小時(shí)糖耐量試驗(yàn)的臨床意義(編輯修改稿)
2025-01-31 09:56 本頁面
【文章內(nèi)容簡介】 up 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 () () The DECODE group, Arch Intern Med 2022。 161:397404 Hazards ratio for mortality in diabetic p
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