糖尿病脂代谢紊乱的治疗与临床指南PPT课件.ppt

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1、ClinicalTrialsandGuidelinesforLipidManagementintheDiabeticPatientStevenHaffner,MDUKPDSDesignAimTodeterminewhetherintensifiedbloodglucosecontrol,witheithersulphonylureaorinsulin,reducestheriskofmacrovascularormicrovascularcomplicationsintype2diabetesPatients3867newlydiagnosedty

2、pe2diabeticpatientswhowereasymptomaticafter3monthsofdiet;fastingglucose6.1-15mmol/L(110-270mg/dl);treatfor10yearsAdaptedfromUKProspectiveDiabetesStudy(UKPDS)Group.Lancet1998;352:837-853;TurnerRetal.AnnInternMed1996;124:136-145.UKPDSGroup.Lancet1998;352:837-853.UKPDS10-YearFol

3、low-upResults:GlycemicControl,Weight,andPlasmaInsulinYearsfromRandomization01234567891011120123456789101112YearsfromRandomizationConventionalConventionalIntensiveIntensiveConventionalIntensiveIntensiveConventionalFastingplasmaglucoseMedian(mmol/L)HemoglobinA1cWeightPlasmainsul

4、in111098760Median(%)987607.552.50-2.5Baseline=75kgMeanChange(kg)403020100-10-20MedianChange(pmol/L)Baseline=89pmol/LUKPDS:ProportionofPatientsTakingDifferentTherapiesintheConventional-TherapyGroupCourtesyofDr.AmandaAdler%ofpatients10080604020Dietalone1357911Yearsfromrandomizat

5、ionAdditionalpharmacologictherapyUKPDS:CausesofDeathbyGlucoseTreatmentGroupRate/1000patient-yearsMIStrokeSuddendeathPVDAllmacrovascularRenaldiseaseCancerOtherspecifiedUnknownTotalUKPDSGroup.Lancet1998;352:837-853.%Rate/1000patient-years%7.61.60.90.110.20.34.42.40

6、.517.8Cause43951582251331008.01.31.60.311.20.24.42.70.218.74378260124141100ConventionalIntensiveUKPDS:EndpointsbyGlucoseTreatmentGroupRate/1000Patient-YearsAnydiabetes-related*MIStrokePVD**MicrovascularUKPDSGroup.Lancet1998;352:837-853.Rate/1000Patient-YearsP

7、Cause40.914.75.61.18.6*Combinedmicrovascularandmacrovascularevents**AmputationordeathfromPVD%RiskReduction46.017.45.01.611.40.0290.0520.520.150.00991216––25ConventionalIntensiveUKPDS:ImpactofGlucose-LoweringAgentsonMIandStrokeSulphonylureaorexogenousinsulin(n=2729)MI16%reduc

8、tion(P=0.052)Stroke11%increase(P=0.52)Metformininoverweightsu