【优质】2型糖尿病全球防治指南新特点.ppt

2型糖尿病全球防治指南新特点 内容概括 1.背景资料 2.糖尿病危害性 3.诊断及监测 4.治疗概论 5.住院病人治疗原则 1.背景资料 1. 根据循证医学原则制定,内容参考近5年来国际上出版的指南、meta分析、及相关刊物。 2. 根据不同地区、不同医疗资源制定3个等级标准。 三个等级医疗标准 2.糖尿病危害性 1. 发病人数日益增长。无论是在发达国家还是在发展中国家，均明显增加。其中90%为2型糖尿病。（见下图） 2. 发展中国家增长的速度超过了发达国家。（200%比45%），21世纪DM 将在中国、印度等发展中国家流行 。 3. DM 的主要并发症已经成为病人致残和早亡的主要原因，每年全球约 3 000 000 人口因糖尿病而死亡。 4. 2型糖尿病占我国糖尿病人群的90%以上，它的血管并发症使人们丧失劳动能力,预期寿命缩短8-12年。 A much quoted paper by Haffner et al, suggested that people with Type 2 diabetes have a CV risk equivalent to non-diabetic people with previous CVD。 Haffner SM, Lehto S, R鰊nemaa T, Pyorala K, Laakso M.Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339: 229-34. 糖尿病急性并发症及大血管和微血管等慢性并发症，致死、致残率高，一旦发生，难以逆转，降低病人的生活质量，缩短寿命。 3. 诊断及监测 提倡早期诊断 早期诊断的意义； Type 2 diabetes has a long asymptomatic pre-clinical phase which frequently goes undetected. At the time of diagnosis, over half have one or more diabetes complications. Retinopathy rates at the time of diagnosis range from 20 % to 40 %. Of people with Type 2 diabetes, the proportion who are undiagnosed ranges from 30 % to 90 %. SM, Meyer LC, Neil HAW, Ross IS, Turner RC,Holman RR. Complications in newly diagnosed type 2 diabetic patients and their association with different clinical and biochemical risk factors. UKPDS 6. Diabetes Res 1990; 13: 1-11. Harris MI, Klein R, Welborn TA, Knuiman MW. Onset of NIDDM occurs at least 4-7 yr before clinical diagnosis.Diabetes Care 1992; 15: 815-19. UKPDS Group. UK Prospective Diabetes Study 30: Diabetic retinopathy at diagnosis of type 2 diabetes and associated risk factors. Arch Ophthalmol 1998; 116: 297-303. 早期诊断 早期诊断的方法----目前全球根据各地区约有30%-90%糖尿病漏诊率. For diagnosis, an oral glucose tolerance test (OGTT) should be performed in people with a fasting plasma glucose ≥5.6 mmol/l (≥100 mg/dl) and 7.0 mmol/