糖尿病治疗的新共识PPT.ppt

* 在20世纪末和21世纪初，2型糖尿病的患病率显著上升，血糖控制达标可以显著降低糖尿病并发症的发病率和死亡率(1–3)，所以有效控制高血糖成为一个首要重要的问题。 高血糖是与2型糖尿病相关的代谢异常的标记，在糖尿病的治疗中有重要意义，针对其他共同存在的问题，如脂代谢紊乱、高血压、高凝状态、肥胖和胰岛素抵抗的治疗也是治疗和研究的焦点。 在1型糖尿病中，维持血糖水平在接近非糖尿病的范围内可以有效降低糖尿病并发症，包括视网膜病变、肾脏病变等，在2型糖尿病，强化治疗同样可以减少并发症(6–8)。 在1型糖尿病中强化治疗可以降低CVD并发症(9,10)，但对于2型糖尿病强化治疗对CVD的作用还需要研究(11,12)，有些针对降糖的治疗对CVD危险因素有额外的作用，有些治疗除降糖外没有额外的益处。 尽管近年来发表了很多关于2型糖尿病管理的综述(13–16)，临床医生还是没有一个明确的可以参照的方法。 这篇共识的产生即是为指导和帮助健康工作者为他们的在非妊娠2型糖尿病患者，选择最适当的管理高血糖的措施。 Conclusions/summary： DIABETES CARE.2006; 29(8):1969－1970 Type 2 diabetes is epidemic. Its long-term consequences translate into enormous human suffering and economic costs. We now understand that much of the morbidity associated with long-term complications can be substantially reduced with interventions that achieve glucose levels close to the nondiabetic range. Although new classes of medications, and numerous combinations, have been demonstrated to lower glycemia, current-day management has failed to achieve and maintain the glycemic levels most likely to provide optimal health care status for people with diabetes. * 这里提供了充足的信息供临床医生参考选择不同的治疗，推荐了选择的顺序以及如何联合治疗。 * * 欧盟的IDF最新的建议的HbA1C＜ 6.5% 对于伴随2型糖尿病的除高血糖外的其他异常，如高血压、脂代谢紊乱的管理，也已经证明可以改善微血管和大血管并发症，对于这些血糖外的危险因素的治疗指南以及建议也已经出版(1,21,22)。 The most recent glycemic goal set by the European Union– International Diabetes Federation is an A1C level 6.5%. The upper limit of the nondiabetic range is 6.1% (mean A1C of 5%2 SD) with the DCCT-standardized assay, which has been promulgated through the National Glycohemoglobin Standardization Program (NGSP) and adopted by the vast majority of commercially available assays (20). Readers are referred to published guidelines for a discussion of the rationale and goals of therapy for the nonglycemic risk factors, as well as recommendations as to how to achieve them (1,21,22). * * The most recent glycemic goal recommended by the American Diabetes Association, selected on the basis of practicality and the projected reduction in compl