优化血糖新课件.pptVIP

* * * * * * * * IDF 2006 Meet the Expert 2002年的一项研究证实在糖尿病诊断之前心血管疾病发生风险就已经明显增加，也进一步证实在糖尿病前期大血管病变就已经存在 OBJECTIVE—To examine whether the risk of cardiovascular disease (CVD) is elevated before clinical diagnosis of type 2 diabetes in women. RESEARCH DESIGN AND METHODS—A total of 117,629 female nurses aged 30–55 years who were free of diagnosed CVD at baseline were recruited in 1976 and followed for 20 years. RESULTS—A total of 1,508 women had diagnosed type 2 diabetes at baseline in 1976. During 20 years of follow-up, 110,227 women remained free of diabetes diagnosis and 5,894 women developed type 2 diabetes. During 2.2 million person-years of follow-up, we documented 1,556 new cases of myocardial infarction (MI), 1,405 strokes, 815 fatal coronary heart disease (CHD), and 300 fatal strokes. Among women who developed type 2 diabetes during follow-up, the age-adjusted RRs of MI were 3.75 (95% CI 3.10–4.53) for the period before the diagnosis and 4.57 (3.87–5.39) for the period after the diagnosis, compared with women who remained free of diabetes diagnosis. The multivariate RRs further adjusting for BMI, smoking, and other cardiovascular risk factors were 3.17 (2.61–3.85) and 3.97 (3.35–4.71). The risk of stroke was also significantly elevated before diagnosis of diabetes (multivariate RR = 2.30 [1.76–2.99]). Further adjustment for history of hypertension or hypercholesterolemia did not appreciably alter the results. CONCLUSIONS—Our data indicate a substantially elevated risk of CVD before clinical diagnosis of type 2 diabetes in women. These findings suggest that aggressive management of cardiovascular risk factors is warranted in individuals at increased risk for diabetes. * * 本研究是一项多中心(包括加拿大、德国、奥地利、丹麦、瑞典等9个国家)、双盲、安慰剂对照、随机的前瞻性研究。研究者从高危人群，尤其是2型糖尿病患者的一级亲属中筛查入选患者。筛查14742例人群(年龄40～70岁，体重指数25～40kg／m2)；1429例患者入选：75g葡萄糖负荷后2小时血糖≥7．8mmol／L，但11．1mmol／L；空腹血糖5．5～7．7mmol／L。合格的患者随机分入安慰剂组或阿卡波糖组。阿卡波糖的服用：为使胃肠道副作用降低到最低程度，以每天50mg为起始量(进餐第一口时服下)，逐渐增加到每日三次，每次100mg。入选时。研究者指导所有入选者降低体重或维持