糖尿病肾脏病病人的血糖控制.pptVIP

糖尿病肾脏病病人的血糖控制 唐雯 北京大学第三医院 大纲 目前已经存在的在糖尿病肾脏病病人中的血糖控制效果的证据 肾功能基本正常的1和2型糖尿病病人 透析前的病人 HD和PD的病人 目前已经建议的糖尿病肾脏病病人血糖控制的方法 降糖药物的治疗 胰岛素治疗 可能的研究领域 Intensive treatment of hyperglycemia prevents DKD and may slow the progression of established kidney disease Lowering HbA1c levels to approximately7.0% reduces the development ofmicroalbuminuria. (Strong) Lowering HbA1c levels to approximately 7.0% reduces the development of macroalbuminuria. (Moderate) Lowering HbA1c levels to approximately 7.0% reduces the rate of decrease in GFR.　(Weak) Effect of Glycemic Control on Kidney Function and Albuminuria in Type 1 Diabetes  The Diabetes Control and Complications Trial : DCCT Study design: a multicenter，randomized clinical trial Participants： 1441 patients with type 1 diabetes Group: primary-prevention cohort： 726 with no retinopathy secondary-intervention cohort： 715 with mild retinopathy Intervention： intensive therapy ：administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring conventional therapy ： one or two daily insulin injections Followed for a mean of 6.5 years Main Outcome Measures: appearance and progression of retinopathy and other complications DCCT-Measurements of Glycosylated Hemoglobin and Blood Glucose in Patients with IDDM Receiving Intensive or Conventional Therapy DCCT The Epidemiology of Diabetes Interventions and Complications: EDIC study Study design: Observational study begun in 1993 (following DCCT closeout) in 28 medical centers in the United States and Canada. During the EDIC study: glycemic levels no longer differed substantially Participants:1349 (of 1375) EDIC volunteers who had kidney evaluation at years 7 or 8 Main Outcome Measures： Development of microalbuminuria, clinical-grade albuminuria, hypertension, or increase in serum creatinine level. EDIC EDIC EDIC Develop hypertension: intensive treatment group 29.9% conventional-treatment: 40.3%; P001. A seru