小時糖耐量試驗的臨床意義-wenkub
2023-01-19 09:56:54 本頁面
【正文】 5059 6069 7079 8089 Prevalence (%) of newly diagnosed DM in DECODE populations The DECODE group, Diabetes Care 2022。 1857 (66%) elective pts before discharge or within 2 mo. Euro Heart Survey Bartnik M et al。, 1, 1189。 Mean + 95%CI) Owens D ,Zinman B amp。 Bolli G : Lancet 358,739,2022 Meal Times 80 40 0 Insulin (mU/L) h Glucose (mmol/L) 8 4 2 6 什么是糖耐量異常 ? 1. 高于均值 +2標準差可診斷糖尿病 : ? 根據(jù)年輕 (2030 歲 ) 健康人群資料 , 純統(tǒng)計！不考慮臨床，預(yù)后及年齡 (50年代 ) ? 2h全血血糖 =120mg/dl (100g糖耐量 )診斷糖尿病 (血漿血糖比全血高 1416%!) ? 發(fā)病率高 ? 診斷標準混亂 (血樣，服糖量，時間 ) ? 直到 70年代 Mosenthal . and Barry E (Ann Intern Med 33: 1175, 1950) 什么是糖耐量異常 ? 1. 均值 +2標準差 2. 血糖雙峰分布 ,小血管病變 (眼病，腎病等 ): 糖尿病高發(fā)人群 , 如 Pima Indians (1971), MexicanAmericans, Micronesians, Polynesians Bimodal distribution of glucose and prevalence of retinopathy and proteinuria in Pima Indians Knowler WC etc. Diabetes Metab Rev 6: 127, 1990 Copyright 169。, 2 hours ? WHO 1980: adopted the NDDG criteria, 2h glucose= mmol/l after 75g load as “金標準” ? WHO 1985: slightly modified the WHO 1980 criteria ? ADA 1997: FPG mmol/l to mmol/l， Not use OGTT ? WHO 1999: adopted the FPG mmol/l, retained the 2h OGTT ? WHO/IDF 2022: no changes except for some terms 什么是糖耐量異常 ? 1. 均值 +2標準差 2. 血糖雙峰分布 ,小血管病變 : 心腦血管及外周血管病變 Dysglycemia Normoglycemia in Acute and Stable CV Disease ? Consecutive pts: 2107 inpts。 Eur Ht J 2022。 26: 6169. 051015202530354045I F G amp。 26: 688696 010002022300040001 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1701234513 .02 h o u r pla s ma g luc o s e ( mm o l/ l)CVD mortality by 2hour plasma glucose Frequency Hazard ratio DECODE, Diabetes Care 26: 688696 CVD mortality by fasting plasma glucose 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170123450202240006000800010000 8 . 5 4 . 0F a s t ing pla s ma glu c o s e ( mm o l/ l)Frequency Hazard ratio DECODE, Diabetes Care 26: 688696 Hazard ratio for mortality by FPG categories, the DECODA Study FPG (mmol/l) (n=5547) (n=462) ? (n=297) P for trend CVD Model 1 Model 2 1 1 () () () () Allcause Model 1 Model 2 1 1 () () () () Model 1: Adjusted for age, sex, cohort, BMI, sysBP, Chol and smoking Model 2: Additional adjustment for 2hPG DECODA Study Group, Diabetologia 2022。 26:29102914 Effect of intensive glycemic control on the risk for any type of macrovascular events C Stettler, Am Heart J 2022。 CVD: T1 DM DCCT/EDIC NEJM 2022。 OR documented angina。353:2643 Primary CV Composite RRR= 42% (963) RRR after adj. for updated GHb until end of DCCT (or CV event during DCCT): 16% (64 – 57) P= Intensive Insulin Rx amp。290:486 HR () (. 32/686 vs. 15/682 MI, Angina, Revasc, CV Death, CHF, Stroke, or PVD) Copyright 169。 161:397404 Adjusted for age, center, sex, cholesterol, BMI, BP, smoking Hazards ratio for mortality in diabetic pati
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