2型糖尿病防治的新理念.pptVIP

2型糖尿病防治的新理念 Diabetes: a disease with serious clinical outcomes Diabetes is a heterogeneous metabolic disease characterized with persistent elevated blood glucose which results in increased risks of getting complications Type 2 Diabetes Macrovascular disease in Type 2 diabetes Microvascular disease at diagnosis of diabetes eyes –retinopathy kidneys –nephropathy nerves –neuropathy blood vessels or arteries - heart attacks and strokes. Type 2 Diabetes: A Complex Metabolic Disorder Dyslipidaemia Impaired insulin secretion Macrovascular complications Central obesity Insulin resistance Microvascular complications Hypertension Type 2 diabetes Insulin Resistance syndrome Insulin resistant and low insulin secretion (54%) Insulin resistant; good insulin secretion (28.7%) Neither (1.5%) Low insulin secretion; insulin sensitive (15.9%) (n = 195) Haffner SM, et al. Circulation 2000; 101:975–980. Distribution by metabolic status among converters to type 2 diabetes 2–3 x increased risk of fatal stroke3* 1. Wingard DL et al. Diabetes Care 1993; 16: 1022-25. 2. UKPDS 6. Diabetes Res 1990; 13: 1–11. 3. Balkau B et al. Lancet 1997; 350: 1680. 4. King’s Fund. Counting the Cost. BDA, 1996. 5. Most RS, Sinnock P. Diabetes Care 1983. 6: 67-91. 2–4 x increased risk of fatal heart disease3* Hypertension2 15 x increased risk of amputation4,5 7% 18% 35% 4.5% Prevalence Cerebrovascular disease1 Abnormal ECG2 Intermittent claudication1 *compared with general population 1. UKPDS 6. Diabetes Res 1990; 13: 1–11. 2. The Hypertension in Diabetes Group. J Hypertens 1993; 11: 309–17. Retinopathy1 21% Nephropathy2 18.1% Erectile dysfunction1 20% Absent foot pulses1 13% Ischaemic skin changes (foot)1 6% Abnormal vibration threshold (foot)1 7% Type 2 diabetes is associated with increased risks of stroke, myocardial infarction, hypertension and intermittent claudication.1,2,3 7% of people with Type 2 diabetes have had a stroke at time of diagnosis and, indeed, stroke is the sec