代谢综合症在慢病管理中的重要意义 PPT.pptVIP

The relationship between conversion to type 2 diabetes and insulin resistance (assessed by homeostasis model assessment of insulin resistance, HOMA-IR) and insulin secretion (assessed on the basis of the secretory response to a glucose load) is examined ? Fifty-four percent of those who converted to type 2 diabetes had both insulin resistance and low insulin secretion ? Another 28.7% had insulin resistance alone Data from long-term follow-up of the UKPDS appears to be consistent with the finding that early metabolic control has enduring beneficial effects in Type 2 diabetes1 The lower panel shows the converging of HbA1c values between patients who initially achieve intensified glycaemic control with those who have less intensive control2 References 1 UKPDS. Diabetes 195; 44: 1249-1258 2 LeRoith DM, Fonesca V, Vinik A. Diabetes Metab Res Rev 2005; 21: 85-90 Composite endpoint of death from CV causes, nonfatal MI, CABG, PCI, nonfatal stroke, amputation, or surgery for PAD: STENO-2 In Steno-2, the intensive therapy group had a 53% reduction in macrovascular disease, relative to the conventional therapy group. This 53% reduction in macrovascular disease is much higher than the percent reduction reported in single intervention trials of blood pressure, lipids, or ACE inhibitors, suggesting that multiple risk factor interventions are critical in high-risk subjects. Reference: G?de P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003;348:383-393. 不同的干预组2型糖尿病发生率/100 人年 13.3 8.3 5.1 6.8 11.5 10.8 11.6 17.3 0 2 4 6 8 10 12 14 16 18 20 对照 饮食 运动 饮食+运动 BMI25 BMI25 大庆IGT和糖尿病研究第一次证明： 如果采取积极措施，鼓励人们改变其不健康高风险的生活方式能在很大程度上预防2型糖尿病. 大庆糖尿病前期人群20年随访 对照组90%的患者发展成了糖尿病 死亡 142/568 占 25% 心血管病和脑卒中死亡 68例 非心脑血管病死亡 74例 321 心梗和脑卒中事件，56.5% 211例为首发，37% 60例为多发，10.6%  大庆糖尿病预防终点研究随访期间累积的糖尿病的发病率 t risk, control/intervention: 135 105 69 48 40 37 34 27 27 23 14 428