2小时糖耐量试验的临床意义66课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,2小时糖耐量试验的临床意义,Finnish,Academy Research Fellow,芬兰赫尔辛基大学及 国立公共卫生研究院,北大糖尿病论坛2007年 5 月12日，北京,乔青,MD,Ph.D,2小时糖耐量试验的临床意义 乔青,糖尿病诊断试验:历史回顾,糖尿病,症状,尿糖,空腹血糖,糖耐量(1913年),Jacobsen A.,Biochem Z 51:443,1913,糖尿病诊断试验:历史回顾糖尿病症状Jacobsen A.,Normal Glucose Homeostasis,Daytime Profile(N=12,health,;Mean+95%CI),Owens D,Zinman B&Bolli G:Lancet 358,739,2001,Meal Times,80,40,0,Insulin(mU/L),08.00,13.00,16.00,19.00 h,Glucose(mmol/L),8,4,2,6,Normal Glucose Homeostasis Owe,2小时糖耐量试验的临床意义66课件,2小时糖耐量试验的临床意义66课件,Bimodal distribution of glucoseand prevalence of retinopathy and proteinuria in Pima Indians,Knowler WC etc.Diabetes Metab Rev 6:1-27,1990,Bimodal distribution of glucos,Copyright 1994 BMJ Publishing Group Ltd.,McCane,D R et al.BMJ 1994;308:1323-8,5,year cumulative incidence(top)and prevalence(bottom)of retinopathy in relation to tenths of,2hPG,FPG,and,HBa1c,Copyright 1994 BMJ Publishing,现用诊断标准,NDDG1979:FPG=7.8 mmol/l and 75g OGTT at,1,1,2 hours,WHO 1980:adopted the NDDG criteria,2h glucose=11.1 mmol/l after 75g load as“金标准”,WHO 1985:slightly modified the WHO 1980 criteria,ADA 1997:FPG 7.8 mmol/l to 7.0 mmol/l，Not use OGTT,WHO 1999:adopted the FPG 7.0 mmol/l,retained the 2h OGTT,WHO/IDF 2006:no changes except for some terms,现用诊断标准NDDG1979:FPG=7.8 mmol/,什么是糖耐量异常?,1.均值+2标准差,2.血糖双峰分布,小血管病变,3.大血管病变:,心脑血管及外周血管病变,什么是糖耐量异常?1.均值+2标准差,Dysglycemia Normoglycemia in Acute and Stable CV Disease,Consecutive pts:2107 in-pts;2854 out-pt elective CV consults in Europe(71%men;mean age 66),OGTT/old DM in 1587(75%)acute&1857(66%)elective pts before discharge or within 2 mo.,Euro Heart Survey,Bartnik,M,et al;Eur Ht J 2004;1880,NGT,IFG,IGT,Known DM,New DM,29%,35%,22%,22%,31%,30%,15%,10%,3%,3%,0,20,40,60,80,100,%,Acute,Elective,Dysglycemia Normoglycemia i,The,DECODE,Study(,http:/www.ktl.fi/decode/index.html),D,iabetes,E,pidemiology:,C,ollaborative analysis,O,f,D,iagnostic criteria in,E,urope,The DECODE Study(http:/www.k,2-hour plasma glucose(mmol/l),7.8,7.811.0,11.1,Total,6.1,6.16.9,21,968,2,020,2,562,893,316,206,24,846,3,119,7.0,276,378,489,1,143,Fasting,plasma,glucose,(mmol/l),Total,24,264,3,833,1,011,29,108,Adapted from DECODE Study Group.Br Med J 1998;317:371375,Classification of individuals-the DECODE Study,2-hour plasma glucose(mmo,Discrepancy of FPG and 2hPG criteria in the DECODA study,Diabetologia 2000;43:1470-1475,Discrepancy of FPG and 2hPG cr,30-39 40-49 50-59 60-69 70-79 80-89,Prevalence(%)of newly diagnosed DM in DECODE populations,The DECODE group,Diabetes Care 2003;26:61-69.,30-39,30-39 40-49 50-59 60-69 70-79 80-89,Prevalence(%)of IGT but not IFG increases with age in DECODE population,The DECODE group,Diabetes Care 2003;26:61-69.,30-39 40-,Hazards ratio for all-cause mortality in subjects without prior history of diabetes,Adj.for age,cohorts,sex,chol,BMI,SBP,smoking,2-hour plasma glucose(mmol/l),7.06.16.96.1,11.1,7.811.0,7.8,Fasting plasma glucose(mmol/l),2.5,2.0,1.5,1.0,0.5,0.0,Hazard ratio,Adapted from DECODE Study Group,Lancet 1999;354:617621,Hazards ratio for all-cause mo,All-cause mortality has a linear,relationship with 2-hour plasma glucose,DECODE,Diabetes Care 2003;,26,:688-696,All-cause mortality has a line,CVD mortality by 2-hour plasma glucose,Frequency,Hazard ratio,DECODE,Diabetes Care,26,:688-696,CVD mortality by 2-hour plasma,CVD mortality by fasting plasma glucose,Frequency,Hazard ratio,DECODE,Diabetes Care,26,:688-696,CVD mortality by fasting plasm,Hazard ratio for mortality by FPG categories,the DECODA Study,FPG,(mmol/l),6.1,(n=5547),6.1-6.9,(n=462),7.0,(n=297),P for trend,CVD,Model 1,Model 2,1,1,1.4(0.9-2.1),1.1(0.7-1.7),2.0(1.3-3.1),0.9(0.5-1.5),0.006,0.83,All-cause,Model 1,Model 2,1,1,1.2(0.9-1.6),0.9(0.7-1.3),1.8(1.3-2.5),0.9(0.6-1.3),0.001,0.81,Model 1:Adjusted for age,sex,cohort,BMI,sysBP,Chol and smoking,Model 2:Additional adjustment for 2hPG,DECODA Study Group,Diabetologia 2004;47:385-394,Hazard ratio for mortality by,Hazard ratio for mortality by 2hPG categories,the DECODA Study,2hPG,(mmol/l),7.8,(n=4753),7.8-11.0,(n=1106),11.1,(n=447),P for trend,CVD,Model 1,Model 2,1,1,1.3(0.9-1.9),1.3(0.9-1.9),3.2(2.2-4.7),3.4(2.1-5.4),0.001,0.001,All-cause,Model 1,Model 2,1,1,1.3(1.0-1.7),1.4(1.0-1.8),2.9(2.2-3.8),3.0(2.2-4.2),0.001,0.001,Model 1:Adjusted for age,sex,cohort,BMI,sysBP,Chol and smoking,Model 2:Additional adjustment for FPG,DECODA Study Group,Diabetologia 2004;47:385-394,Hazard ratio for mortality by,Non-diabetic,Diabetic,Follow-up,Baseline 2hPG,NGT,IGT,Non-diabetic,CHD incidence,5.3,9.7,16.1,CVD mortality,3.1,7.9,8.7,All-cause mortality,7.6,12.8,15.5,Incidence density(no./per 1000 person-years),Qiao et al.Diabetes Care 2003;26:2910-2914,Non-diabetic DiabeticFollow-up,Hazard ratio(95%CI)by glucose status at baseline and at follow-up,Follow-up,Non-diabetic,Diabetic,Baseline 2hPG,NGT,IGT,Non-diabetic,CHD incidence,1,1.5(1.0-2.3),1.8(1.0-3.2),CVD mortality,1,2.3(1.4-3.9),1.7(0.8-3.5),All-cause mortal