餐后高血糖和心血管危险因素优秀课件.ppt
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1、餐后高血糖和心血餐后高血糖和心血管危管危险因素因素第1页,本讲稿共29页The increasing global burden of diabetesPopulation aged 20 yearsKing H,et al.Diabetes Care 1998;21:141431.Developed countriesDevelopingcountriesWorldtotalPrevalence(%)0246820252000第2页,本讲稿共29页CVD drives the economic burden of type 2 diabetesCVD:cardiovascular disea
2、seNichols GA,Brown JB.Diabetes Care 2002;25:4826.Copyright 2002 American Diabetes Association;reprinted with permission from The American Diabetes Association.1086420Cost in 1999(x1,000 US$)No CVD,no diabetesn=13,286No CVD,diabetesn=11,130CVD,no diabetesn=2,894CVD anddiabetesn=5,050$2,562$4,402$6,39
3、6$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%PharmacyOutpatientInpatient第3页,本讲稿共29页Pathophysiology of type 2 diabetesJanka HU.Fortschr Med 1992;110:63741.Macro-vasculardiseaseInsulin sensitivityInsulin secretionPlasma glucoseMicro-vasculardiseaseImpaired glucose toleranceHyper
4、glycemia第4页,本讲稿共29页Diagnosing glucose intolerance criteria reflect a need for early intervention*Determined post 75g glucose load2h-PG:2-hour postchallenge plasma glucose,FPG:fasting plasma glucose,IFG:impaired fasting glucose,IGT:impaired glucose tolerance World Health Organization,1999.Diagnosis V
5、enous plasma glucose concentration (mmol/L)DiabetesFPG or 7.02h-PG*11.1IGTFPG(if measured)and 7.8 and 6.1 and 7.02h-PG*(if measured)7.8第5页,本讲稿共29页FPG and 2h-PG values identify different people with diabetes2h-PG:2-hour postchallenge plasma glucose,FPG:fasting plasma glucoseDECODE Study Group.BMJ 199
6、8;317:3715.FPG40%Both FPG and 2h-PG28%Younger,more obesepeopleOlder,leanerpeople2h-PG32%第6页,本讲稿共29页The Relative Contribution of FPG and Mealtime Glucose Spikes to 24-hour Glycemic LevelRiddle MC.Diabetes Care 1990;13:6766863002001000Plasma glucose(mg/dl)06001200180024000600Time(hours)Mealtimeglucose
7、spikesFastinghyperglycemiaNormal第7页,本讲稿共29页Kuusisto et al,1994Glycemic Control and CHDCHD MortalityAll CHD Events第8页,本讲稿共29页A Comparison of Hba1c Levels Achieved in the Conventional Versus Intensive Groups of Major Trials10987650123456789 10Time from randomization(years)HbA1cDCCTKumamoto Study987600
8、3691215Median HbA1c(%)Time from randomization(years)UKPDSConventional therapyIntensive therapy121110987650122436486072MonthsHbA1c(%)第9页,本讲稿共29页FPG=fasting plasma glucose;PPG=postprandial plasma glucose.HbA1CPPGFPG+=第10页,本讲稿共29页4.85.05.25.45.65.86.06.26.4HbA1c(%)6080100120140160180200Fasting/2 hour p
9、lasma glucose(mg/dl)Harris MI et al Diabetes Care,1998Hba1c,Fasting and 2hr Plasma Glucose第11页,本讲稿共29页UKPDS 10 yr-Cohort Data:Dissociation Between FPG&HbA1CHbAHbA1c1cFPGFPGDel Prato S.2001PPGPPG第12页,本讲稿共29页Duration of Daily Metabolic ConditionsBFLunchDinner0:00 am4:00 amBFPostprandialPostabsorptiveF
10、astingMonnier L,Europ J Clin Invest,2000第13页,本讲稿共29页Intensive Treatment Policies DCCT Kumamoto Study UKPDS Fasting plasma glucose(mmol/l)3.9 6.7 7.8 6 2-hr pp glucose(mmol/l)10 11 Not defined 第14页,本讲稿共29页The Funagata Cohort Population*Tominaga M et al.Diabetes Care,1999NGTNGT -IFGIFG -DMDMAll causes
11、 of death0.8600.8800.9000.9200.9400.9600.9801.00001234567Years第15页,本讲稿共29页The Funagata Cohort Population*Tominaga M et al.Diabetes Care,1999*NGTNGT -IGTIGT -DMDM第16页,本讲稿共29页Summary 1.Type 2 DM begins as a postprandial disease2.Postprandial hyperglycemia contributes to elevations in HbA1c and complic
12、ations3.Treatment of postprandial hyperglycemia is critical to achieving optimal outcomes in type 2 DM4.Nevertheless,treatment of postprandial hyperglycemia is inadequately addressed第17页,本讲稿共29页STOP-NIDDMStudy to Prevent Non-insulin Dependent Diabetes MellitusSTOPNIDDM第18页,本讲稿共29页Study designSTOPNID
13、DMPlacebo t.i.d.(n=715)Acarbose 100mg t.i.d.(n=714)1036612182430Months1234567891011121314VisitsPlacebon=1,4293 monthsplacebo60Close-out visitt.i.d.:three times dailyChiasson JL,et al.Lancet 2002;359:20727.第19页,本讲稿共29页Acarbose reduces the risk of developing diabetesSTOPNIDDMAcarbose reduces the incid
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