餐后高血糖的意义及其控制策略课件.ppt

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1、控制餐后高血糖的意义以及NovoMix30的特点解放军总医院内分泌科母义明糖尿病的临床后果DiabetesTheleadingcauseofnewcasesofendstagerenaldisease(40%)A2-to4-foldincreaseincardio-vascularmortalityTheleadingcauseofnewcasesofblindnessinworking-agedadults(30%)TheleadingcauseofnontraumaticlowerextremityamputationsMec

2、hanismofMacrovascularDiseaseinIRMCP-1ICAM-1VCAM-1InsulinResistanceDyslipidemiaHypertensionHyperglycemiaActivationofDAGandPKCNF-kBactivation?仅仅1/3糖尿病患者HbA1c达标010203040506070ProportionofpatientsachievingHbA1c<7.0%010203040506070ProportionofpatientsachievingHbA1c<6.5%<7.

3、0%7.0%<6.5%6.5%NHANES1999–2000(US)1CODE-2(Europe)21SaydahSHetal.JAMA2004;291:335-3422LieblA.Diabetologia2002;45:S23–S2836%64%31%69%NHANES—美国全国健康和营养状况调查CODE-2—欧洲糖尿病花费调查-2DM患者HbA1c达标率并没有改善SaydahSHetal.JAMA2004;291:335-342*PatientsachievinggoalsforHbA1c,bloodpressurea

4、ndtotalcholesterolPatientsachievinggoalsforHbA1cbloodpressureandtotalcholesterolinNHANESIII(1988–1994)versusNHANES(1999–2000)5%34%29%44%7%48%36%37%0102030405060Patientsachievinggoals(%)NHANESIII(1988–1994)NHANES(1999–2000)HbA1c<7.0%BP<130/80mmHgTotalcholesterol<200mg/

5、dlGoodcontrol*???NHANES—美国全国健康和营养状况调查为什么血糖达标率那么低？PatientsachievingtreatmentgoalsintheSteno-2StudyHbA1c<6.5%Cholesterol<175mg/dlTriglycerides<150mg/dlSystolicBP<130mmHgDiastolicBP<80mmHgMeanfollow-up=7.8years15%3%72%22%58%46%46%19%72%60%GaedeMD,etal.NewEnglJMed2003;348

6、:383–393???阻碍达标的因素：饮食/运动疗法失败药物缺乏期望的功效保守的治疗方式病人的依从性差7698HbA1c(%)10OAD单药治疗饮食控制OAD联合治疗OAD加用基础胰岛素OAD单药逐渐加大剂量糖尿病发病时间OAD加大剂量的胰岛素/天保守治疗方式:传统的阶梯式给药OAD+基础胰岛素注射OAD+胰岛素每日多次注射饮食控制OAD单一治疗OAD联合治疗OADs逐渐加大剂量糖尿病发病时间7698HbA1c(%)10积极方式:早期联合用药的治疗方式DCCTResearchGroup.NEnglJMed.1993;329:977

7、-986.OhkuboY,etal.DiabetesResClinPract.1995;28:103-117.UKPDS33:Lancet1998;352,837-853.StrattonIMetal.BMJ.2000;321:405-412.严格血糖控制降低糖尿病并发症的风险A1cRetinopathyNephropathyNeuropathyCVdiseaseType1DCCT197%63%54%60%41%*Type2Kumamoto297%69%70%-52%*Type2UKPDS387%17-21%24-33%-1

8、6%**Notstatisticallysignificantduetosmallnumberofevents.Showedstatisticalsignificanceinsubsequentepidemiologicanalysis4餐后血