冠心病高血糖管理的新时代.pptVIP

糖尿病心血管病并发症* Each year 3.8 million deaths worldwide are attributable to diabetes Diabetes is associated with complications such as: Diabetic neuropathy Renal failure Blindness Macrovascular disease Macrovascular complications are a major cause of death in people with diabetes 高血糖的诊断 中国糖尿病患病率增长迅速 中国糖尿病患病率逐年增长 不同研究基线情况 ACCORD研究 ACCORD 研究是NIH一项大型的临床试验 研究目的：评估强化血糖控制、调脂（升高HDL，降低LDL）以及强化血压控制对心血管事件的影响 共纳入10,251例高危中老年2型糖尿病患者 强化血糖治疗组的治疗目标是将HbA1c控制在6.0%以下，标准治疗组为将HbA1c控制在7.0%-7.9%之间 随访6年 ADVANCE研究 11140例2型糖尿病患者，患者平均年龄66岁，平均病程8年，平均HbA1c水平7.5% 强化降糖治疗组(HbA1c靶目标值6.5%)或标准治疗组(HbA1c靶目标值根据当地指南制定) 主要终点事件为主要大血管事件(非致死性心肌梗死,非致死性脑卒中或心血管相关死亡)的复合终点,以及主要微血管事件的独立及联合评估。 UKPDS随访研究的结论 Readout 小 　结 结　论 Growing prevalences of diabetes and prediabetes in China 全球糖尿病患病率* 246 million people with diabetes worldwide = roughly 6% of the adult population In 2007, the five countries with the largest numbers of people with diabetes are: India, China, United States, Russia, Germany By 2025, the largest increases in diabetes prevalence will occur in low- and middle-income countries Each year an additional 7 million people worldwide develop diabetes 基线死亡率的结果显示　CHD死亡比预期的高 * 而中国的 IGT人数却高于印度，目前已超过6000万，位居世界首位。 * IDF流行病学调查显示糖尿病前期在全世界的流行范围在继续扩大，患病率在不断的攀升。预计到2025年，全世界将会有4亿1千9百万糖尿病前期人群，比2007年增加36%。 This slide indicates that the prevalence of diabetes in China increased every year, which was about 7.4% in the year 2000-2001. The gray bar gives data for IGT patients. We can see that the prevalence of IGT is higher than DM. Data from Da Qing stusy the results showed The propotion of ischemic ECG presentated 10 times higher in IGT subjects than that in the NGT which was evaluated by independent Cardiologists group. As we know,diabetes is a serious chronic disease creating a heavy burden on patient and society due to debilitating complications. In a recent model investigating the decline in CHD deaths in England and Wales between 1981 and 2000, The decrease in CHD mortality was attributed to reducti