餐后高血糖和心血管危险因素

HbA1c
10
DCCT
9
8
7
6
5 0 1 2 3 4 5 6 7 8 9 10
Time from randomization (years)
UKPDS 9
8
7
6 0
0 3 6 9 12 15
Time from randomization (years)
HbA1c (%)
12 11 10
9 8 7 6 5
World total
CVD drives the economic burden of type 2 diabetes
Inpatient Outpatient Pharmacy
10
$10,172
Cost in 1999 (x1,000 US$)
8
21.1%
6
4
$2,562
20.0%
2
48.1%
0
n=5,050
CVD: cardiovascular disease Nichols GA, Brown JB. Diabetes Care 2002;2Leabharlann Baidu:482–6. Copyright ©2002 American Diabetes Association; reprinted with permission from The American Diabetes Association.
Pathophysiology of type 2 diabetes
Impaired glucose tolerance
Hyperglycemia
Insulin sensitivity Insulin secretion Plasma glucose
Janka HU. Fortschr Med 1992;110:637–41.
The increasing global burden of diabetes
2000 2025 8
Prevalence (%)
6
4
2
0
Developed countries
Developing countries
Population aged >20 years King H, et al. Diabetes Care 1998;21:1414–31.
31.9%
$4,402 28.6% 40.3% 31.2%
$6,396 17.2% 31.8%
51.0%
28.0% 50.9%
No CVD, No CVD,
CVD,
CVD and
no diabetes diabetes no diabetes diabetes
n=13,286
n=11,130
n=2,894
FPG and 2h-PG values identify different people with diabetes
FPG 40%
Both FPG and
2h-PG 28%
2h-PG 32%
Younger, more obese
people
Older, leaner people
2h-PG: 2-hour postchallenge plasma glucose, FPG: fasting plasma glucose DECODE Study Group. BMJ 1998;317:371–5.
Fasting/2 hour plasma glucose (mg/dl)
0
Kumamoto Study
12 24 36 48 60 72 Months
Conventional therapy Intensive therapy
Median HbA1c (%)
HbA1C =
FPG +PPG
FPG = fasting plasma glucose; PPG = postprandial plasma glucose.
(mmol/L)
Diabetes FPG or 2h-PG*
>7.0 >11.1
IGT FPG (if measured) and 2h-PG*
<7.0 >7.8 and <11.1
IFG FPG and 2h-PG* (if measured)
>6.1 and <7.0 <7.8
*Determined post 75g glucose load 2h-PG: 2-hour postchallenge plasma glucose, FPG: fasting plasma glucose, IFG: impaired fasting glucose, IGT: impaired glucose tolerance World Health Organization, 1999.
The Relative Contribution of FPG and Mealtime Glucose Spikes to 24hour Glycemic Level
300
Plasma glucose (mg/dl)
200
100
0 0600
Mealtime glucose spikes
Fasting hyperglycemia
Normal
1200
1800 Time (hours)
2400
0600
Riddle MC. Diabetes Care 1990;13:676–686
Glycemic Control and CHD
Incidence (%) Incidence (%)
CHCDHMDOMRToArLtaITliYty
25 20 15 10
5 0
<6.0 6.1-7.9 >8 HbA1c
All CHD Events
ALL CHD EVENTS
25 20 15 10
5 0
<6.0 6.1-7.9 >8 HbA1c
Kuusisto et al, 1994
A Comparison of Hba1c Levels Achieved in the Conventional Versus Intensive Groups of Major Trials
Microvascular disease
Macrovascular disease
Diagnosing glucose intolerance – criteria reflect a need for early intervention
Diagnosis
Venous plasma glucose concentration