外科系统糖尿病治疗.1讲解.ppt

1) 妊娠糖尿病的诊断标准有较大的变动：仍采取75gOGTT，但去掉了“服糖后3h”时间点，同时空腹标准改为≥5.1 mmol/L (2010版为5.3)，服糖后2h标准改为≥8.5mmol/L(2010版为8.6)，“1个以上”时间点高于上述标准可确定诊断(2010版为“2个以上”时间点) 2) 较2010 版指南，GDM的筛查取消了“两步法”(即先行50gOGTT初筛，再75gOGTT)；删除了GDM的分级 3) 结合2013年的最新进展资料，根据WHO发表的《妊娠期新诊断高血糖诊断标准和分类》，将妊娠期间发现的高血糖分为两类：妊娠期间的糖尿病和妊娠期糖尿病，增加了“妊娠期间的糖尿病”的诊断标准 指隔夜禁食8-10小时后进早餐前检测的血糖。 意义：与基础胰岛素分泌有关，如基础胰岛素分泌不足可表现为空腹高血糖。空腹血糖是决定全天血糖的主要因素，为临床上最常用的诊断糖尿病的指标，也可作为用药初期观察及评价药物疗效的重要指标。 正常值：4.4~6.1mmol/L (新的控制目标为5.6mmol/L) 进餐后2小时的血糖值（从进第一口餐时开始计时，不能从餐中或餐后开始计时），包括早餐、中餐及晚餐后2小时的血糖，是人体血糖的峰值，一般选早餐后的血糖作为代表。 意义：反应机体进餐刺激后的胰岛素的分泌情况。利于检出高血糖 正常值：4.4~7.8mmol/L Slide 6-4 TYPE 2 DIABETES…A PROGRESSIVE DISEASE Progressive Decline of b-Cell Function in the UKPDS In 1996, results of 6 years of follow-up of the patients in the UK Prospective Diabetes Study were reported. Although the patients who received intensive treatment maintained significantly better glycemic control, all groups showed progressive hyperglycemia over the 6 years, with associated decrease in b-cell function. b-Cell function deteriorated in the patients who were allocated to and remained on diet therapy, with a significant decrease from 1 to 6 years (53% to 26%; P .0001). Those on sulfonylurea therapy displayed an increase in b-cell function during the first year of therapy (46% to 78%) that subsequently decreased significantly to 52% (P .0001) by year 6. Patients who were allocated to metformin therapy also had an increase in b-cell function in the first year that deteriorated at 6 years (66% to 38%), which was similar to that seen in the patients treated with diet alone. UK Prospective Diabetes Study Group. UK Prospective Diabetes Study 16: Overview of 6 years’ therapy of type II diabetes: A progressive disease. Diabetes. 1995;44:1249-1258. 磺脲类药物的主要作用是促进胰岛B细胞分泌胰岛素。可以使HbA1c降低1%～2%。磺脲类药物如果使用不当可以导致低血糖，特别是在老年患者和肝、肾功能不全者；磺脲类药物还可以导致体重增加。有肾功能轻度不全的患者，宜选择格列喹酮。患者依从性差时，建议每天只需服用1次的磺脲类药物。 格列奈类药物为非磺脲类胰岛素促泌剂，本类药物通过刺激胰岛素的早期分泌，有效降低餐后血糖，具有吸收快、起效快和作用时间短的特点。可降低HbA1c 0.3%～1.5%。此类药物需在餐前即刻服用