糖尿病诊断及分型 PPT课件.ppt

2型糖尿病的自然病程 正常 IGT 2型糖尿病 致残 致死 并发症 一级预防 二级预防 三级预防 “糖尿病前期” Adapted from Stratton IM, et al. UKPDS 35. BMJ 2000; 321:405–412. UKPDS: decreased risk of diabetes-related complications associated with a 1% decrease in A1C Percentage increase in relative risk corresponding to a 1% rise in HbA1C ** Any diabetes- related endpoint 21% ** Diabetes- related death 21% ** All cause mortality 14% * Stroke 12% ** Peripheral vascular disease? 43% ** Myocardial infarction 14% ** Micro- vascular disease 37% ** Cataract extraction 19% Observational analysis from UKPDS study data ?Lower extremity amputation or fatal peripheral vascular disease *P = 0.035; **P 0.0001 * 平均HbA1c水平与心梗和微血管终点事件发生率的关系: UKPDS 20 40 60 80 每1000患者-年发生率 研究人群:UKPDS研究中的白人、亚裔印度人、和非洲-加勒比海人 (n = 4,585) 。 年龄、性别和民族均经过校正。 5 6 7 8 9 1 0 1 1 心梗 微血管并发症 校正后的平均 HbA1c (%) 误差柱 = 95% 可信限 Adapted from Stratton IM, et al. Br Med J 2000; 321:405–412. 0 0 Turner RC, et al. UKPDS 49. JAMA 1999; 281:2005–2012. 100 Years from randomization 3 6 9 0 20 40 60 80 3 6 9 3 6 9 3 6 9 Diet Insulin Metformin Sulfonylurea Overweight patients Proportion of patients (%) 50% Proportion of patients with A1C 7.0% on monotherapy at 3, 6 and 9 years Error bars = 95% CI * Consensus 共识 全球已提出10方面关键建议以使T2DM血糖达标 Recommendations fall into four groups: 达到血糖良好控制 使T2DM并存的病理生理达标 早期联合有效治疗 使T2DM病人更好了解其益处 Sense of urgency defined as: treat early to glycemic goal earlier use of combination therapy 口服降糖药+ 胰岛素 口服降糖药+ 多次胰岛素 饮食 口服降糖药单药治疗 口服降糖药联合治疗 积极控制高血糖：早期联合治疗 口服降糖药单药剂量递增治疗 糖尿病病程 7 6 9 8 HbA1c (%) 10 * * Prior to the manifestation of the metabolic defects that lead to type 2 diabetes, fasting and post-pyramidal insulin levels are similar and constant. In the majority of patients that go on to develop type 2 diabetes, increasing insulin resistance leads to compensatory increases in circulating insulin which prevents an increase in glucose levels. As time progresses, the insulin resistance reaches a peak and stab