餐后血糖再认识ppt课件.pptVIP

* Objective: HbA1c values reflect overall glycemic exposure over the past 2–3 months and are determined by both fasting (FPG) andpostprandial plasma glucose (PPG) levels. Cross-sectional studies suggest that attainment of HbA1c goals requires specifictargeting of postprandial hyperglycemia. Research design and methods: We undertook a prospective intervention trial to assess the relative contribution of controlling FPGand PPG for achieving recommended HbA1c goals. One hundred and sixty-four patients (90 male and 74 female) withunsatisfactory glycemic control (HbA1c 7.5%) were enrolled in an individualized forced titration intensified treatment program. Results: After 3 months HbA1c levels decreased from 8.7 0.1 to 6.5 0.1% ( p 0.001); FPG decreased from 174 4 to 117 2 mg/dl ( p 0.001); PPG decreased from 224 4 to 159 3 mg/dl ( p 0.001) and daylong hyperglycemia (average of premeal, postprandial and bedtime plasma glucose excluding FPG) decreased from 199 4 to 141 2 mg/dl ( p 0.0001). Patients’ weight remained unchanged (84.0 1.4 kg versus 82.9 1.5 kg, p = 0.36). No severe hypoglycemia occurred. Only 64% of patients achieving FPG targets of 100 mg/dl achieved an HbA1c target of 7% whereas 94% of patients achieving the postprandial target of 140 mg/dl did. Decreases in PPG accounted for nearly twice as much for the decreases in HbA1c as did decreases in FPG. PPG accounted 80% of HbA1c when HbA1c was 6.2% and only about 40% when HbA1c was above 9.0%. Conclusions: Control of fasting hyperglycemia is necessary but usually insufficient for achieving HbA1c goals 7%. Control of postprandial hyperglycemia is essential for achieving recommended HbA1c goals. 入选患者： 121名台湾非胰岛素依赖糖尿病门诊患者 按照HbA1c水平（5.7%~12.7%）不同分为5组，持续观察血糖变化情况 评价方法： 评价PPG对HbA1c的贡献： (AUC PPG/AUC 总) × 100% 评价空腹血糖（FG）或餐前血糖对 HbA1c的贡献： [(AUC 总 ? AUC PPG)/AUC 总] ×100% * * * 最近由Woerle等人发表的一项研究1显示控制空腹高血糖是必要的但是通常不足以达到HbA1c7%的目标，控制餐后高血糖对于达到推荐的HbA1c目标值是必须的。Woerle及其同事1在164例2型糖尿病HbA1c ≥7.5%的患者评价了控制空腹和餐后血糖的相对贡献率。经