《冠心病合并糖尿病患者的血糖控制》课件.ppt

目的：明确对于超重的糖尿病患者，体重减轻可以带来什么获益。 研究设计和方式：我们从美国癌症协会癌症预防研究I中，入组并随访12年（1959－1972）4970名超重的糖尿病患者，年龄在40－64岁。观察心血死亡率。 结果：34％的患者体重减轻。在改善了BMI后，人口学因素，卫生状况和体育锻炼，体重减轻后，总的死亡率降低25％（RR＝0。75；95％CI 0.67-0.84）， 冠心病和糖尿病的死亡率下降28％（RR＝0.72;0.63-0.82）.体重减轻20－29磅，可以降低最多的死亡率33％。如果体重减轻70磅，死亡率则会带来轻微的升高。 结果：这项观察性研究发现，对于超重的糖尿病患者，体重适当减轻可以降低死亡率！ OBJECTIVE— To estimate the effect of intentional weight loss on mortality in overweight individuals with diabetes. RESEARCH DESIGN AND METHODS— We performed a prospective analysis with a 12-year mortality follow-up (1959–1972) of 4,970 overweight individuals with diabetes, 40–64 years of age, who were enrolled in the American Cancer Society’s Cancer Prevention Study I. Rate ratios (RRs) were calculated, comparing overall death rates, and death from cardiovascular disease (CVD) or diabetes in individuals with and without reported intentional weight loss. RESULTS— Intentional weight loss was reported by 34% of the cohort. After adjustment for initial BMI, sociodemographic factors, health status, and physical activity, intentional weight loss was associated with a 25% reduction in total mortality (RR = 0.75; 95% CI 0.67–0.84), and a 28% reduction in CVD and diabetes mortality (RR = 0.72; 0.63–0.82). Intentional weight loss of 20–29 lb was associated with the largest reductions in mortality (33%). Weight loss 70 lb was associated with small increases in mortality. CONCLUSIONS— Intentional weight loss was associated with substantial reductions in mortality in this observational study of overweight individuals with diabetes. 早期，2型糖尿病的治疗策略是一种保守的阶梯式降糖治疗，即先饮食控制和锻炼，不能获得满意的血糖控制后在饮食和运动的基础上给予单一口服降糖药治疗，若疗效不佳，则逐渐增加剂量，再不行则几种口服降糖药联合治疗，最后，加用基础胰岛素直至一天多次胰岛素注射。 * Reductions in HbA1c indicate an improvement in blood glucose control, which is associated with a reduced risk of complications. 一个观念上的更新：在糖化血红蛋白刚超过欠佳水平时，就开始加强治疗，较早使用胰岛素，不等到病情很重， 迫不得已时才开始。 2型糖尿病为何要胰岛素治疗？ 为什么现在开始治疗不再晚一点开始，是不是现在病情就很重了？ 胰岛素治疗有什么好处？我的顾虑？ 40 The early, aggressive approach to type 2 diabetes management av