糖尿病治疗中的餐后血糖控制-(NXPowerLite).pptVIP

确定血糖达标的关键理念 A1C的重要意义 A1C的局限性 结论: Conclusions: Conclusion: Conclusions: Conclusions: Conclusions: 急性血糖升高加重糖尿病并发症的可能机制 Donahue, et al., Diabetes, 1987; 36:689. 40-114 mg/dL 115-133 mg/dL 134-156 mg/dL 157-189 mg/dL 190-532 mg/dL Casual 1-hr Serum Glucose 0 10 20 30 40 50 60 Fatal CHD Fatal CHD + Non-Fatal MI Rates per 1000 p0.01 p0.001 (p-values compare 5th quintile with 1st quintile) Honolulu Heart Program: Risk of Fatal CHD Nonfatal MI Increases With Increasing Post-Challenge Glucose Levels 发生致死性冠心病或致死性冠心病+非致死性心梗的风险随糖负荷后1小时血糖水平的升高而持续增加 最高血糖组CHD发生率是最低血糖组的3倍 糖负荷后1小时血糖水平是CHD发生的独立而持续的风险因素 Donahue, et al., Diabetes, 1987; 36:689. Chicago Heart Study Study Design Lowe, et al., Diabetes Care, 1997; 20:163. Lowe, et al., Diabetes Care, 1997; 20:163. Chicago Heart Study: Risk of CVD and All-Cause Mortality Increases With Increasing Blood Glucose Values (Post-Glucose Challenge or Diagnosed Diabetes) Asymptomatic Hyperglycemia Diabetes 0 20 40 60 80 100 120 140 160 Blacks Whites Blacks Whites Rate/patient year CV Mortality All-Cause Mortality 无论白种或黑种中年男性,无症状性高血糖和临床糖尿病者死亡风险均显著增加(RR1.24, RR1.88) 死亡风险的增加与高血糖的程度密切相关 提示控制血糖对降低糖尿病死亡风险非常重要 Lowe, et al., Diabetes Care, 1997; 20:163. 糖尿病及其并发症的流行病学特征 A1C在糖尿病治疗达标中的意义 餐后血糖与糖尿病大血管病变 餐后血糖与糖尿病微血管病变 餐后血糖参与并发症发生的机制 微血管并发症: Kumamoto Study Gestational Diabetes Pima Indians Egyptians NHANES III 餐后高血糖与并发症相关的证据 The Kumamoto Study: Postprandial Blood Glucose and Microvascular Complications Prospective, randomized, 6-year parallel group study 110 Japanese patients with type 2 diabetes without retinopathy or nephropathy at baseline, or with simple retinopathy and urinary albumin excretion 300 mg/24 h Patients randomized to Conventional insulin injection treatment: 1 or 2 daily injections of intermediate-acting insulin Multiple insulin injection treatment: short-acting insulin at meals, intermediate-acting insulin at bedtime Ohkubo Y et al. Diabetes Res Clin Pract 1995;28:103-117. Study Design Kumamoto Study: Complications Oh