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餐后高血糖和心血管危险因素培训讲学.ppt

餐后高血糖和心血管危险因素培训讲学.ppt

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时间：2020-12-03

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1、餐后高血糖和心血管危险因素Pathophysiologyoftype2diabetesJankaHU.FortschrMed1992;110:637–41.Macro- vascular diseaseInsulinsensitivityInsulinsecretionPlasmaglucoseMicro- vascular diseaseImpairedglucosetoleranceHyperglycemiaDiagnosingglucoseintolerance– criteriareflect

2、aneedforearlyintervention*Determinedpost75gglucoseload 2h-PG:2-hourpostchallengeplasmaglucose,FPG:fastingplasmaglucose,IFG:impairedfastingglucose,IGT:impairedglucosetolerance WorldHealthOrganization,1999.DiagnosisVenousplasma glucoseconcentration (mmol/

3、L)DiabetesFPGor>7.02h-PG*>11.1IGTFPG(ifmeasured)and<7.02h-PG*>7.8and<11.1IFGFPGand>6.1and<7.02h-PG*(ifmeasured)<7.8FPGand2h-PGvaluesidentify differentpeoplewithdiabetes2h-PG:2-hourpostchallengeplasmaglucose,FPG:fastingplasmaglucose DECODEStudyGroup.BMJ1

4、998;317:371–5.FPG 40%BothFPGand 2h-PG 28%Younger,moreobese peopleOlder,leaner people2h-PG 32%TheRelativeContributionofFPGandMealtimeGlucoseSpikesto24-hourGlycemicLevelRiddleMC.DiabetesCare1990;13:676–6863002001000Plasmaglucose(mg/dl)060012001800240006

5、00Time(hours)Mealtime glucose spikesFasting hyperglycemiaNormalKuusistoetal,1994GlycemicControlandCHDCHDMortalityAllCHDEventsAComparisonofHba1cLevelsAchievedintheConventionalVersusIntensiveGroupsofMajorTrials1098765012345678910Timefromrandomization(year

6、s)HbA1cDCCTKumamotoStudy9876003691215MedianHbA1c(%)Timefromrandomization(years)UKPDSConventionaltherapyIntensivetherapy121110987650122436486072MonthsHbA1c(%)FPG=fastingplasmaglucose;PPG=postprandialplasmaglucose.HbA1CPPGFPG+=4.85.05.25.45.65.86.06.26.4H

7、bA1c(%)6080100120140160180200Fasting/2hourplasmaglucose(mg/dl)HarrisMIetalDiabetesCare,1998Hba1c,Fastingand2hrPlasmaGlucoseUKPDS10yr-CohortData:DissociationBetweenFPG&HbA1CHbA1cFPGDelPratoS.2001PPGDurationofDailyMetabolicConditionsBFLunchDinner0:00am4:0

8、0amBFPostprandialPostabsorptiveFastingMonnierL,EuropJClinInvest,2000IntensiveTreatmentPoliciesDCCTKumamotoStudyUKPDSFastingplasmaglucose(mmol/l)3.9–6.7<7.8<62-hrppglucose(mmol/l)<10<11NotdefinedTheFunagataCohortPopulation********

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