糖尿病和冠心病若干问题_吴先正幻灯片.ppt

糖尿病和冠心病若干问题 同济大学附属同济医院 吴先正 目录 流行病学 糖尿病诊断标准的变迁 糖尿病心血管并发症 强化降糖治疗：来自三大试验的启示 从临床角度看糖尿病 从心血管危险因素干预到心血管保护 流行病学：糖尿病的全球负担 据世界卫生组织（WHO）估计，全球目前有超过1.5亿糖尿病患者，到2025年，全世界的糖尿病患者将达3亿。 注释：这一数据可能大大低估了其实际发病率，因受累患者高达一半未被诊断。在近年来修改了2型糖尿病诊断标准后更是如此。 诊断标准的选择对所报告的发病率有明显影响。 中国人的糖尿病患病率 2007年6月至2008年5月，杨文英教授等进行一项全国性研究。纳入≥20岁的46239名成年人。 结果表明：糖尿病在中国已成为重要的公共健康问题，并且需要制定针对糖尿病预防和治疗的策略。 March 25th，2010《The New England Journal of Medicine》 Prevalence of Diabetes among Men and Women in China Background Because of the rapid change in lifestyle in China, there is concern that diabetes may become epidemic. We conducted a national study from June 2007 through May 2008 to estimate the prevalence of diabetes among Chinese adults. Methods A nationally representative sample of 46,239 adults, 20 years of age or older, from 14 provinces and municipalities participated in the study. After an overnight fast, participants underwent an oral glucose-tolerance test, and fasting and 2-hour glucose levels were measured to identify undiagnosed diabetes and prediabetes (i.e., impaired fasting glucose or impaired glucose tolerance). Previously diagnosed diabetes was determined on the basis of self-report. Results The age-standardized prevalences of total diabetes (which included both previously diagnosed diabetes and previously undiagnosed diabetes) and prediabetes were 9.7% (10.6% among men and 8.8% among women) and 15.5% (16.1% among men and 14.9% among women), respectively, accounting for 92.4 million adults with diabetes (50.2 million men and 42.2 million women) and 148.2 million adults with prediabetes (76.1 million men and 72.1 million women). The prevalence of diabetes increased with increasing age (3.2%, 11.5%, and 20.4% among persons who were 20 to 39, 40 to 59, and 60 years of age, respectively) and with increasing weight (4.5%, 7.6%, 12.8%, and 18.5% among persons with a body-mass index [the weight in kilograms divided by the square of the height in meters] of 18.5, 18.5 to 24.9, 25.