共同关注血糖一心内科医生站在糖尿病防治的上游防线一胡大一.ppt

* Dr. Haffner is professor of internal medicine at the University of Texas Health Science Center, Department of Medicine, Division of Clinical Epidemiology in San Antonio. He received his medical degree in 1975 from Albert Einstein College of Medicine in New York. He also received a masters in public health in 1982 (epidemiology) from the University of Washington. Dr. Haffner has published more than 350 scientific publications and has written many review articles and book chapters in his field. His major research interests include insulin resistance and type 2 diabetes as well as diabetes and cardiovascular disease. Dr. Haffner wrote the American Diabetes Association technical review on diabetic dyslipidemia, which suggested that type 2 diabetes might be considered a coronary heart disease equivalent. This hypothesis was accepted by the National Cholesterol Education Program of which Dr. Haffner was a consultant. He also helped to establish that the pre-diabetic state is atherogenic. Dr. Haffner has been on the steering committee and taken part in several NIH-funded projects including the Diabetes Education Program, Look AHEAD (weight loss effect on cardiovascular disease in diabetic subjects) and the Insulin Resistant Atherosclerosis Study. * * 从图中可以看到，糖尿病及糖耐量受损人群的动脉内中层厚度，内膜连续性和动脉粥样硬化积分都较糖耐量正常人群有显著差异。 INTERHEART是一个标准、严格的病例对照研究，这一研究的筛选涉及了整个非洲、亚洲、澳洲、欧洲、中东、北美和南美52个国家的262个中心的AMI的病人，所有病人均为确诊的初次心肌梗死时患者并住在冠心病监护病室（CCU）或心血管病房。 研究对传统的心血管疾病危险因素（吸烟、高血压、高胆固醇和糖尿病）和正在呈现的新的心血管疾病危险因素（糖耐量异常、腹型肥胖、高半胱氨酸以及其他饮食和心理社会因素）与心梗的相关性进行了研究分析。 * Treatment * 这是DECODA研究的数据经过校正之后的结果。 也就是说，经过对空腹血糖进行校正后，负荷后高血糖与全因死亡率、心血管死亡率密切相关。即除外空腹血糖的影响，负荷后高血糖是上述两种死亡率独立危险因素。 而当对2小时血糖进行校正后，空腹血糖水平与全因死亡率、心血管死亡率无关。也就是说空腹血糖水平与全因死亡率、心血管死亡率相关联是基于混杂设计的研究结果，其中2小时血糖即是其中的混杂因素 Multivariate hazard ratio * * * * 共同关注血糖 —心内科医生站在糖尿病防治的上游防线 目 录 糖尿病——让心血管疾病更危险 心血管疾病合并高血糖的管理原则 Risk factors management Early intervention All-sides glucose control Combination rationality Hypoglycemia prevention