培训课件-糖尿病诊断与分型.ppt

* * 以芬兰人群为基础的研究表明，2432名2型糖尿病、没有心梗病史的病人心肌梗死的风险比非2型糖尿病、有心梗病人还高。 本研究结果表明应该强有力的控制2型糖尿病病人的心血管危险因素。 Haffner SM, et al. New Engl J Med 1998; 339:229–234. * * Balkau et al.1 分析Whitehall男性人群 、Helsinki警察人群中年龄在44-55岁之间的男性20年的死亡率,2 Helsinki研究中75%死与心血管疾病，而在Whitehall 56%、法国31%死于心血管疾病 1. Balkau B, et al. Lancet 1997; 350:1680. 2. Reid DD, et al. Lancet 1974; i:469–473. 3. Ducitemière P, et al. Diabetologia 1980; 19:205–210. 4. Pyorala K. Diabetes Care 1979; 2:131–141. * * 2型糖尿病带来了沉重的社会负担： 2型糖尿病是导致心血管疾病、脑血管疾病、截肢、肾功能不全等疾病的主要病因之一 糖尿病患者常伴有脂代谢异常、高血压、肥胖等心血管病危险因子 50-75% 的患者死于冠心病 心血管并发症的治疗成本占2型糖尿所有并发症治疗成本的52% （中国糖尿病药物经济学研究最新结果） 医疗保健系统巨大的经济负担 迫切需要新的策略针对疾病管理及预防 * * UKPDS研究结果表明：心梗和2型糖尿病临床并发症的发生率与血糖显著相关。 研究人群包括4,585 参加UKPDS研究的患者，不管是随机接受或未接受治疗。在这些患者中，有 3,642名患者包含在相对危险度分析中，用以明确长期暴露在高血糖环境同大血管或微血管并发症危险性的相关性。 与糖尿病相关的任一终点事件发生率随校正后HbA1c平均水平的升高而增加。 随着血糖的升高，微血管终点事件发生率的增加明显高于心梗发生率的增加。因此，在HbA1c接近正常水平时，心梗的危险度是微血管终点的2-3倍，但到了最高级别的HbA1c 浓度时，微血管并发症的危险度比心梗的危险度高。 Stratton IM, et al. Br Med J 2000; 321:405–412. * * In the UKPDS, a 1% decrease in HbA1c was estimated to correspond with significant reductions in any diabetes-related endpoint, diabetes-related death, all-cause mortality, myocardial infarction, stroke, peripheral vascular disease, microvascular disease and cataract extraction. UKPDS 35 was a prospective observational study to determine the relationship between exposure to hyperglycaemia over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes who were participants in the UKPDS. 3,642 white, Asian Indian and Afro-Caribbean UKPDS patients who had HbA1c measured 3 months after their diabetes diagnosis and with complete data for potential confounders were included in the sub-analysis of relative risk. Reductions in the risk of microvascular and macrovascular complications that might be achieved by lowering HbA1c by 1% were estimated. The incidence of clinical complications was found to be significantly associated with hyperglycaemia. While any re