餐后血糖再认识 课件.ppt

该项研究纳入290例非胰岛素和非拜唐苹治疗的2型糖尿病患者，空腹8:00 am和餐后11:00 pm,2:00 pm,5:00 pm监测血液葡萄糖浓度。计算曲线下增量面积。研究发现，餐后血糖增量对HbA1c的贡献值从最高的69.7%到最低的30.5%，P0.001;空腹血糖增量对HbA1c的贡献从最低的30.0%到最高的69.5%不等，P0.001.如图所示，当HbA1c 8.4%时PPG的贡献50%。 餐后高血糖影响糖尿病患者结局的一种方式可能是通过它对整体血糖水平的贡献，后者以HbA1c 表示。Monnier等人报道的一篇学术论文中1，餐后血糖水平和空腹血糖水平对整体血糖水平的准确贡献率是通过290例非胰岛素和非拜唐苹治疗的2型糖尿病患者评价的。在确定五分位HbA1c的餐后和空腹血糖浓度后，发现餐后血糖在一定范围HbA1c水平内对整体血糖水平起主要作用。虽然在血糖控制好的糖尿病患者(HbA1c 7.3)餐后血糖对整体血糖的贡献率高达70%，而且其相对贡献率随着HbA1c 水平的升高而降低，但是在那些血糖控制不佳的糖尿病患者(HbA1c10.2)其贡献率仍然高达30%。这与空腹血糖的相对贡献率相反，其贡献率随着血糖控制不佳而升高。 * Objective: HbA1c values reflect overall glycemic exposure over the past 2–3 months and are determined by both fasting (FPG) andpostprandial plasma glucose (PPG) levels. Cross-sectional studies suggest that attainment of HbA1c goals requires specifictargeting of postprandial hyperglycemia. Research design and methods: We undertook a prospective intervention trial to assess the relative contribution of controlling FPGand PPG for achieving recommended HbA1c goals. One hundred and sixty-four patients (90 male and 74 female) withunsatisfactory glycemic control (HbA1c 7.5%) were enrolled in an individualized forced titration intensified treatment program. Results: After 3 months HbA1c levels decreased from 8.7 0.1 to 6.5 0.1% ( p 0.001); FPG decreased from 174 4 to 117 2 mg/dl ( p 0.001); PPG decreased from 224 4 to 159 3 mg/dl ( p 0.001) and daylong hyperglycemia (average of premeal, postprandial and bedtime plasma glucose excluding FPG) decreased from 199 4 to 141 2 mg/dl ( p 0.0001). Patients’ weight remained unchanged (84.0 1.4 kg versus 82.9 1.5 kg, p = 0.36). No severe hypoglycemia occurred. Only 64% of patients achieving FPG targets of 100 mg/dl achieved an HbA1c target of 7% whereas 94% of patients achieving the postprandial target of 140 mg/dl did. Decreases in PPG accounted for nearly twice as much for the decreases in HbA1c as did decreases in FPG. PPG accounted 80% of HbA1c when HbA1c was 6.2% and only about 40% when HbA1c was