强化血糖达标的十个步骤—培训课件.pptVIP

* 谢谢大家！ * * * * 因Hb共有三个亚型，成人大部份都是HbA（97%）；HbA1是被糖基化的，而被糖基化的HBA1大部份是以HBA1C受体存在。 * * 以ADA的标准HBA1C7%，相对应的空腹血糖应少于120mg,餐后2小时应少于160mg,全天的平均血糖少于170mg; 以CDA，AACE，IDF的标准HBA1C6.5%,相对应的空腹血粮应少于110mg,餐后2小时应少于140mg,全天的平均血糖少于152mg; * * * * * * * * * * * * * * * In order to decrease the risk of diabetes-related complications, individuals with diabetes should receive intensive and effective treatment for all metabolic disturbances, including hyperglycemia. However, data from several studies indicate that treatment of hyperglycemia may be more difficult to achieve relative to management of dyslipidemia and hypertension. For example, in the Steno-2 study, only 15% of individuals with diabetes assigned intensive treatment achieved their HbA1c goal of ?6.5%, compared with notably more individuals achieving goals for cholesterol (72%) or triglyceride (58%) levels or systolic/diastolic blood pressure (46% and 72%, respectively). This may be caused by a number of factors, for example: the complexity of managing hyperglycemia relative to dyslipidemia or hypertension differences in the efficacy of available antidiabetic medications relative to lipid-lowering agents or antihypertensive drugs greater public awareness and acceptance of the general health benefits of lowering lipids and blood pressure relative to glycemic control. Gaede P, et al. N Engl J Med 2003; 348:383–393. * 在美国和欧盟，大约3分之2的2型糖尿病患者血糖水平不达标。 美国国家健康调查III （在1988年到1994年间进行）结果显示：根据目前ADA指南，44.5%的2型糖尿病患者血糖控制尚可。来自NHANES 的最新数据表明，在1999-2001年，这一数字降到了35.8% 1 欧洲2型糖尿病费用研究(CODE-2)评估了7000名2型糖尿病患者血糖控制对并发症的影响，发现根据当前欧洲治疗指南，仅有31%的患者血糖控制达标(HbA1c ? 6.5%)2 1. Koro CE, et al. Diabetes Care 2004; 27:17–20. 2. Liebl A. Diabetologia 2002; 45:S23–S28. * 8 * 39 The traditional stepwise approach aims primarily to control acute symptoms. Dietary measures and exercise are not usually sufficient to control glycemia beyond the first year of therapy. If monotherapy with an OAD (oral anti-diabetic) proves inadequate, combination therapy is usually sta