餐后高血糖和心血管危险因素优秀课件.ppt

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1、餐后高血糖和心血餐后高血糖和心血管危管危险因素因素第1页，本讲稿共29页The increasing global burden of diabetesPopulation aged 20 yearsKing H,et al.Diabetes Care 1998;21:141431.Developed countriesDevelopingcountriesWorldtotalPrevalence(%)0246820252000第2页，本讲稿共29页CVD drives the economic burden of type 2 diabetesCVD:cardiovascular disea

2、seNichols GA,Brown JB.Diabetes Care 2002;25:4826.Copyright 2002 American Diabetes Association;reprinted with permission from The American Diabetes Association.1086420Cost in 1999(x1,000 US$)No CVD,no diabetesn=13,286No CVD,diabetesn=11,130CVD,no diabetesn=2,894CVD anddiabetesn=5,050$2,562$4,402$6,39

3、6$10,17231.9%48.1%20.0%28.6%40.3%31.2%17.2%31.8%51.0%21.1%28.0%50.9%PharmacyOutpatientInpatient第3页，本讲稿共29页Pathophysiology of type 2 diabetesJanka HU.Fortschr Med 1992;110:63741.Macro-vasculardiseaseInsulin sensitivityInsulin secretionPlasma glucoseMicro-vasculardiseaseImpaired glucose toleranceHyper

4、glycemia第4页，本讲稿共29页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 glucose tolerance World Health Organization,1999.Diagnosis V

5、enous plasma glucose concentration (mmol/L)DiabetesFPG or 7.02h-PG*11.1IGTFPG(if measured)and 7.8 and 6.1 and 7.02h-PG*(if measured)7.8第5页，本讲稿共29页FPG and 2h-PG values identify different people with diabetes2h-PG:2-hour postchallenge plasma glucose,FPG:fasting plasma glucoseDECODE Study Group.BMJ 199

6、8;317:3715.FPG40%Both FPG and 2h-PG28%Younger,more obesepeopleOlder,leanerpeople2h-PG32%第6页，本讲稿共29页The Relative Contribution of FPG and Mealtime Glucose Spikes to 24-hour Glycemic LevelRiddle MC.Diabetes Care 1990;13:6766863002001000Plasma glucose(mg/dl)06001200180024000600Time(hours)Mealtimeglucose

7、spikesFastinghyperglycemiaNormal第7页，本讲稿共29页Kuusisto et al,1994Glycemic Control and CHDCHD MortalityAll CHD Events第8页，本讲稿共29页A Comparison of Hba1c Levels Achieved in the Conventional Versus Intensive Groups of Major Trials10987650123456789 10Time from randomization(years)HbA1cDCCTKumamoto Study987600

8、3691215Median HbA1c(%)Time from randomization(years)UKPDSConventional therapyIntensive therapy121110987650122436486072MonthsHbA1c(%)第9页，本讲稿共29页FPG=fasting plasma glucose;PPG=postprandial plasma glucose.HbA1CPPGFPG+=第10页，本讲稿共29页4.85.05.25.45.65.86.06.26.4HbA1c(%)6080100120140160180200Fasting/2 hour p

9、lasma glucose(mg/dl)Harris MI et al Diabetes Care,1998Hba1c,Fasting and 2hr Plasma Glucose第11页，本讲稿共29页UKPDS 10 yr-Cohort Data:Dissociation Between FPG&HbA1CHbAHbA1c1cFPGFPGDel Prato S.2001PPGPPG第12页，本讲稿共29页Duration of Daily Metabolic ConditionsBFLunchDinner0:00 am4:00 amBFPostprandialPostabsorptiveF

10、astingMonnier L,Europ J Clin Invest,2000第13页，本讲稿共29页Intensive Treatment Policies DCCT Kumamoto Study UKPDS Fasting plasma glucose(mmol/l)3.9 6.7 7.8 6 2-hr pp glucose(mmol/l)10 11 Not defined 第14页，本讲稿共29页The Funagata Cohort Population*Tominaga M et al.Diabetes Care,1999NGTNGT -IFGIFG -DMDMAll causes

11、 of death0.8600.8800.9000.9200.9400.9600.9801.00001234567Years第15页，本讲稿共29页The Funagata Cohort Population*Tominaga M et al.Diabetes Care,1999*NGTNGT -IGTIGT -DMDM第16页，本讲稿共29页Summary 1.Type 2 DM begins as a postprandial disease2.Postprandial hyperglycemia contributes to elevations in HbA1c and complic

12、ations3.Treatment of postprandial hyperglycemia is critical to achieving optimal outcomes in type 2 DM4.Nevertheless,treatment of postprandial hyperglycemia is inadequately addressed第17页，本讲稿共29页STOP-NIDDMStudy to Prevent Non-insulin Dependent Diabetes MellitusSTOPNIDDM第18页，本讲稿共29页Study designSTOPNID

13、DMPlacebo t.i.d.(n=715)Acarbose 100mg t.i.d.(n=714)1036612182430Months1234567891011121314VisitsPlacebon=1,4293 monthsplacebo60Close-out visitt.i.d.:three times dailyChiasson JL,et al.Lancet 2002;359:20727.第19页，本讲稿共29页Acarbose reduces the risk of developing diabetesSTOPNIDDMAcarbose reduces the incid

