课件：糖尿病的口服降糖药物治疗.ppt

* Slide 6-6 TYPE 2 DIABETES…A PROGRESSIVE DISEASE Natural History of Type 2 Diabetes The natural history of type 2 diabetes shows the progressive emergence of the disorder. Well before diagnosis, patients may have had significant hyperglycemia for years, perhaps more than a decade. Patients with type 2 diabetes have altered islet b-cell function and impaired insulin action in varying degrees. Plasma glucose may rise above normal in early adulthood, and as age-related declines in b-cell function occur—together with less physical activity and increases in adipose tissue mass—plasma glucose continues to rise. By the time diabetes is diagnosed, plasma glucose may range from 180 to 220 mg/dL. It has been estimated that only about one third of the population has acceptable glycemic control by current standards. Based on the progressive nature of diabetes, complications that may take years to develop are often already present at the time of diagnosis. Riddle MC. Tactics for type II diabetes. Endocrinol Metab Clin North Am. 1997;26:659-677; Skyler JS. Insulin therapy in type 2 diabetes mellitus. In: DeFronzo RA, ed. Current Therapies of Diabetes Mellitus. St Louis, Mo: Mosby-Year Book Inc; 1998:108-116. * 随着医学的发展，医疗知识的普及，急性并发症的发生及预后已经有明显改善，一是发生率减低，二是发生后抢救成功率较高 这时，慢性并发症却成为糖尿病治疗的一大大敌 ，糖尿病被称为“无声的杀手” 提醒患者的注意，阐明糖尿病本身而论并不可怕，可怕的是血糖控制不稳定之后出现的各种并发症，主要有以下7个方面，均会在系列篇中阐述： 1.心血管并发症（冠心病，即心绞痛心肌梗塞等，以及糖尿病性心肌病变等） 2.脑血管并发症（多件脑梗塞，老百姓所说的中风，后果严重，致残率高，严重影响生活质量） 3.周围血管病变（多为血管粥样硬化后形成闭塞性血管病变，严重可导致截肢） 4.肾脏病变(糖尿病已经成为终末期肾病的首要危险因素，在2型糖尿病患者中50％的患者存在不同程度的肾脏损害（DEMAND研究数据），因此，在血液透析、肾移植的患者中糖尿病肾病所占比例越来越大) 5.视网膜并发症（失明的主要原因） 6.周围神经并发症（包括周围遍布全身的神经系统，有运动神经、感觉神经及植物神经等，出汗异常、性功能障碍、便秘等与植物神经病变有关。） 7.足部坏疽（是周围血管病变及周围神经病变的共同作用结果，严重者截肢、感染严重时引起败血症） 8..生活质量下降、抑郁症的发生 * Improving control of HbA1C reduces the risk of diabetic complications An epidemiological analysis of the results of the UKPDS shows that the relationship between HbA1C and the risk of any diabetic complication is continuous and extends down to HbA1C values