动态血糖监测的技术在妊娠合并糖尿病中的临床价值V2.ppt

早期“健康和疾病的发育起源”的相关研究主要关注疾病的风险，如胎儿生长受限、低出生体重儿与其成年时2型糖尿病发生风险的关系，并由此提出“节俭表型假设”，该假设认为胎儿在发育过程中由于宫内营养不良导致一定程度的胰岛素抵抗，却增加了成年后发生糖尿病的风险。 * 如果不予治疗，糖尿病对孕妇和后代的影响将形成恶性循环。 如图所示：妊娠期发生糖尿病或肥胖的孕妇，其所生婴儿发生糖尿病或肥胖的几率增加，所生女儿在成年后妊娠时也会有极大可能发生妊娠期糖尿病或肥胖，如此一代一代形成恶性循环。 * * 从2011年1月开始，美国糖尿病协会(ADA)在Diabetes Care公布了其最新诊治指南。 与2010年ADA关于GDM的诊断标准相比，2011年诊断标准有许多不同之处值得注意。 指南最大的变化是关于GDM筛查和诊断的调整: - 相比2010年ADA关于GDM采用100g OGTT的筛查方法，新指南推荐采用口服75 g葡萄糖筛查的一步法诊断GDM - 而且，其界定的空腹、服糖后2小时血糖值均有下调，并且，只要有任意一点血糖值异常即可诊断为GDM。 新指南的变化充分体现了当今对GDM更加严格的管理趋势。 目前，201ADA和我国指南均沿用这一标准。 * 我国2013年糖尿病控制目标是HbA1c：＜7% FPG：4.4-7.0mmol/L PPG：10.0mmol/L 指南推荐的妊娠期血糖控制目标为： GDM: - 空腹或餐前≤ 5.3mmol/L(95mg/dl) - 餐后1h ≤ 7.8mmol/L(140mg/dl) - 餐后2h ≤ 6.7mmol/L (120mg/dl) 孕前1型或2型DM妊娠 - 餐前、睡前及夜间3.3–5.4 mmol/L（60–99 mg/dl） - 餐后血糖峰值5.4 –7.1mmol/L（100 –129 mg/dl） - 糖化血红蛋白 6.0% - 避免低血糖 * * * OBJECTIVE: To evaluate the risk of hypoglycemia associated with intensive insulin therapy of type I diabetes during pregnancy. METHODS: Eighty-four women with type I diabetes were recruited before 9 weeks gestation and received intensive insulin therapy throughout pregnancy. Patients monitored glucose concentrations with memory glucometers, and insulin dosages were adjusted weekly accordingly. A detailed history of clinical hypoglycemic events was obtained at each weekly clinic visit. RESULTS: Clinically significant hypoglycemia requiring assistance from another person occurred in 71% of pregnant patients, with a peak incidence between 10-15 weeks. Severe hypoglycemia during the early weeks of embryogenesis was not associated with an increase in embryopathy. Glycemic control was similar in women with or without recurrent hypoglycemia, but glucose fluctuations were significantly greater in hypoglycemic women. CONCLUSION: Severe hypoglycemia is a significant maternal risk associated with intensive insulin therapy of pregnant women with type I diabetes. In women with recurrent episodes of hypoglycemia, the clear benefits