餐后高血糖和心血管危险因素参考课件
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Post Prandial Hyperglycemia: A Significant Cardiovascular Risk Factor & Treatable Precedent of
Type 2 Diabetes
Diagnostic Criteria for Type 2 DM Pathophysiology of type 2 DM Post Prandial Hyperglycemia (PPH) and diabetic complications Prevention of Type 2 DM
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 00 3 6 9 12 Nhomakorabea5Time from randomization (years)
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
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
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.
Normal
1200
1800 Time (hours)
2400
0600
Riddle MC. Diabetes Care 1990;13:676–686
Glycemic Control and CHD
Incidence (%) Incidence (%)
CHCDHMDOMRToArLtaITliYty
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
Microvascular disease
Macrovascular disease
Diagnosing glucose intolerance – criteria reflect a need for early intervention
Diagnosis
Venous plasma glucose concentration
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.
Pathophysiology of type 2 diabetes
Impaired glucose tolerance
Hyperglycemia
Insulin sensitivity Insulin secretion Plasma glucose
Janka HU. Fortschr Med 1992;110:637–41.
(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.
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;25:482–6. Copyright ©2002 American Diabetes Association; reprinted with permission from The American Diabetes Association.
Type 2 Diabetes
Diagnostic Criteria for Type 2 DM Pathophysiology of type 2 DM Post Prandial Hyperglycemia (PPH) and diabetic complications Prevention of Type 2 DM
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 00 3 6 9 12 Nhomakorabea5Time from randomization (years)
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
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
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.
Normal
1200
1800 Time (hours)
2400
0600
Riddle MC. Diabetes Care 1990;13:676–686
Glycemic Control and CHD
Incidence (%) Incidence (%)
CHCDHMDOMRToArLtaITliYty
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
Microvascular disease
Macrovascular disease
Diagnosing glucose intolerance – criteria reflect a need for early intervention
Diagnosis
Venous plasma glucose concentration
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.
Pathophysiology of type 2 diabetes
Impaired glucose tolerance
Hyperglycemia
Insulin sensitivity Insulin secretion Plasma glucose
Janka HU. Fortschr Med 1992;110:637–41.
(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.
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;25:482–6. Copyright ©2002 American Diabetes Association; reprinted with permission from The American Diabetes Association.