餐后高血糖和心血管危险因素.ppt

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1、Post Prandial Hyperglycemia:A Significant Cardiovascular Risk Factor&Treatable Precedent of Type 2 Diabetes,Diagnostic Criteria for Type 2 DM Pathophysiology of type 2 DMPost Prandial Hyperglycemia(PPH)and diabetic complicationsPrevention of Type 2 DM,The increasing global burden of diabetes,CVD dri

2、ves the economic burden of type 2 diabetes,Pathophysiology of type 2 diabetes,Diagnosing glucose intolerance criteria reflect a need for early intervention,*Determined post 75g glucose load2h-PG:2-hour postchallenge plasma glucose,FPG:fasting plasma glucose,IFG:impaired fasting glucose,IGT:impaired

3、glucose tolerance World Health Organization,1999.,FPG and 2h-PG values identify different people with diabetes,The Relative Contribution of FPG and Mealtime Glucose Spikes to 24-hour Glycemic Level,Riddle MC.Diabetes Care 1990;13:676686,3002001000,Plasma glucose(mg/dl),06001200180024000600,Time(hour

4、s),MealtimeglucosespikesFastinghyperglycemiaNormal,Kuusisto et al,1994,Glycemic Control and CHD,CHD Mortality,All CHD Events,A Comparison of Hba1c Levels Achieved in the Conventional Versus Intensive Groups of Major Trials,1098765,012345678910,Time from randomization(years),HbA1c,DCCT,Kumamoto Study

5、,9876,0,03691215,Median HbA1c(%),Time from randomization(years),UKPDS,Conventional therapyIntensive therapy,12111098765,0122436486072,Months,HbA1c(%),FPG=fasting plasma glucose;PPG=postprandial plasma glucose.,HbA1C,PPG,FPG,+,=,HbA1c(%),Fasting/2 hour plasma glucose(mg/dl),Harris MI et al Diabetes C

6、are,1998,Hba1c,Fasting and 2hr Plasma Glucose,UKPDS 10 yr-Cohort Data:Dissociation Between FPG&HbA1C,Del Prato S.2001,Duration of Daily Metabolic Conditions,Postabsorptive,Fasting,Monnier L,Europ J Clin Invest,2000,Intensive Treatment Policies,DCCT,Kumamoto,Study,UKPDS,Fasting plasma,glucose(mmol/l)

7、,3.9,6.7,7.8,6,2,-,hr pp glucose,(mmol/l),10,11,Not defined,The Funagata Cohort Population,*,*,*,*,*,*,*,*,*,*,Tominaga M et al.Diabetes Care,1999,NGT-IFG-DM,The Funagata Cohort Population,*,*,*,*,*,*,*,*,*,*,Tominaga M et al.Diabetes Care,1999,*,*,*,*,*,NGT-IGT-DM,Summary,1.Type 2 DM begins as a po

8、stprandial disease2.Postprandial hyperglycemia contributes to elevations in HbA1c and complications3.Treatment of postprandial hyperglycemia is critical to achieving optimal outcomes in type 2 DM4.Nevertheless,treatment of postprandial hyperglycemia is inadequately addressed,STOP-NIDDMStudy to Preve

9、nt Non-insulin Dependent Diabetes Mellitus,STOPNIDDM,Study design,STOPNIDDM,Acarbose reduces the risk of developing diabetes,STOPNIDDM,Acarbose has a rapid and sustained effect on diabetes risk,STOPNIDDM,Efficacy of acarbose is unaffected by baseline BMI or age,STOPNIDDM,Acarbose increases the rever

10、sion of IGT to NGT,STOPNIDDM,Acarbose an exceptional safety profile,STOPNIDDM,Acarbose reduces the risk of cardiovascular disease,STOPNIDDM,Reducing postprandial hyperglycaemia decreases the risk of diabetes and CVD,STOPNIDDM,Chinese studies support the efficacy of acarbose in patients with IGT,An emerging algorithm to manage IGT,Conclusions,