餐后高血糖和心血管危險因素

1、Post Prandial Hyperglycemia: A Significant Cardiovascular Risk Factor & Treatable Precedent of Type 2 Diabetes,Diagnostic Criteria for Type 2 DM Pathophysiology of type 2 DMPost Prandial Hyperglycemia (PPH) and di

2、abetic complicationsPrevention of Type 2 DM,The increasing global burden of diabetes,CVD drives the economic burden of type 2 diabetes,,,,,,,,,,,,,Pathophysiology of type 2 diabetes,Diagnosing glucose intolerance –cri

3、teria 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

4、 Health Organization, 1999.,FPG and 2h-PG values identify different people with diabetes,,,The Relative Contribution of FPG and Mealtime Glucose Spikes to 24-hour Glycemic Level,Riddle MC. Diabetes Care 1990;13:676–686,

5、3002001000,Plasma glucose (mg/dl),06001200180024000600,Time (hours),MealtimeglucosespikesFastinghyperglycemiaNormal,,,Kuusisto et al, 1994,Glycemic Control and CHD,CHD Mortality,All CHD Events,A Comparison of

6、 Hba1c Levels Achieved in the Conventional Versus Intensive Groups of Major Trials,1098765,012345678910,Time from randomization (years),HbA1c,DCCT,Kumamoto Study,9876,0,03691215,Median HbA1c (%),Ti

7、me from randomization (years),UKPDS,Conventional therapyIntensive therapy,12111098765,0122436486072,Months,HbA1c (%),FPG = fasting plasma glucose; PPG = postprandial plasma glucose.,HbA1C,PPG,FPG,+,=,,HbA1c

8、 (%),Fasting/2 hour plasma glucose (mg/dl),Harris MI et al Diabetes Care, 1998,Hba1c, Fasting and 2hr Plasma Glucose,UKPDS 10 yr-Cohort Data: Dissociation Between FPG & HbA1C,,,,Del Prato S. 2001,,Duration of Daily M

9、etabolic Conditions,,,Postabsorptive,,Fasting,Monnier L, Europ J Clin Invest, 2000,Intensive Treatment Policies,,DCCT,,Kumamoto,Study,,UKPDS,,,Fasting plasma,glucose (mmol/l),,,,3.9,–,6.7,,,,< 7.8,,,,< 6,,,2,-,hr p

10、p glucose,(mmol/l),,,< 10,,,< 11,,,Not defined,,,,,,,,,,,,,,The Funagata Cohort Population,*,*,*,*,*,*,*,*,*,*,Tominaga M et al. Diabetes Care, 1999,NGT - IFG - DM,The Funagata Cohort Population,*,*,*,*,*,*,*,*,*,*

11、,Tominaga M et al. Diabetes Care, 1999,*,*,*,*,*,NGT - IGT - DM,Summary,,,1. Type 2 DM begins as a postprandial disease2. Postprandial hyperglycemia contributes to elevations in HbA1c and complications3. Treatment of

12、 postprandial hyperglycemia is critical to achieving optimal outcomes in type 2 DM4. Nevertheless, treatment of postprandial hyperglycemia is inadequately addressed,STOP-NIDDMStudy to Prevent Non-insulin Dependent Di

13、abetes Mellitus,STOPNIDDM,Study design,STOPNIDDM,Acarbose reduces the risk of developing diabetes,STOPNIDDM,Acarbose has a rapid and sustained effect on diabetes risk,STOPNIDDM,Efficacy of acarbose is unaffected by

14、baseline BMI or age,STOPNIDDM,Acarbose increases the reversion of IGT to NGT,STOPNIDDM,,Acarbose – an exceptional safety profile,STOPNIDDM,Acarbose reduces the risk of cardiovascular disease,STOPNIDDM,Reducing pos