2型糖尿病患者严格血糖控制和心血管事 件的预防.pptVIP

2型糖尿病患者严格血糖控制和心血管事件的预防 中山大学附属第一医院内分泌科 肖 海 鹏 Challenge To have patients believe in your guidance for the management of their diabetes mellitus. Prevalence of Diabetes and Obesity Global prevalence of diabetes * 246 million people with diabetes worldwide = roughly 6% of the adult population In 2007, the five countries with the largest numbers of people with diabetes are: India, China, United States, Russia, Germany By 2025, the largest increases in diabetes prevalence will occur in low- and middle-income countries Each year an additional 7 million people worldwide develop diabetes Diabetes complications Each year 3.8 million deaths worldwide are attributable to diabetes Diabetes is associated with complications such as: Diabetic neuropathy Renal failure Blindness Macrovascular disease Macrovascular complications are a major cause of death in people with diabetes 心血管疾病在糖尿病者中的比率 新诊断的2型糖尿病患者 ～25% 总糖尿病人群 ～50% 占糖尿病死亡原因 ～65-75% 欧洲心脏调查结果 43,509 例高危人群中9,125例合并心血管疾病 OGTT 结果 GAMI:急性心梗患者中的糖代谢异常 GAMI :新诊断高血糖是心肌梗死后“无心血管事件存活”的预测因素 中国心脏调查结果-汇总（n=3513） Risk of cardiovascular disease (CVD) in relation to HbA1c– The ARIC Study ADA 2008 Anual Meeting in SanFrancisco No positive trial effect of Intensive glucose lowering on macrovascular complications in type 2 diabetes, at least in the types of patients studied Hazard Ratios for the Primary Outcome and Death from Any Cause in Prespecified Subgroups (ACCORD) Steno-2 Post Trial aim 1 To examine whether an intensified multifactorial intervention similar to current guidelines has an impact on mortality in patients with type 2 diabetes and microalbuminuria 2 To examine whether risk reductions already achieved for both macro- and microvascular disease with intensified multifactorial intervention were sustained in a clinical setting outside the structured framework of a clinical trial Implications of these findings for clinical care Treatment to A1C targets below or around 7% in the years soon