2型糖尿病全球防治指南新特点

Global Guideline for Type 2 Diabetes
P.Zimmet et al.Bulletin of the International Diabetes Federation 48:13,2003
Global Guideline for Type 2 Diabetes
A much quoted paper by Haffner et al, suggested that people with Type 2 diabetes have a CV risk equivalent to non-diabetic people with previous CVD。
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OGTT的方法:
早餐空腹取血(空腹8-14小时后），取血后于5分钟内服完溶于 250-300ml水内的无水葡萄糖75克（如用1分子结晶水葡萄糖， 则为82.5克） 试验过程中不喝任何饮料、不吸咽、不做剧烈运动，无需卧床 从口服第一口糖水时计时，于服糖后30分钟、1小时、2小时及3 小时取血（用于诊断可仅取空腹及2小时血）
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Global Guideline for Type 2 Diabetes
每年全面检测一次
Global Guideline for Type 2 Diabetes
检测原则及目的
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General principles include:
annual review of control and complications;
Global Guideline for Type 2 Diabetes
诊断标准:WHO-1999 criteria
Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications.Report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus. Geneva: WHO
2型糖尿病全球防治指南新特点
Global Guideline for Type 2 Diabetes
Global Guideline for Type 2 Diabetes
内容概括
1.背景资料 2.糖尿病危害性 3.诊断及监测 4.治疗概论 5.住院病人治疗原则
Global Guideline for Type 2 Diabetes
Where a random plasma glucose level ≥5.6 mmol/l (≥100 mg/dl) and <11.1 mmol/l (<200 mg/dl) is detected on opportunistic screening, it should be repeated fasting, or an OGTT performed.
1.背景资料
Global Guideline for Type 2 Diabetes
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1. 根据循证医学原则制定,内容参考 近5年来国际上出版的指南、meta 分析、及相关刊物。 2. 根据不同地区、不同医疗资源制 定3个等级标准。
Global Guideline for Type 2 Diabetes
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血脂控制水平
Reassess at all routine clinical contacts to review achievement of lipid targets: LDL cholesterol <2.5 mmol/l (<95 mg/dl), triglyceride <2.3 mmol/l(<200 mg/dl), HDL cholesterol >1.0 mmol/l (>39 mg/dl).
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血压控制水平
Aim to maintain blood pressure below 130/80 mmHg Accept that even 140/80 mmHg may not be achievable with 3 to 5 antihypertensive drugs in some people. Revise individual targets upwards if there is signi. cant risk of postural hypotension and falls.
Global Guideline for Type 2 Diabetes
早期诊断
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早期诊断的方法----目前全球根据各地区约有30%90%糖尿病漏诊率.
For diagnosis, an oral glucose tolerance test (OGTT) should be performed in people with a fasting plasma glucose ≥5.6 mmol/l (≥100 mg/dl) and <7.0 mmol/l (<126 mg/dl);
Global Guideline for Type 2 Diabetes
糖尿病急性并发症及大血管和微血管等慢性并 发症，致死、致残率高，一旦发生，难以逆转， 降低病人的生活质量，缩短寿命。
Global Guideline for Type 2 Diabetes
3. 诊断及监测
Global Guideline for Type 2 Diabetes
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Global Guideline for Type 2 Diabetes
控制指标水平
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血糖控制水平；
HbA1c < 6.5 % Equivalent target levels for capillary plasma glucose levels are <6.0 mmol/l(<110 mg/dl) before meals, and <8.0 mmol/l (<145 mg/dl) 1-2 h after meals.
Global Guideline for Type 2 Diabetes
自我血糖监测方法
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Self-monitoring of blood glucose (SMBG) should be available to those;
For all newly diagnosed people with Type 2 diabetes; those on insulin treatment; to provide information on hypoglycaemia; to assess glucose excursions due to medications and lifestyle changes to monitor changes during intercurrent illness.
Global Guideline for Type 2 Diabetes
临床血糖监测方法
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HbA1c performed every 2 to 6 months depending on level and stability of blood glucose control,and change in therapy. Site-of-care capillary plasma glucose monitoring at random times of day is not generally recommended.
SM, Meyer LC, Neil HAW, Ross IS, Turner RC,Holman RR. Complications in newly diagnosed type 2 diabetic patients and their association with different clinical and biochemical risk factors. UKPDS 6. Diabetes Res 1990; 13: 1-11. Harris MI, KleinOnset of NIDDM occurs at least 4-7 yr before clinical diagnosis.Diabetes Care 1992; 15: 815-19. UKPDS Group. UK Prospective Diabetes Study 30: Diabetic retinopathy at diagnosis of type 2 diabetes and associated risk factors. Arch Ophthalmol 1998; 116: 297-303.
三个等级医疗标准
Minimal Care
Standard Care
Comprehensive Care
Global Guideline for Type 2 Diabetes
2.糖尿病危害性
Global Guideline for Type 2 Diabetes
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1. 发病人数日益增长。无论是在发达国家还是在发展 中国家，均明显增加。其中90%为2型糖尿病。（见下图） 2. 发展中国家增长的速度超过了发达国家。（200%比 45%），21世纪DM 将在中国、印度等发展中国家流行 。 3. DM 的主要并发症已经成为病人致残和早亡的主要 原因，每年全球约 3 000 000 人口因糖尿病而死亡。 4. 2型糖尿病占我国糖尿病人群的90%以上，它的血管 并发症使人们丧失劳动能力,预期寿命缩短8-12年。
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SMBG can be considered in relation to: