H, FIELDING R A，et al. Effect of tai chi versus aerobic exercise for fibromyalgia：comparative effectiveness randomized controlled trial[J]. BMJ，2018,360:k851. DOI：10.1136/bmj.k851.
[85]	KHOSRAVIZADE TABASI H, MADARSHAHIAN F, KHOSHNIAT NIKOO M，et al. Impact of family support improvement behaviors on anti diabetic medication adherence and cognition in type 2 diabetic patients[J]. J Diabetes Metab Disord，2014,13(1):113. DOI：10.1186/s40200-014-0113-2.
[86]	高洪刚.气功应用于2型糖尿病患者HbA_1c及提高免疫机能水平的影响观察[J].中医临床研究，2017,9(24):61-62.DOI：10.3969/j.issn.1674-7860.2017.24.026.
[87]	牛鹏，王爱民，张玲，等. 八段锦对2型糖尿病患者血糖控制效果的影响[J].中华护理杂志，2012,47(8):701-703. DOI：10.3761/j.issn.0254-1769.2012.08.009.
[88]	李兴海. 健身气功·八段锦对2型糖尿病内皮依赖性血管舒张功能影响的研究[J].沈阳体育学院学报，2009,28(1):50-51,55.
[89]	ZOU L, PAN Z, YEUNG A，et al. A review study on the beneficial effects of Baduanjin[J]. J Altern Complement Med，2018,24(4):324-335. DOI：10.1089/acm.2017.0241.
[90]	ZIERATH J R, HE L, GUMÀ A，et al. Insulin action on glucose transport and plasma membrane GLUT4 content in skeletal muscle from patients with NIDDM[J]. Diabetologia，1996,39(10):1180-1189. DOI：10.1007/BF02658504.
[91]	KENNEDY J W, HIRSHMAN M F, GERVINO E V，et al. Acute exercise induces GLUT4 translocation in skeletal muscle of normal human subjects and subjects with type 2 diabetes[J]. Diabetes，1999,48(5):1192-1197. DOI：10.2337/diabetes.48.5.1192.
[92]	MUSI N, FUJII N, HIRSHMAN M F，et al. AMP-activated protein kinase （AMPK） is activated in muscle of subjects with type 2 diabetes during exercise[J]. Diabetes，2001,50(5):921-927. DOI：10.2337/diabetes.50.5.921.
[93]	BUSSAU V A, FERREIRA L D, JONES T W，et al. A 10-s sprint performed prior to moderate-intensity exercise prevents early post-exercise fall in glycaemia in individuals with type 1 diabetes[J]. Diabetologia，2007,50(9):1815-1818. DOI：10.1007/s00125-007-0727-8.
[94]	BUSSAU V A, FERREIRA L D, JONES T W，et al. The 10-s maximal sprint：a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes[J]. Diabetes Care，2006,29(3):601-606. DOI：10.2337/diacare.29.03.06.dc05-1764.
[95]	FAHEY A J, PARAMALINGAM N, DAVEY R J，et al. The effect of a short sprint on postexercise whole-body glucose production and utilization rates in individuals with type 1 diabetes mellitus[J]. J Clin Endocrinol Metab，2012,97(11):4193-4200. DOI：10.1210/jc.2012-1604.
[96]	MARAN A, PAVAN P, BONSEMBIANTE B，et al. Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes[J]. Diabetes Technol Ther，2010,12(10):763-768. DOI：10.1089/dia.2010.0038.
[97]	ISCOE K E, RIDDELL M C. Continuous moderate-intensity exercise with or without intermittent high-intensity work：effects on acute and late glycaemia in athletes with type 1 diabetes mellitus[J]. Diabet Med，2011,28(7):824-832. DOI：10.1111/j.1464-5491.2011.03274.x.
[98]	CAMPBELL M D, WEST D J, BAIN S C，et al. Simulated games activity vs continuous running exercise：a novel comparison of the glycemic and metabolic responses in T1DM patients[J]. Scand J Med Sci Sports，2015,25(2):216-222. DOI：10.1111/sms.12192.
[99]	YARDLEY J E, KENNY G P, PERKINS B A，et al. Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes[J]. Diabetes Care，2012,35(4):669-675. DOI：10.2337/dc11-1844.
[100]	TSALIKIAN E, MAURAS N, BECK R W，et al. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus[J]. J Pediatr，2005,147(4):528-534. DOI：10.1016/j.jpeds.2005.04.065.
[101]	CAMPBELL M D, WALKER M, BRACKEN R M，et al. Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes：a randomized controlled trial[J]. BMJ Open Diabetes Res Care，2015,3(1):e000085. DOI：10.1136/bmjdrc-2015-000085.
[102]	RIDDELL M C, GALLEN I W, SMART C E，et al. Exercise management in type 1 diabetes：a consensus statement[J]. Lancet Diabetes Endocrinol，2017,5(5):377-390. DOI：10.1016/S2213-8587(17)30014-1.
[103]	GORDON B A, BIRD S R, MACISAAC R J，et al. Does a single bout of resistance or aerobic exercise after insulin dose reduction modulate glycaemic control in type 2 diabetes? A randomised cross-over trial[J]. J Sci Med Sport，2016,19(10):795-799. DOI：10.1016/j.jsams.2016.01.004.
[104]	KJAER M, HOLLENBECK C B, FREY-HEWITT B，et al. Glucoregulation and hormonal responses to maximal exercise in non-insulin-dependent diabetes[J]. J Appl Physiol（1985），1990,68(5):2067-2074. DOI：10.1152/jappl.1990.68.5.2067.
[105]	HERNANDEZ-QUILES C, RAMIREZ-DUQUE N, ACOSTA-DELGADO D. Ketoacidosis due to empagliflozin，a paradigm shift：case report and review of literature[J]. Curr Diabetes Rev，2019,15(4):259-262. DOI：10.2174/1573399814666180726114044.
[106]	American Diabetes Association. 11. Microvascular complications and foot care：standards of medical care in diabetes-2021[J]. Diabetes Care，2021,44(Suppl 1):S151-167. DOI：10.2337/dc21-S011.
[107]	American Diabetes Association. 10. Cardiovascular disease and risk management：standards of medical care in diabetes-2021[J]. Diabetes Care，2021,44(Suppl 1):S125-150. DOI：10.2337/dc21-S010.
[108]	ROSSBOTH S, LECHLEITNER M, OBERAIGNER W. Risk factors for diabetic foot complications in type 2 diabetes-a systematic review[J]. Endocrinol Diabetes Metab，2021,4(1):e00175. DOI：10.1002/edm2.175.
[109]	BISWAS A, OH P I, FAULKNER G E，et al. Sedentary time and its association with risk for disease incidence，mortality，and hospitalization in adults：a systematic review and meta-analysis[J]. Ann Intern Med，2015,162(2):123-132. DOI：10.7326/M14-1651.
[110]	WILMOT E G, EDWARDSON C L, ACHANA F A，et al. Sedentary time in adults and the association with diabetes，cardiovascular disease and death：systematic review and meta-analysis[J]. Diabetologia，2012,55(11):2895-2905. DOI：10.1007/s00125-012-2677-z.
[111]	RIEBE D, FRANKLIN B A, THOMPSON P D，et al. Updating ACSM's recommendations for exercise preparticipation health screening[J]. Med Sci Sports Exerc，2015,47(11):2473-2479. DOI：10.1249/MSS.0000000000000664.
[112]	JOHANSEN K L. Exercise and chronic kidney disease：current recommendations[J]. Sports Med，2005,35(6):485-499. DOI：10.2165/00007256-200535060-00003.
[113]	KING D S, BALDUS P J, SHARP R L，et al. Time course for exercise-induced alterations in insulin action and glucose tolerance in middle-aged people[J]. J Appl Physiol （1985），1995,78(1):17-22. DOI：10.1152/jappl.1995.78.1.17.
[114]	PAINTER P. Exercise after renal transplantation[J]. Adv Ren Replace Ther，1999,6(2):159-164. DOI：10.1016/s1073-4449(99)70034-8.
[115]	中华医学会糖尿病学分会神经并发症学组. 糖尿病神经病变诊治专家共识（2021年版）[J]. 中华糖尿病杂志，2021,13(6):540-557. DOI：10.3760/cma.j.cn115791-20210310-00143.
[116]	CHEN P, VILORIO N C, DHATARIYA K，et al. Guidelines on interventions to enhance healing of foot ulcers in people with diabetes （IWGDF 2023 update）[J]. Diabetes Metab Res Rev，2024,40(3):e3644. DOI：10.1002/dmrr.3644.
[117]	YARDLEY J E, STAPLETON J M, SIGAL R J，et al. Do heat events pose a greater health risk for individuals with type 2 diabetes?[J]. Diabetes Technol Ther，2013,15(6):520-529. DOI：10.1089/dia.2012.0324.
[118]	GHILARDUCCI L E, HOLLY R G, AMSTERDAM E A. Effects of high resistance training in coronary artery disease[J]. Am J Cardiol，1989,64(14):866-870. DOI：10.1016/0002-9149(89)90833-3.
[119]	NOTLEY S R, POIRIER M P, SIGAL R J，et al. Exercise heat stress in patients with and without type 2 diabetes[J]. JAMA，2019,322(14):1409-1411. DOI：10.1001/jama.2019.10943.
[120]	KENNY G P, STAPLETON J M, YARDLEY J E，et al. Older adults with type 2 diabetes store more heat during exercise[J]. Med Sci Sports Exerc，2013,45(10):1906-1914. DOI：10.1249/MSS.0b013e3182940836.
[121]	LAYTON J B, LI W, YUAN J，et al. Heatwaves，medications，and heat-related hospitalization in older Medicare beneficiaries with chronic conditions[J]. PLoS One，2020,15(12):e0243665. DOI：10.1371/journal.pone.0243665.
[122]	ROSS R, DAGNONE D, JONES P J，et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized，controlled trial[J]. Ann Intern Med，2000,133(2):92-103. DOI：10.7326/0003-4819-133-2-200007180-00008.
[123]	GIANNOPOULOU I, FERNHALL B, CARHART R，et al. Effects of diet and/or exercise on the adipocytokine and inflammatory cytokine levels of postmenopausal women with type 2 diabetes[J]. Metabolism，2005,54(7):866-875. DOI：10.1016/j.metabol.2005.01.033.
[124]	MINGRONE G, PANUNZI S, DE GAETANO A，et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes：10-year follow-up of an open-label，single-centre，randomised controlled trial[J]. Lancet，2021,397(10271):293-304. DOI：10.1016/S0140-6736(20)32649-0.
[125]	SCHAUER P R, BHATT D L, KIRWAN J P，et al. Bariatric surgery versus intensive medical therapy for diabetes-5-year outcomes[J]. N Engl J Med，2017,376(7):641-651. DOI：10.1056/NEJMoa1600869.
[126]	GILBERTSON N M, GAITÁN J M, OSINSKI V，et al. Pre-operative aerobic exercise on metabolic health and surgical outcomes in patients receiving bariatric surgery：a pilot trial[J]. PLoS One，2020,15(10):e0239130. DOI：10.1371/journal.pone.0239130.
[127]	GILBERTSON N M, EICHNER N, KHURSHID M，et al. Impact of pre-operative aerobic exercise on cardiometabolic health and quality of life in patients undergoing bariatric surgery[J]. Front Physiol，2020,11:1018. DOI：10.3389/fphys.2020.01018.
[128]	BAILLOT A, MAMPUYA W M, DIONNE I J，et al. Impacts of supervised exercise training in addition to interdisciplinary lifestyle management in subjects awaiting bariatric surgery：a randomized controlled study[J]. Obes Surg，2016,26(11):2602-2610. DOI：10.1007/s11695-016-2153-9.
[129]	BERGLIND D, WILLMER M, ERIKSSON U，et al. Longitudinal assessment of physical activity in women undergoing Roux-en-Y gastric bypass[J]. Obes Surg，2015,25(1):119-125. DOI：10.1007/s11695-014-1331-x.
[130]	BOND D S, JAKICIC J M, UNICK J L，et al. Pre-to postoperative physical activity changes in bariatric surgery patients：self report vs. objective measures[J]. Obesity （Silver Spring），2010,18(12):2395-2397. DOI：10.1038/oby.2010.88.
[131]	中华医学会内分泌学分会，中华医学会糖尿病学分会. 中国成人2型糖尿病合并非酒精性脂肪性肝病管理专家共识[J].中华内分泌代谢杂志，2021,37(7):589-598. DOI：10.3760/cma.j.cn311282-20210105-00016.
[132]	CRUZ-JENTOFT A J, SAYER A A. Sarcopenia[J]. Lancet，2019,393(10191):2636-2646. DOI：10.1016/S0140-6736(19)31138-9.
