小時(shí)糖耐量試驗(yàn)的臨床意義【特薦(編輯修改稿)
2025-01-31 09:56 本頁(yè)面
【文章內(nèi)容簡(jiǎn)介】 azard ratio (95% CI) by glucose status at baseline and at followup Followup Nondiabetic Diabetic Baseline 2hPG NGT IGT Nondiabetic CHD incidence 1 () () CVD mortality 1 () () Allcause mortality 1 () () Adjusted for age, sex, WHR, SBP, Chol, HDL and smoking Qiao et al. Diabetes Care 2022。 26:29102914 Effect of intensive glycemic control on the risk for any type of macrovascular events C Stettler, Am Heart J 2022。 152:2738 STOPNIDDM Trial (1) 0 0 , 2 0 , 4 0 , 6 0 , 8 1 1 , 2 1 , 4Myocardial infarction Angina Revascularization procedure Cardiovascular death Cerebrovascular event or stroke Peripheral vascular disease Any cardiovascular event Favours Acarbose Favours Placebo Chiasson JL JAMA 2022。 23: 290:48694 The main changes from baseline to 3 years: Acarbose Placebo STOPNIDDM Trial (3) Body Weight (kg) BMI (kg/m2) Waist (cm) SysBP (mmHg) DiasBP (mmHg) 2hPG (mmol/L) Triglycerides (mmol/L) All p for the difference between the two groups Summary ? Diabetes diagnosed by either FPG or 2h criteria are risk factor for CVD disease, but 2h criteria identify those who are not diabetic by FPG alone ? IGT is over IFG with regard to the prediction of the CVD ? More trials are required to show that intensive treatment of postprandial hyperglycemia can reduce the CVD RCT Metaanalysis: G Lowering Type 1 Diabetes Trials Am Heart J 2022。152:27 Intensive Insulin Rx amp。 CVD: T1 DM DCCT/EDIC NEJM 2022。353:2643 Participants: 1394 (97% of the original cohort) DCCT participants Oute: Nonfatal MI or stroke。 OR CV death。 OR silent MI。 OR documented angina。 OR revascularization Followup: Until 50 conventional pts CV event 11 yrs post DCCT。 17 yrs altogether GHb Results: DCCT End EDIC End Intensive () () Conventional () () Intensive Insulin Rx amp。 CVD: T1 DM DCCT/EDIC NEJM 2022。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。 CVD: T1 DM DCCT/EDIC NEJM 2022。353:2643 MI, Stroke, CV Death RRR= 57% (1279) Chronic G Lowering amp。 CVD: IGT STOP NIDDM Analysis: Chiasson et al. JAMA 2022。290:486 HR () (. 32/686 vs. 15/682 MI, Angina, Revasc, CV Death, CHF, Stroke, or PVD) Copyright 169。1994 BMJ Publishing Group Ltd. McCane, D R et al. BMJ 1994。308:13238 ROC curves for prevalence of retinopathy (top) and nephropathy (bottom) for 2hPG (), FPG (....), and HbA1 () concentrations 1Specificity Relative risk (95% CI) of mortality significantly increased in subjects with IGT Multivariate adjusted: for age, center, sex, cholesterol, BMI, BP, smoking Mortality RR, multivariate adjusted RR, adjusted also for FPG CVD () () CHD () () Stroke () () Allcause () () T
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