糖尿病全程血糖控制Microsoft PowerPoint 演示文稿精品.pptVIP

某患者“双C”治疗前的血糖图 双C治疗前血糖 双C治疗1月后血糖 ——第64届ADA大会Banting奖得主提出  糖尿病治疗的首要目标——全面控制血糖长期达标从而减少并发症 Stratton IM et al. BMJ 2000; 321: 405–412. 糖尿病相关的死亡* 21% 微血管并发症 * 37% 12% 周围血管疾病* 43% 中风** 心肌梗塞* 14% * p0.0001 ** p=0.035 1% HbA1c  严格控制血糖，延缓并发症的发生与发展 Thanks * 2型糖尿病中有两个主要的致病机理，即两个主要的病理生理变化。其一是胰岛素效应发生抵抗，简称胰岛素抵抗，即外周组织（肌肉与脂肪）摄取葡萄糖加以利用，产能或贮藏的过程发生障碍。肝脏不是外周组织，正常时胰岛素促使肝摄取葡萄糖，抑制肝输出糖，使肝输出糖减少。但胰岛素抵抗时，其对肝的效应也会减弱。胰岛素有很多的全身性不良作用，如对血管内皮的不良作用，使内皮增殖功能障碍，对脂代谢VLDL合成的作用、通过钠离子重吸收增高血氨等作用。但这些方面的作用在胰岛素抵抗时，并未减轻，所以，胰岛素抵抗的发生对糖代谢、脂代谢有明显不利影响，而且随之发生的高胰岛素血症的不利影响依然存在。胰岛素抵抗的病因有遗传因素、环境因素如代谢障碍、激素紊乱、药物、急慢性应激状态。 * Diagnosis of type 2 diabetes may occur years after its onset and, by the time of diagnosis, serious complications have often already developed.1 In addition, on average 50% of pancreatic β-cell function has already been lost by the time of diagnosis.2 Despite the need for intensive management strategies to delay further progression of the disease and to reduce loss of glycemic control, studies have shown that the majority of patients do not achieve HbA1c goals.3,4 Only approximately 25% of patients in the UKPDS treated with monotherapy achieved their glycemic goals after 9 years and required polypharmacy.5 1UKPDS Group. Diabetologia 1991; 34:877–890.2Holman RR. Diabetes Res Clin Prac 1998; 40 (Suppl.):S21–S25. 3Saydah SH, et al. JAMA 2004; 291:335–342.4Liebl A, et al. Diabetologia 2002; 45:S23–S28.5Turner RC, et al. JAMA 1999; 281:2005–2012. * The ideal treatment for Type 2 diabetes would have the characteristics shown in the slide. It would target a fundamental cause of Type 2 diabetes – insulin resistance. It would have the potential to slow deterioration of beta-cell function. It would reduce the risk of diabetes-related complications through lasting glycaemic control and reduction of the metabolic consequences of insulin resistance. It would be acceptable to the patient in terms of side effects and treatment regimen. It would have a low potential for drug interaction