14、ence of type 2 diabetes in individuals with IGT Based on onepositive OGTT 25%p=0.0015Based on two consecutivepositive OGTTs36%p=0.0017IGT:impaired glucose tolerance,OGTT:oral glucose tolerance testChiasson JL,et al.Diabetologia 2002;45(Suppl.2):A104.第20页，本讲稿共29页Acarbose has a rapid and sustained eff

15、ect on diabetes riskAcarbose-associated reduction in risk of diabetes was evident after 1 year Acarbose significantly reduced the risk of diabetes at each follow-up time point The beneficial effects of acarbose persisted for the duration of the trialResults of the STOP-NIDDM show that acarbose has l

16、ong-term therapeutic efficacy in individuals with IGT IGT:impaired glucose intolerance,STOP-NIDDM:Study to Prevent Non-insulin Dependent Diabetes MellitusChiasson JL,et al,Lancet 2002;359:20727.STOPNIDDM第21页，本讲稿共29页Efficacy of acarbose is unaffected by baseline BMI or ageSTOPNIDDMBMI:body mass index

17、Chiasson JL,et al.Lancet 2002;359:20727.p 25%0.0015 21%0.0559 31%0.008423%0.038229%0.008924%0.026930%0.011500.5 1.0 1.5 2.0FavoursFavoursacarboseacarboseOverallAge(years)55 Sex Male FemaleBMI(kg/m2)30 30FavoursFavoursplaceboplaceboReduction in incidence 第22页，本讲稿共29页Acarbose increases the reversion o

18、f IGT to NGTNGTIGTDiabetesAt baselineAcarbose group(%)Placebo group(%)324228253531At end of treatment100%*No post-randomisation dataIGT:impaired glucose tolerance,NGT:normal glucose toleranceChiasson JL,et al.Lancet 2002;359:20727.STOPNIDDM第23页，本讲稿共29页Acarbose an exceptional safety profile*Events st

19、arting on the first day and up to 7 days after last day of treatmentBayer AG,data on file 2002.Adverse events 155(21.7)277 160(22.4)260experiencedBody as a whole56 (7.8)77 58 (8.1)72Cardiovascular33 (4.6)48 39 (5.5)61Endocrine4 (0.6)5 5 (0.7)5Haemic2 (0.3)2 4 (0.6)4and lymphaticMetabolic and 2 (0.3)

20、2 1 (0.1)1 nutritionalAdverse events*Acarbose(n=714)Patients Events No.(%)No.Placebo(n=715)Patients EventsNo.(%)No.STOPNIDDM第24页，本讲稿共29页Acarbose reduces the risk of cardiovascular diseaseSTOPNIDDM*Reduction in risk of developing hypertensionData were analysed using the Cox proportional hazard modelC

21、hiasson JL,et al.Diabetologia 2002;45(Suppl.2):A104.Hypertension*MyocardialinfarctionAny cardio-vascular eventp=0.0059p=0.0226p=0.032634%91%49%第25页，本讲稿共29页Reducing postprandial hyperglycaemia decreases the risk of diabetes and CVDSTOPNIDDMAcarbose treatment resulted in a lRelative risk reduction of

22、25%for the development of diabetes(p=0.0015)1lRelative risk reduction of 36%using two consecutive OGTTs(p=0.0017)1l30%increase in the incidence of normal glucose tolerance(p0.0001)2lStatistically significant reduction in the risk ofhypertensionmyocardial infarctionany cardiovascular eventCVD:cardiov

23、ascular disease,OGTT:oral glucose tolerance test1.Chiasson JL,et al.Diabetologia 2002;45(Suppl.2):A104.2.Bayer AG,data on file 2002.第26页，本讲稿共29页Chinese studies support the efficacy of acarbose in patients with IGT NGT IGT DiabetesControl27.737.434.9(n=83)Diet and exercise28.147.424.6(n=60)Metformin4

24、4.443.212.4(n=88)Acarbose71.122.9 6.0(n=88)Percentage of patientsIGT:impaired glucose tolerance,NGT:normal glucose tolerance Wenying Y,et al.Chin J Endocrinol Metab 2001;17:1316.Study group第27页，本讲稿共29页An emerging algorithm to manage IGT Development of evidence-based systems to identify those with IG

25、T at most risk of diabetesLifestyle intervention as first-line therapy for high-risk populationPharmacotherapy for those who are not able to attain stable glycaemia with lifestyle interventionPharmacotherapy following lifestyle intervention failure is supported by the International Diabetes Federati

26、on IGT:impaired glucose tolerance第28页，本讲稿共29页ConclusionsManagement of the diabetes epidemic is an urgent global priorityIGT is an appropriate target for intervention to prevent diabetesAcarbose has a proven record for safe,long-term management of postprandial hyperglycaemiaAcarbose is proven to reduce the risk of diabetesand cardiovascular diseaseSTOP-NIDDM results suggest that acarbose can reduce the burden that type 2 diabetes places on individuals and society IGT:impaired glucose tolerance,STOP-NIDDM:Study to Prevent Non-insulin Dependent Diabetes Mellitus第29页，本讲稿共29页