新版中国2型DM防治指南特点解读终极版.pptVIP

* 1989年，来自不同医疗领域的专家共同制定了欧洲第一部国际性糖尿病治疗指南，该指南尽量采用类似于共识的工作方式以消除个别专家的偏见对治疗建议的影响。随后，在指南的发展过程中，又引入了“循证证据”这一概念，即对现有文献进行系统回顾，在对现有证据进行谨慎和正确的分析后，为临床提供治疗建议。 * 国内贾伟平教授的流行病学调查也发现，新诊断2型糖尿病患者中，以餐后血糖升高多于空腹血糖生高 * 在这项研究中，将130例2型糖尿病患者按HbA1C水平分成5组，用24小时动态血糖监测观察其血糖谱的不同。发现在糖化水平较低的时候，患者首先表现为餐后血糖升高，随着糖化水平的升高，黎明时期血糖逐渐升高；最后，变成持续性高血糖，即夜间空腹血糖也升高。 OBJECTIVE: The aim of the study was to determine whether the loss of fasting and postprandial glycemic control occurs in parallel or sequentially in the evolution of type 2 diabetes. RESEARCH DESIGN AND METHODS: In 130 type 2 diabetic patients, 24-h glucose profiles were obtained using a continuous glucose monitoring system. The individuals with type 2 diabetes were divided into five groups according to A1C levels: 1 (6.5%, n = 30), 2 (6.5-6.9%, n = 17), 3 (7-7.9%, n = 32), 4 (8-8.9%, n = 25), and 5 ( or =9%, n = 26). The glucose profiles between the groups were compared. The overall glucose concentrations for the diurnal, nocturnal, and morning periods, which represent the postprandial, fasting, and the dawn phenomenon states, respectively, were also compared. RESULTS: Glucose concentrations increased steadily from group 1 to 5 in a stepwise manner. The initial differences in mean glucose concentrations reaching statistical significance occurred 1) between groups 1 and 2 (6.4 vs. 7.7 mmol/l, P = 0.0004) for daytime postprandial periods, followed by differences; 2) between groups 2 and 3 (7.5 vs. 9.3 mmol/l, P = 0.0003) for the morning periods (dawn phenomenon); and finally 3) between groups 3 and 4 (6.3 vs. 8.4 mmol/l, P 0.0001) for nocturnal fasting periods. CONCLUSIONS: The deterioration of glucose homeostasis in individuals with type 2 diabetes progressed from postprandial to fasting hyperglycemia following a three-step process. The first step related to the three diurnal postmeal periods considered as a whole, the second step occurred during the morning period, and the third and final step corresponded to sustained hyperglycemia over the noc