[133]	徐娟兰，汪亚男，宋红玲. 2型糖尿病合并肌少症患者抗阻运动研究进展[J].中华现代护理杂志，2016,22(31):4577-4580. DOI：10.3760/cma.j.issn.1674-2907.2016.31.038.
[134]	IZQUIERDO M, MERCHANT R A, MORLEY J E，et al. International exercise recommendations in older adults （ICFSR）：expert consensus guidelines[J]. J Nutr Health Aging，2021,25(7):824-853. DOI：10.1007/s12603-021-1665-8.
[135]	ADAMS V. Electromyostimulation to fight atrophy and to build muscle：facts and numbers[J]. J Cachexia Sarcopenia Muscle，2018,9(4):631-634. DOI：10.1002/jcsm.12332.
[136]	CENTNER C, RITZMANN R, GOLLHOFER A，et al. Effects of whole-body vibration training and blood flow restriction on muscle adaptations in women：a randomized controlled trial[J]. J Strength Cond Res，2020,34(3):603-608. DOI：10.1519/JSC.0000000000003401.
[137]	中国高血压防治指南修订委员会，高血压联盟（中国），中华医学会心血管病学分会中国医师协会高血压专业委员会，等. 中国高血压防治指南（2018年修订版）[J]. 中国心血管杂志，2019,24(1):24-56. DOI：10.3969/j.issn.1007-5410.2019.01.002.
[138]	WRIGHT J T Jr, WILLIAMSON J D, WHELTON P K，et al. A randomized trial of intensive versus standard blood-pressure control[J]. N Engl J Med，2015,373(22):2103-2116. DOI：10.1056/NEJMoa1511939.
[139]	PALATINI P, AGABITI-ROSEI E, MANCIA G. Blood pressure changes following isometric resistance exercise therapy[M]// PALATINI P，AGABITI-ROSEI E，MANCIA G. Exercise，sports and hypertension（Updates in hypertension and cardiovascular protection）. Berlin：Springer，2022.
[140]	EDWARDS J J, DEENMAMODE A, GRIFFITHS M，et al. Exercise training and resting blood pressure：a large-scale pairwise and network meta-analysis of randomised controlled trials[J]. Br J Sports Med，2023,57(20):1317-1326. DOI：10.1136/bjsports-2022-106503.
[141]	American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation Programs. 6th ed[M]. Champaign：Human Kinetics，2020.
[142]	胡大一. 中国心血管疾病康复/二级预防指南：2015版[M]. 北京：北京科学技术出版社，2015.
[143]	PATE R R, DURSTINE J L. Exercise physiology and its role in clinical sports medicine[J]. South Med J，2004,97(9):881-885. DOI：10.1097/01.SMJ.0000140116.17258.F1.
[144]	NIKOLAIDIS S, VIRGILIOU C, VEKIOU M，et al. Effect of exercise on key pharmacokinetic parameters related to metformin absorption in healthy humans：a pilot study[J]. Scand J Med Sci Sports，2020,30(5):858-864. DOI：10.1111/sms.13628.
[145]	中华人民共和国国家卫生健康委员会. 成人糖尿病食养指南（2023年版）[J]. 全科医学临床与教育，2023,21(5):388-391. DOI：10.13558/j.cnki.issn1672-3686.2023.005.002.
[146]	国家体育总局. 糖尿病患者如何科学运动[EB/OL]. （2023-05-24）[2024-03-27].
[147]	HANDELSMAN Y, HENRY R R, BLOOMGARDEN Z T，et al. American association of clinical endocrinologists and american college of endocrinology position statement on the association of SGLT-2 inhibitors and diabetic ketoacidosis[J]. Endocr Pract，2016,22(6):753-762. DOI：10.4158/EP161292.PS.
[148]	TOYAMA T, NEUEN B L, JUN M，et al. Effect of SGLT2 inhibitors on cardiovascular，renal and safety outcomes in patients with type 2 diabetes mellitus and chronic kidney disease：a systematic review and meta-analysis[J]. Diabetes Obes Metab，2019,21(5):1237-1250. DOI：10.1111/dom.13648.
[149]	LIEW A, LYDIA A, MATAWARAN B J，et al. Practical considerations for the use of SGLT-2 inhibitors in the Asia-Pacific countries-an expert consensus statement[J]. Nephrology （Carlton），2023,28(8):415-424. DOI：10.1111/nep.14167.
