2小时糖耐量试验的临床意义47.pptVIP

2小时糖耐量试验的临床意义 Finnish Academy Research Fellow 芬兰赫尔辛基大学及 国立公共卫生研究院 北大糖尿病论坛2007年 5 月12日， 北京 糖尿病诊断试验:历史回顾 什么是糖耐量异常? 1. 高于均值+2标准差可诊断糖尿病: 根据年轻 (20-30 岁) 健康人群资料, 纯统计！不考虑临床，预后及年龄 (50年代) 2h全血血糖=120mg/dl (100g糖耐量)诊断糖尿病 (血浆血糖比全血高14-16%!) 发病率高 诊断标准混乱 (血样，服糖量，时间) 直到70年代 什么是糖耐量异常? 1. 均值+2标准差 2. 血糖双峰分布,小血管病变 (眼病，肾病等): 糖尿病高发人群, 如Pima Indians (1971), Mexican-Americans, Micronesians, Polynesians Bimodal distribution of glucoseand prevalence of retinopathy and proteinuria in Pima Indians 现用诊断标准 NDDG1979: FPG=7.8 mmol/l and 75g OGTT at ?, 1, 1?, 2 hours WHO 1980: adopted the NDDG criteria, 2h glucose=11.1 mmol/l after 75g load as “金标准” WHO 1985: slightly modified the WHO 1980 criteria ADA 1997: FPG 7.8 mmol/l to 7.0 mmol/l，Not use OGTT WHO 1999: adopted the FPG 7.0 mmol/l, retained the 2h OGTT WHO/IDF 2006: no changes except for some terms 什么是糖耐量异常? 1. 均值+2标准差 2. 血糖双峰分布,小血管病变 3.大血管病变: 心脑血管及外周血管病变 Dysglycemia Normoglycemia in Acute and Stable CV Disease The DECODE Study (http://www.ktl.fi/decode/index.html) Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe Classification of individuals - the DECODE Study Discrepancy of FPG and 2hPG criteria in the DECODA study Hazards ratio for all-cause mortality in subjects without prior history of diabetes CVD mortality by fasting plasma glucose Hazard ratio for mortality by FPG categories, the DECODA Study Hazard ratio for mortality by 2hPG categories, the DECODA Study Hazard ratio (95% CI) by glucose status at baseline and at follow-up Effect of intensive glycemic control on the risk for any type of macrovascular events STOP-NIDDM Trial (1) STOP-NIDDM Trial (3) The main changes from baseline to 3 years: Acarbose Placebo Summary Diabetes diagnosed by either FPG or 2h criteria are risk factor for CVD disease, but 2h criteria identify those who are not diabetic by FPG alone IGT is over IFG with regard to the predict