2 糖尿病患者的微血管并发症PPT.ppt

Key Points There are advantages and disadvantages to the various means of analyzing microalbuminuria. Random spot collection is easy to perform, and usually provides accurate information. First void or morning collection eliminates the diurnal variations in albumin excretion. Timed collection is thought of as the gold standard, but it is very labour and time intensive, and patient cooperation can be difficult. Key Points Screening for microalbuminuria provides a unique window of opportunity for early intervention, particularly the administration of ACE inhibitors. It should be performed once a year with the following measures: spot urine albumin to creatinine ratio measurement of a serum creatinine an estimate of GFR (using an MDRD calculator) Key Points Here is a simple calculator available online. On this and the next slide, we see GFR values for male patients of two different ages. Key Points This shows a result for an older patient, male aged 78. Key Points Metabolic control is key in managing diabetic nephropathy. This means tight glycemic control and tight blood pressure control. Key Points Blood pressure should be tested at each office visit; normal range is determined to be less than 130/80 mmHg. Urinary albumin should be tested annually in people with type 2 diabetes, beginning at the moment of diagnosis, and annually in type 1 patients, beginning 5 years following diagnosis. American Diabetes Association. Nephropathy in Diabetes (Position Statement). Diabetes Care 2004;27(Suppl1):S79-S83. Key Points Returning again to a look at the DCCT, 1441 type 1 patients, half of whom had mild retinopathy, were randomized to intensive (A1C 7%) or conventional (A1C 9%) insulin therapy. Intensive therapy reduced risk for macroalbuminuria by 56%. Key Points UKPDS set out to determine whether tight blood pressure control policy can reduce morbidity and mortality in type 2 diabetic patients. A total of 1148 patients with newly diagnose