[150]	LUNDGREN J R, JANUS C, JENSEN S，et al. Healthy weight loss maintenance with exercise，liraglutide，or both combined[J]. N Engl J Med，2021,384(18):1719-1730. DOI：10.1056/NEJMoa2028198.
[151]	SHETTY V B, FOURNIER P A, DAVEY R J，et al. Effect of exercise intensity on glucose requirements to maintain euglycemia during exercise in type 1 diabetes[J]. J Clin Endocrinol Metab，2016,101(3):972-980. DOI：10.1210/jc.2015-4026.
[152]	DRENTHEN L, AJIE M, ABBINK E J，et al. No insulin degludec dose adjustment required after aerobic exercise for people with type 1 diabetes：the ADREM study[J]. Diabetologia，2023,66(6):1035-1044. DOI：10.1007/s00125-023-05893-9.
[153]	DEICHMANN R E, LAVIE C J, ASHER T，et al. The interaction between statins and exercise：mechanisms and strategies to counter the musculoskeletal side effects of this combination therapy[J]. Ochsner J，2015,15(4):429-437.
[154]	BONFIM M R, OLIVEIRA A S, DO AMARAL S L，et al. Treatment of dyslipidemia with statins and physical exercises：recent findings of skeletal muscle responses[J]. Arq Bras Cardiol，2015,104(4):324-331. DOI：10.5935/abc.20150005.
[155]	MOHOLDT T, PARR E B, DEVLIN B L，et al. The effect of morning vs evening exercise training on glycaemic control and serum metabolites in overweight/obese men：a randomised trial[J]. Diabetologia，2021,64(9):2061-2076. DOI：10.1007/s00125-021-05477-5.
[156]	TEO S, KANALEY J A, GUELFI K J，et al. The effect of exercise timing on glycemic control：a randomized clinical trial[J]. Med Sci Sports Exerc，2020,52(2):323-334. DOI：10.1249/MSS.0000000000002139.
[157]	李政，胡蕴，马建华. 晚餐后不同时段运动对2型糖尿病患者餐后血糖谱的影响[J]. 南方医科大学学报，2018,38(10):1165-1170. DOI：10.12122/j.issn.1673-4254.2018.10.03.
[158]	LARSEN J J, DELA F, MADSBAD S，et al. The effect of intense exercise on postprandial glucose homeostasis in typeⅡ diabetic patients[J]. Diabetologia，1999,42(11):1282-1292. DOI：10.1007/s001250051440.
[159]	DERAVE W, MERTENS A, MULS E，et al. Effects of post-absorptive and postprandial exercise on glucoregulation in metabolic syndrome[J]. Obesity （Silver Spring），2007,15(3):704-711. DOI：10.1038/oby.2007.548.
[160]	POIRIER P, MAWHINNEY S, GRONDIN L，et al. Prior meal enhances the plasma glucose lowering effect of exercise in type 2 diabetes[J]. Med Sci Sports Exerc，2001,33(8):1259-1264. DOI：10.1097/00005768-200108000-00003.
[161]	HUANG T, LU C, SCHUMANN M，et al. Timing of exercise affects glycemic control in type 2 diabetes patients treated with metformin[J]. J Diabetes Res，2018:2483273. DOI：10.1155/2018/2483273.
[162]	COLBERG S R, ZARRABI L, BENNINGTON L，et al. Postprandial walking is better for lowering the glycemic effect of dinner than pre-dinner exercise in type 2 diabetic individuals[J]. J Am Med Dir Assoc，2009,10(6):394-397. DOI：10.1016/j.jamda.2009.03.015.
[163]	ROLLO M E, AGUIAR E J, WILLIAMS R L，et al. eHealth technologies to support nutrition and physical activity behaviors in diabetes self-management[J]. Diabetes Metab Syndr Obes，2016,9:381-390. DOI：10.2147/DMSO.S95247.
[164]	CHEN S, LU J, PENG D，et al. Effect of a mobile health technology-based diabetes education program on glucose control in patients with type 2 diabetes initiating premixed insulin：a prospective，multicenter，observational study[J]. Diabetes Care，2023,46(1):e6-7. DOI：10.2337/dc22-0510.
[165]	SAHIN C, NAYLOR P J. Mixed-methods research in diabetes management via mobile health technologies：a scoping review[J]. JMIR Diabetes，2017,2(1):e3. DOI：10.2196/diabetes.6667.
