课件：糖尿病诊治新进展及糖尿病教育现状.ppt

* * 美国糖尿病预防计划 糖尿病预防计划是由美国NIH开展的，目前为止最大的糖尿病前期干预研究，研究目的是评价不同干预对IGT进展为2型糖尿病的影响。研究原计划随访3－6年，但常规数据监测显示研究的关键问题已经得到证实后，研究被提前终止。 受试者被随机分为3 组： a) 安慰剂加标准生活方式（每年健康教育，记录饮食、运动和吸烟等情况）； b) 二甲双胍（850 mg 每日2 次）加上标准生活方式； c) 强化生活干预组。治疗目标为体重下降 7%，低热量低脂肪饮食，每周 150 min的中等强度体力活动，24周16次的饮食、运动和行为方式等方面的指导课程，定期与研究者联系并举行小组会。 二甲双胍组和安慰剂组的比较是双盲的【强化生活干预和其他治疗方法的比较则不是双盲】。原计划有第4 组采用曲格列酮进行干预，由于担心其肝毒性，而提前中止【药物最终退市】。 The Diabetes Prevention Program (USA) The Diabetes Prevention Program, the largest intervention study in pre-diabetic subjects to date, was conducted by US National Institutes of Health and was designed to measure progression from IGT to type 2 diabetes. The intended follow-up was 3–6 years, but was terminated early as routine data monitoring revealed that the study had already answered its key research question. Subjects with IGT were randomised to receive: a) Placebo plus standard lifestyle advice (annual meeting with a healthcare professional and written material on diet, physical activity and smoking). b) Metformin (target dose 850 mg b.i.d.) plus standard lifestyle advice, or c) Intensive lifestyle intervention (weight loss target of 7%, low-calorie/low-fat diet, 150 min/week of moderate-intensity exercise, 16 lessons on diet, exercise and behaviour modification for 24 weeks, then monthly contact with case managers with occasional group support sessions). The comparison between metformin and placebo was double-blind. A troglitazone arm was terminated early when this agent was withdrawn from clinical practice due to concerns about hepatotoxicity. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403 * * DPP研究: 二甲双胍与强化生活方式比较 二甲双胍和强化生活方式干预均显著降低IGT进展为2型糖尿病的危险。强化生活方式干预降低危险的程度更为显著些。 【同安慰剂相比较，随机进行强化生活方式干预或应用二甲双胍治疗能分别使新发糖尿病的危险下降58%（P 0.001）和31%（P0.001）】 Diabetes Prevention Program: metformin vs. intensive lifestyle intervention The risk of developing type 2 diabetes was reduced signif