(内科学课件）16-Diabetes2017.ppt

总结 * KEY MESSAGE: The DCCT showed that people with type 1 diabetes who followed an intensive therapy regimen that lowered their A1c values had fewer long-term complications. Supporting Points The DCCT is the longest and largest study to show that lowering blood glucose to improve A1c results slows or prevents the development of complications in type 1 diabetes. The DCCT examined more than 1,400 people with type 1 diabetes for 10 years. Two groups of patients were followed: one treated conventionally and another treated intensively. The volunteers in the intensive treatment group tested their blood more often and followed a more stringent schedule for insulin injection (multiple daily insulin injections or treatment with an insulin pump). Compared with people who had conventional therapy, the intensive treatment group had 35% to 56% less kidney damage (decreases in microalbuminuria and albuminuria, respectively), 60% less nerve damage (clinical neuropathy), and 76% less eye disease (retinopathy). Improved glycemic control also was associated with fewer cardiovascular events in the DCCT. However, this finding was not statistically significant, perhaps because the study volunteers were young adults in whom the incidence of heart disease would be expected to be low. * KEY MESSAGE: The UKPDS showed that tight control of blood glucose reduces long-term complications in people with type 2 diabetes. Supporting Points The UKPDS showed that long-term complications in type 2 diabetes are not inevitable. The UKPDS studied more than 5,000 people with type 2 diabetes for an average of 10 years to learn if intensive management would help delay or prevent complications. Those people who kept their blood glucose levels as close to normal as possible (A1c at 7% or less) had less eye disease, kidney disease, and nerve damage. The UKPDS also showed the importance of blood pressure management in reducing cardiovascular complications. People with type 2 diabetes who followed an in