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1、餐后高血糖和心血管危险因素.CVDdrivestheeconomicburdenoftype2diabetesCVD:cardiovasculardisease NicholsGA,BrownJB.DiabetesCare2002;25:482–6. Copyright©2002AmericanDiabetesAssociation;reprintedwithpermissionfrom TheAmericanDiabetesAssociation.1086420Costin1999(x1,000US$)NoCVD, nodiabetesn=1
2、3,286NoCVD, diabetesn=11,130CVD,nodiabetesn=2,894CVDand diabetesn=5,050$2,562$4,402$6,396$10,17231.9%48.1%20.0%28.6%40.3%31.2%17.2%31.8%51.0%21.1%28.0%50.9%PharmacyOutpatientInpatientPathophysiologyoftype2diabetesJankaHU.FortschrMed1992;110:637–41.Macro- vascular diseaseInsu
3、linsensitivityInsulinsecretionPlasmaglucoseMicro- vascular diseaseImpairedglucosetoleranceHyperglycemiaDiagnosingglucoseintolerance– criteriareflectaneedforearlyintervention*Determinedpost75gglucoseload 2h-PG:2-hourpostchallengeplasmaglucose,FPG:fastingplasmaglucose,IFG:impa
4、iredfastingglucose,IGT:impairedglucosetolerance WorldHealthOrganization,1999.DiagnosisVenousplasma glucoseconcentration (mmol/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 differen
5、tpeoplewithdiabetes2h-PG:2-hourpostchallengeplasmaglucose,FPG:fastingplasmaglucose DECODEStudyGroup.BMJ1998;317:371–5.FPG 40%BothFPGand 2h-PG 28%Younger,moreobese peopleOlder,leaner people2h-PG 32%TheRelativeContributionofFPGandMealtimeGlucoseSpikesto24-hourGlycemicLevelRi
6、ddleMC.DiabetesCare1990;13:676–6863002001000Plasmaglucose(mg/dl)06001200180024000600Time(hours)Mealtime glucose spikesFasting hyperglycemiaNormalKuusistoetal,1994GlycemicControlandCHDCHDMortalityAllCHDEventsAComparisonofHba1cLevelsAchievedintheConventionalVersusIntensiveGrou
7、psofMajorTrials1098765012345678910Timefromrandomization(years)HbA1cDCCTKumamotoStudy9876003691215MedianHbA1c(%)Timefromrandomization(years)UKPDSConventionaltherapyIntensivetherapy121110987650122436486072MonthsHbA1c(%)FPG=fastingplasmaglucose;PPG=postprandialplasmaglucose.HbA
8、1CPPGFPG+=4.85.05.25.45.65.86.06.26.4HbA1c(%)6080100120140160180200Fasting/
