正确认识糖尿病患者的强化治疗-孙宁玲.pptVIP

糖尿病多重心血管危险因素干预 是预防大血管并发症的主要策略 危险因素 控制目标 HbA1c 6.5% Bp 130/80mmHg LDL-C 2.5 mmol/l (95 mg/dl) TG 2.3 mmol/l(200 mg/dl) HDL-C 1.0 mmol/l (39 mg/dl) 2005 IDF Guideline 结 论 1、糖尿病患者是需要早期强化治疗（包括IGT) 2、糖尿病患者需要综合性治疗（减重、降压、调 脂） 3、高危糖尿病患者降糖药缓慢，避免发生低血糖 适当的强化降糖仍然是主流治疗 谢 谢 * 1: Lancet. 1998 Sep 12;352(9131):837-53 Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. [No authors listed] BACKGROUND: Improved blood-glucose control decreases the progression of diabetic microvascular disease, but the effect on macrovascular complications is unknown. There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation. We compared the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a randomised controlled trial. METHODS: 3867 newly diagnosed patients with type 2 diabetes, median age 54 years (IQR 48-60 years), who after 3 months diet treatment had a mean of two fasting plasma glucose (FPG) concentrations of 6.1-15.0 mmol/L were randomly assigned intensive policy with a sulphonylurea (chlorpropamide, glibenclamide, or glipizide) or with insulin, or conventional policy with diet. The aim in the intensive group was FPG less than 6 mmol/L. In the conventional group, the aim was the best achievable FPG with diet alone; drugs were added only if there were hyperglycaemic symptoms or FPG greater than 15 mmol/L. Three aggregate endpoints were used to assess differences between conventional and intensive treatment: any diabe