糖尿病的诊断与治疗方案概述.pptVIP

* * 在诊断标准方面，新《指南》暂未把HbA1c作为糖尿病诊断的首选标准，而是延用以往的WHO 1999年点血糖的诊断标准（参照幻灯片内容介绍）。 * * 糖尿病治疗的近期目标是控制糖尿病，防止出现急性代谢并发症，远期目标是通过良好的代谢控制达到预防慢性并发症，提高糖尿病患者的生活质量和延长寿命 每位糖尿病患者一旦诊断就必须接受糖尿病教育，可以是糖尿病教育课堂、小组式教育或个体化的饮食和运动指导 * * * 这是2008年在上海的糖尿病新动态编委会上，与会专家提出的REACH优化血糖管理策略。详细说来，R为Risk factors management 即危险因素综合管理贯穿糖尿病防治始终；E为Early intervention 即糖尿病防治早期，把握最佳血糖干预时机；A为All/sides glucose control 即糖尿病治疗过程中，关注血糖全面控制；C为Combination rationality，即糖尿病治疗晚期，合理配伍，避免不良反应增加；H为Hypoglycemia prevention，即控制高血糖的同时，时刻避免低血糖的发生。 * * 全面血糖管理是REACH策略的重要内容，是指血糖管理不应仅仅关注HbA1c，还要同时关注空腹、餐后、血糖波动各项指标。在下面的幻灯片中我们将分别从HbA1c、餐后、空腹、血糖波动几个角度了解血糖指标与并发症、终点事件的关系。 * * * 在这项研究中，将130例2型糖尿病患者按HbA1C水平分成5组，用24小时动态血糖监测观察其血糖谱的不同。发现在糖化水平较低的时候，患者首先表现为餐后血糖升高，随着糖化水平的升高，黎明时期血糖逐渐升高；最后，变成持续性高血糖，即夜间空腹血糖也升高。 OBJECTIVE: The aim of the study was to determine whether the loss of fasting and postprandial glycemic control occurs in parallel or sequentially in the evolution of type 2 diabetes. RESEARCH DESIGN AND METHODS: In 130 type 2 diabetic patients, 24-h glucose profiles were obtained using a continuous glucose monitoring system. The individuals with type 2 diabetes were divided into five groups according to A1C levels: 1 (6.5%, n = 30), 2 (6.5-6.9%, n = 17), 3 (7-7.9%, n = 32), 4 (8-8.9%, n = 25), and 5 ( or =9%, n = 26). The glucose profiles between the groups were compared. The overall glucose concentrations for the diurnal, nocturnal, and morning periods, which represent the postprandial, fasting, and the dawn phenomenon states, respectively, were also compared. RESULTS: Glucose concentrations increased steadily from group 1 to 5 in a stepwise manner. The initial differences in mean glucose concentrations reaching statistical significance occurred 1) between groups 1 and 2 (6.4 vs. 7.7 mmol/l, P = 0.0004) for daytime postprandial periods, followed by differences; 2) between groups 2 and 3 (7.5 vs. 9.3 mmol/l, P = 0.0003) for the morning periods (dawn phenomenon); and finally 3) between groups 3 and 4 (6.3 vs. 8.4 mmol/l, P 0.0001) for nocturna