阿卡波糖在2型糖尿病早期防治策略中的地位.pptVIP

一线起始 全程推荐阿卡波糖在2型糖尿病早期防治策略中的地位 一线起始治疗地位 联合用药中的价值 阿卡波糖疗效与饮食中碳水化合物含量的关系 胃肠道不良反应是否存在正面的临床意义 糖尿病治疗的目的 糖尿病危害在于急慢性并发症 没有并发症，糖尿病本身没有必要处理 预防糖尿病相关并发症是糖尿病的治疗目的 优化血糖管理是糖尿病管理的重要组成部分 荟萃分析IGT阶段心血管事件危险显著增加 20％ 糖尿病前期干预药物选择的要点 疗效 既显著降低2型糖尿病发病危险 又显著降低心血管事件发病危险 对不同类型的人群都有效 安全性 预防用药的前提是不增加额外的风险 单用 一线起始 Essen-II study：阿卡波糖 二甲双胍 头对头比较研究 阿卡波糖显著延缓IMT进展（合并冠心病的新诊断2型糖尿病和IGT） 联合 全程推荐 随病程进展，联合用药不可避免（以促泌剂为例） 阿卡波糖联合二甲双胍：消峰去谷 阿卡波糖联合胰岛素：消峰去谷 关注过程优化血糖管理是糖尿病治疗的过程 着眼终点 预防糖尿病心血管事件是治疗的目的 谢谢！ * IDF 2006 Meet the Expert 2002年的一项研究证实在糖尿病诊断之前心血管疾病发生风险就已经明显增加，也进一步证实在糖尿病前期大血管病变就已经存在 OBJECTIVE—To examine whether the risk of cardiovascular disease (CVD) is elevated before clinical diagnosis of type 2 diabetes in women. RESEARCH DESIGN AND METHODS—A total of 117,629 female nurses aged 30–55 years who were free of diagnosed CVD at baseline were recruited in 1976 and followed for 20 years. RESULTS—A total of 1,508 women had diagnosed type 2 diabetes at baseline in 1976. During 20 years of follow-up, 110,227 women remained free of diabetes diagnosis and 5,894 women developed type 2 diabetes. During 2.2 million person-years of follow-up, we documented 1,556 new cases of myocardial infarction (MI), 1,405 strokes, 815 fatal coronary heart disease (CHD), and 300 fatal strokes. Among women who developed type 2 diabetes during follow-up, the age-adjusted RRs of MI were 3.75 (95% CI 3.10–4.53) for the period before the diagnosis and 4.57 (3.87–5.39) for the period after the diagnosis, compared with women who remained free of diabetes diagnosis. The multivariate RRs further adjusting for BMI, smoking, and other cardiovascular risk factors were 3.17 (2.61–3.85) and 3.97 (3.35–4.71). The risk of stroke was also significantly elevated before diagnosis of diabetes (multivariate RR = 2.30 [1.76–2.99]). Further adjustment for history of hypertension or hypercholesterolemia did not appreciably alter the results. CONCLUSIONS—Our data indicate a substantially elevated risk of CVD before clinical diagnosis o