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1、控制餐后高血糖的意義以及NovoMix30的特點解放軍總醫(yī)院內(nèi)分泌科母義明糖尿病的臨床后果DiabetesTheleadingcauseofnewcasesofendstagerenaldisease(40%)A2-to4-foldincreaseincardio-vascularmortalityTheleadingcauseofnewcasesofblindnessinworking-agedadults(30%)TheleadingcauseofnontraumaticlowerextremityamputationsMec
2、hanismofMacrovascularDiseaseinIRMCP-1ICAM-1VCAM-1InsulinResistanceDyslipidemiaHypertensionHyperglycemiaActivationofDAGandPKCNF-kBactivation?僅僅1/3糖尿病患者HbA1c達標010203040506070ProportionofpatientsachievingHbA1c<7.0%010203040506070ProportionofpatientsachievingHbA1c<6.5%<7.
3、0%?7.0%<6.5%?6.5%NHANES1999–2000(US)1CODE-2(Europe)21SaydahSHetal.JAMA2004;291:335-3422LieblA.Diabetologia2002;45:S23–S2836%64%31%69%NHANES—美國全國健康和營養(yǎng)狀況調(diào)查CODE-2—歐洲糖尿病花費調(diào)查-2DM患者HbA1c達標率并沒有改善SaydahSHetal.JAMA2004;291:335-342*Patientsachievinggoalsfor HbA1c,bloodpressurea
4、ndtotalcholesterolPatientsachievinggoalsforHbA1cbloodpressureandtotalcholesterolinNHANESIII(1988–1994)versusNHANES(1999–2000)5%34%29%44%7%48%36%37%0102030405060Patientsachievinggoals(%)NHANESIII(1988–1994)NHANES(1999–2000)HbA1c<7.0%BP<130/80mmHgTotalcholesterol<200mg/
5、dlGoodcontrol*???NHANES—美國全國健康和營養(yǎng)狀況調(diào)查為什么血糖達標率那么低？PatientsachievingtreatmentgoalsintheSteno-2StudyHbA1c<6.5%Cholesterol<175mg/dlTriglycerides<150mg/dlSystolicBP<130mmHgDiastolicBP<80mmHgMeanfollow-up=7.8years15%3%72%22%58%46%46%19%72%60%GaedeMD,etal.NewEnglJMed2003;348
6、:383–393???阻礙達標的因素：飲食/運動療法失敗藥物缺乏期望的功效保守的治療方式病人的依從性差7698HbA1c(%)10OAD單藥治療飲食控制OAD聯(lián)合治療OAD加用基礎(chǔ)胰島素OAD單藥逐漸加大劑量糖尿病發(fā)病時間OAD加大劑量的胰島素/天保守治療方式:傳統(tǒng)的階梯式給藥OAD+基礎(chǔ)胰島素注射OAD+胰島素每日多次注射飲食控制OAD單一治療OAD聯(lián)合治療OADs逐漸加大劑量糖尿病發(fā)病時間7698HbA1c(%)10積極方式:早期聯(lián)合用藥的治療方式DCCTResearchGroup.NEnglJMed.1993;329:977
7、-986.OhkuboY,etal.DiabetesResClinPract.1995;28:103-117.UKPDS33:Lancet1998;352,837-853.StrattonIMetal.BMJ.2000;321:405-412.嚴格血糖控制降低糖尿病并發(fā)癥的風(fēng)險A1cRetinopathyNephropathyNeuropathyCVdiseaseType1DCCT19?7%63%54%60%41%*Type2Kumamoto29?7%69%70%-52%*Type2UKPDS38?7%17-21%24-33%-1
8、6%*?*Notstatisticallysignificantduetosmallnumberofevents.?Showedstatisticalsignificanceinsubsequentepidemiologicanalysis4餐后血