[166]	ZHANG J, EGGINK E, ZHANG X，et al. Needs and views on healthy lifestyles for the prevention of dementia and the potential role for mobile health（mHealth） interventions in China：a qualitative study[J]. BMJ Open，2022,12(11):e061111. DOI：10.1136/bmjopen-2022-061111.
[167]	中华医学会糖尿病学分会. 中国血糖监测临床应用指南（2021年版）[J]. 中华糖尿病杂志，2021,13(10):936-948. DOI：10.3760/cma.j.cn115791-20210810-00436.
[168]	ADOLFSSON P, TAPLIN C E, ZAHARIEVA D P，et al. ISPAD clinical practice consensus guidelines 2022：exercise in children and adolescents with diabetes[J]. Pediatr Diabetes，2022,23(8):1341-1372. DOI：10.1111/pedi.13452.
[169]	BAKER L B, ROLLO I, STEIN KW，et al. Acute effects of carbohydrate supplementation on intermittent sports performance[J]. Nutrients，2015,7(7):5733-5763. DOI：10.3390/nu7075249.
[170]	CERMAK N M, VAN LOON L J. The use of carbohydrates during exercise as an ergogenic aid[J]. Sports Med，2013,43(11):1139-1155. DOI：10.1007/s40279-013-0079-0.
[171]	SMART C E, EVANS M, O'CONNELL S M，et al. Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes，and the effect is additive[J]. Diabetes Care，2013,36(12):3897-3902. DOI：10.2337/dc13-1195.
[172]	COLLADO-MATEO D, LAVÍN-PÉREZ A M, PEÑACOBA C，et al. Key factors associated with adherence to physical exercise in patients with chronic diseases and older adults：an umbrella review[J]. Int J Environ Res Public Health，2021,18(4):2023. DOI：10.3390/ijerph18042023.
[173]	MCELRATH E, ARENA S, SCULLY J. Exercise prescription considerations to optimize home program adherence[J]. Home Healthc Now，2023,41(2):112-113. DOI：10.1097/NHH.0000000000001156.
[174]	WARD S, ORME M, ZATLOUKAL J，et al. Adherence to walking exercise prescription during pulmonary rehabilitation in COPD with a commercial activity monitor：a feasibility trial[J]. BMC Pulm Med，2021,21(1):30. DOI：10.1186/s12890-021-01406-9.
[175]	SUN T, XU Y, XIE H，et al. Intelligent personalized exercise prescription based on an ehealth promotion system to improve health outcomes of middle-aged and older adult community dwellers：pretest-posttest study[J]. J Med Internet Res，2021,23(5):e28221. DOI：10.2196/28221.
[176]	JOHNSON R W, WILLIAMS S A, GUCCIARDI D F，et al. Can an online exercise prescription tool improve adherence to home exercise programmes in children with cerebral palsy and other neurodevelopmental disabilities? A randomised controlled trial[J]. BMJ Open，2020,10(12):e040108. DOI：10.1136/bmjopen-2020-040108.
[177]	American College of Sports Medicine. ACSM's Guidelines for exercise testing and prescription. 11th ed[EB/OL].[2023-11-12].

序号	具体说明
1	年龄>40岁，有糖尿病，有或无心血管风险因素
2	年龄>30岁，且符合以下任何一项：
	T2DM病程>10年
	高血压
	吸烟
	血脂异常
	增殖性或增殖前期视网膜病变
	慢性肾脏病
3	不论年龄，符合以下任何一项：
	已知疑似心血管、冠状动脉或外周动脉疾病
	自主神经病变
	晚期肾病伴肾衰竭
	备注：鼓励在有条件的情况下，对开具运动处方的所有患者进行体适能的评估

序号	具体说明
1	年龄>40岁，有糖尿病，有或无心血管风险因素
2	年龄>30岁，且符合以下任何一项：
	T2DM病程>10年
	高血压
	吸烟
	血脂异常
	增殖性或增殖前期视网膜病变
	慢性肾脏病
3	不论年龄，符合以下任何一项：
	已知疑似心血管、冠状动脉或外周动脉疾病
	自主神经病变
	晚期肾病伴肾衰竭
	备注：鼓励在有条件的情况下，对开具运动处方的所有患者进行体适能的评估