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,餐后高血糖和心血管危险因素,餐后高血糖和心血管危险因素,The increasing global burden of diabetes,Population aged,20 yearsKing H,et al.Diabetes Care 1998;21:141431.,Developed countries,Developingcountries,Worldtotal,Prevalence(%),0,2,4,6,8,2025,2000,The increasing global burden o,CVD drives the economic burden of,type 2 diabetes,CVD:cardiovascular diseaseNichols GA,Brown JB.Diabetes Care 2002;25:4826.Copyright,2002 American Diabetes Association;reprinted with permission from The American Diabetes Association.,10,8,6,4,2,0,Cost in 1999(x1,000 US$),No CVD,no diabetes,n=13,286,No CVD,diabetes,n=11,130,CVD,no diabetes,n=2,894,CVD anddiabetes,n=5,050,$2,562,$4,402,$6,396,$10,172,31.9%,48.1%,20.0%,28.6%,40.3%,31.2%,17.2%,31.8%,51.0%,21.1%,28.0%,50.9%,Pharmacy,Outpatient,Inpatient,CVD drives the economic burden,Pathophysiology of type 2 diabetes,Janka HU.Fortschr Med 1992;110:63741.,Macro-vasculardisease,Insulin sensitivity,Insulin secretion,Plasma glucose,Micro-vasculardisease,Impaired glucose tolerance,Hyperglycemia,Pathophysiology of type 2 diab,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 Venous plasma glucose concentration (mmol/L),Diabetes,FPG,or,7.0,2h-PG*,11.1,IGT,FPG(if measured),and,7.8 and,6.1 and 7.0,2h-PG*(if measured)7.8,Diagnosing glucose intolerance,FPG and 2h-PG values identify different people with diabetes,2h-PG:2-hour postchallenge plasma glucose,FPG:fasting plasma glucoseDECODE Study Group.BMJ 1998;317:3715.,FPG40%,Both FPG and 2h-PG28%,Younger,more obesepeople,Older,leanerpeople,2h-PG32%,FPG and 2h-PG values identify,The Relative Contribution of FPG and Mealtime Glucose Spikes to 24-hour Glycemic Level,Riddle MC.Diabetes Care 1990;13:676686,300,200,100,0,Plasma glucose(mg/dl),06001200180024000600,Time(hours),Mealtimeglucosespikes,Fastinghyperglycemia,Normal,The Relative Contribution of F,Kuusisto et al,1994,Glycemic Control and CHD,CHD Mortality,All CHD Events,Kuusisto et al,1994Glycemic C,Diet and exercise28.,NGT-IGT-DM,Any cardio-vascular event,The Funagata Cohort Population,Insulin sensitivity,FPG=fasting plasma glucose;PPG=postprandial plasma glucose.,Intensive Treatment Policies,6)48 39 (5.,3)2 4 (0.,Developed countries,Fasting plasma,Diabetes Care,1999,CVD drives the economic burden of,Body as a whole56 (7.,Hyperglycemia,Harris MI et al Diabetes Care,1998,4)260experienced,A Comparison of Hba,1c,Levels Achieved in the Conventional Versus Intensive Groups of Major Trials,10,9,8,7,6,5,012345678910,Time from randomization(years),HbA,1c,DCCT,Kumamoto Study,9,8,7,6,0,03691215,Median HbA,1c,(%),Time from randomization(years),UKPDS,Conventional therapy,Intensive therapy,12,11,10,9,8,7,6,5,0122436486072,Months,HbA,1c,(%),Diet and exercise28.A Compari,FPG=fasting plasma glucose;PPG=postprandial plasma glucose.,HbA,1C,PPG,FPG,+,=,FPG=fasting plasma glucose;,4.8,5.0,5.2,5.4,5.6,5.8,6.0,6.2,6.4,HbA1c(%),60,80,100,120,140,160,180,200,Fasting/2 hour plasma glucose(mg/dl),Harris MI et al Diabetes Care,1998,Hba,1c,Fasting and 2hr Plasma Glucose,4.85.05.25.45.65.86.06.26.4HbA,UKPDS 10 yr-Cohort Data:Dissociation Between FPG&HbA,1C,HbA,1c,FPG,Del Prato S.2001,PPG,UKPDS 10 yr-Cohort Data:Disso,Duration of Daily Metabolic Conditions,BF,Lunch,Dinner,0:00 am,4:00 am,BF,Postprandial,Postabsorptive,Fasting,Monnier L,Europ J Clin Invest,2000,Duration of Daily Metabolic Co,Intensive Treatment Policies,DCCT,Kumamoto,Study,UKPDS,Fasting plasma,glucose(mmol/l),3.9,6,2,-,hr pp glucose,(mmol/l),10,11,Not defined,Intensive Treatment Policies D,Body as a whole56 (7.,Study group,Glycemic Control and CHD,Insulin sensitivity,30%increase in the incidence of normal glucose tolerance(p0.,Hyperglycemia,IGT:impaired glucose intolerance,STOP-NIDDM:Study to Prevent Non-insulin Dependent Diabetes MellitusChiasson JL,et al,Lancet 2002;359:20727.,Developed countries,Prevalence(%),30%increase in the incidence of normal glucose tolerance(p0.,Tominaga M et al.,BMI:body mass indexChiasson JL,et al.,Cardiovascular33 (4.,Body as a whole56 (7.,Reduction in incidence,The Funagata Cohort Population,*,*,*,*,*,*,*,*,*,*,Tominaga M et al.Diabetes Care,1999,NGT,-,IFG,-,DM,All causes of death,0.860,0.880,0.900,0.920,0.940,0.960,0.980,1.000,0,1,2,3,4,5,6,7,Years,Body as a whole56 (7.The F,The Funagata Cohort Population,*,*,*,*,*,*,*,*,*,*,Tominaga M et al.Diabetes Care,1999,*,*,*,*,*,NGT,-,IGT,-,DM,The Funagata Cohort Population,Summary,1.,Type 2 DM begins as a postprandial disease,2.Postprandial hyperglycemia contributes to elevations in HbA1c and complications,3.Treatment of postprandial hyperglycemia is critical to achieving optimal outcomes in type 2 DM,4.Nevertheless,treatment of postprandial hyperglycemia is inadequately addressed,Summary 1.Type 2 DM begins as,STOP-NIDDM,Study to Prevent Non-insulin Dependent Diabetes Mellitus,STOP,NIDD
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