MSD糖尿病视网膜病变20120703课稿.ppt

As hypoglycemia is a barrier to achieving glycemic targets, the UK Prospective Diabetes Study (UKPDS) examined the occurrence of hypoglycaemia and its contributing factors in patients randomised to and remaining for 6 years on diet, sulfonylurea, metformin (overweight subjects only), or insulin monotherapy from diagnosis of Type 2 diabetes. More patients on basal insulin reported hypoglycemia (21.2% per year) than diet (0.8%), sulfonylurea (7.9%), or metformin (1.7%) therapy, but less than on basal and prandial insulin (32.6%) (all P.0001). Reference Wright et al. UKPDS73. Diabetes Complicat 2006;20:395–401. * * 2型糖尿病患者低血糖事件随HbA1c水平下降增高 饮食，磺酰脲 或者二甲双胍 0 10 20 30 40 年度比率, % 0 4 5 6 7 8 9 10 11 近期 HbA1c, % Reproduced with permission of Elsevier, Inc., from Wright et al. J Diabetes Complications. 2006;20:395–401; permission conveyed through Copyright Clearance Center, Inc. * 低血糖是2型糖尿病患者血糖控制的障碍之一 低血糖是血糖管理的重要限制因素，并可能成为治疗依从性的显著障碍 对低血糖的恐惧是血糖控制的额外障碍 一项针对2型糖尿病患者的研究表明，对低血糖的恐惧感会随着发生低血糖事件的程度由轻到重而增加 Amiel SA et al. Diabet Med. 2008;25(3):245–254. * 指南：HbA1c达标即在无低血糖发生的情况下尽可能使血糖接近正常 美国糖尿病协会(2008) 流行病学研究显示，HbA1c从7%降到正常范围将使患者获益更多(尽管从绝对值上看有些小)。因此对于患者而言，达标就是尽可能的使HbA1c接近正常值(6%)而无明显的低血糖发生a aFor those with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions or long-standing diabetes in whom the general goal is difficult to attain, less stringent HbA1c goals should be considered. Specific goals for people with these conditions should be determined by an individual’s health care team.2,3 1. ADA. Diabetes Care. 2008;31(suppl 1):S12–S54. 2. Skyler JS et al. Diabetes Care. 2009;32(1):187–192. 3. Joint statement from ACC, ADA and AHA revises recommendations for glycemic targets for some patients [press release]. December 17, 2008. * 指南：HbA1c达标即在无低血糖发生的情况下尽可能使血糖接近正常 国际糖尿病联盟(2005) 生活方式和教育咨询方面的支持，以及滴定治疗可以使糖尿病患者的HbA1c达到DCCT验证的低于6.5% (可行并期望的), 或更低水平 有时提高胰岛素或磺酰脲类的治疗目标可能会增加低血糖的发生风险，特别是对于那些有其他身体或精神