糖尿病现状-王先化博士.ppt

In summary, the new international guidelines developed by the ADA and EASD make four main recommendations. Firstly, that the main aim of treatment approaches for type 2 diabetes should be to achieve and maintain glycemic control similar to that observed in unaffected individuals as quickly as possible. Secondly, that lifestyle interventions plus metformin therapy should be the first treatment step after diagnosis. The third recommendation is that whenever HbA1c levels are at or above 7%, medications should be added as quickly as possible to avoid prolonged periods of uncontrolled hyperglycemia. Finally, basal insulin therapy should be initiated promptly in patients who are not achieving treatment goals. Nathan DM, et al. Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2006;49:1711–21. [Ref, p. 1233] 从这一曲线可以看出，糖尿病患者的24小时血糖谱显著高于正常个体，包括空腹和餐后血糖。餐后血糖是在升高的空腹血糖的基础上更高，即“水涨船高”。 [Ref, p. 1233] 基础胰岛素的治疗不仅可以降糖空腹血糖，而且有效降低餐后血糖。从这一曲线可以看出，使用基础胰岛素后患者空腹或者说基础血糖降低后，即使餐后血糖的相对于基础血糖的数值没变，但其绝对值也有明显的下降，从而整个24的血糖谱得以有效的降低。 结果平均空腹血糖是7.4? 2.4mmol/L，范围是4.3~14.3mmol/L。空腹血糖水平与30分钟、1小时、2小时、3小时、4小时的绝对餐后血糖水平密切相关，与1小时、2小时、3小时、4小时的餐后血糖至基线的变化也密切相关。总体而言，空腹血糖水平与餐后血糖波动AUC的相关性具有统计学意义（r＝0.71， (P0.001)。 总而言之，空腹血糖的水平预测了餐后高血糖的程度和餐后血糖至基线的波动幅度，也提示临床医生，为改善总体血糖控制，在降低餐后血糖之前，应先控制空腹高血糖。 先看看胰岛素分泌的缺陷.大家都知道,在血糖逐渐增高的同时.患者的一相分泌会逐渐丧失的.尤其是一个早期相的分泌会逐渐缺失.但到了血糖非常高的时候,二相分泌和晚期相分泌也是缺失的. Slide 34: Effect of Fasting Plasma Glucose on the Acute Insulin Response The degree and duration of the insulin secretory response relative to an intravenous glucose load were compared in a series of 66 patients with a wide range of fasting plasma glucose (FPG) levels. The immediate rise in insulin secretion is referred to as the first phase response and the slower return to baseline as the second phase response. The acute, first phase in