糖尿病基础培训ppt课件.ppt

Recent UKPDS data demonstrate a direct relationship between HbA1c levels and risks of complications over the entire range of glycosylated hemoglobin values. There is a constant relative risk gradient in which any reductions in HbA1c are accompanied by meaningful reductions in risk as the HbA1c is reduced toward the normal range. In this study, a 1% reduction in HbA1c was correlated with a 21% reduction in the risk of any complication. Notably, there was no threshold — short of normoglycemia — below which there was no risk of the development or progression of retinopathy, microalbuminuria, and neuropathy. Stratton IM, Adler AI, Neil HAW, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405-412. 6 6 采用连续血糖监测方法检测血糖波动情况。大家可以看到，在连续的2天里，即使每天给予相应的药物治疗血糖波动，仍很显著，没有得到良好的控制。既有低血糖的发生（蓝线以下），也有高血糖的发生（红线以上） 1971年上市。第二代SU 85 临床使用50年 糖尿病病人肾功能减退者可发生药物蓄积 有大规模多中心试验表明其干扰维生素B12的吸收，可以使血清同型半胱氨酸水平升高，成为心血管疾病的危险因子之一。 当发生低血糖时只能口服或静脉输入葡萄糖，口服其他糖类或淀粉无效 价格昂贵！你可能会问，当你通过少吃一些和节省金钱这两种途径都能减少葡萄糖的吸收时，为什么还要为达到这一目的而花钱呢？ One theoretical concern associated with insulin secretagogue therapy is the potential for beta-cell burnout. UKPDS 16 was reported after 6 years of follow-up and showed that intensive therapy was more effective in maintaining FPG and HbA1c levels than conventional therapy. However, the FPG increased progressively with all therapies (P0.0001) and beta-cell function declined regardless of treatment choice. A decline in insulin sensitivity was not observed. Overall, oral sulfonylurea therapy resulted in an initial improvement in beta-cell function. The subsequent decline in beta-cell function with diabetes disease progression was the same for all therapies: metformin, diet, or sulfonylureas. Sulfonylurea (chlorpropamide and glyburide) therapy did not accelerate the decline in beta-cell function. Notably, beta-cell function was already decreased by approximately 50% at the time of d