餐后血糖与心血管病.ppt

餐后血糖与心血管病 正常人餐后状态的定义及持续时间 餐后高血糖对HbA1c有非常大的影响 2 型糖尿病的三个阶段 阶段 Pathophysiology 指示 第一阶段 -胰岛素抵抗 -胰岛素分泌↑ - 正常 PG 第二阶段 -更严重的胰岛素抵抗 -早期餐后胰岛素分泌受损 IGT(餐后高血糖） 第三阶段 -严重的胰岛素抵抗 -受损的胰岛素分泌 - 空腹高血糖 -增高的内源性葡萄糖代谢 - 餐后高血糖 1.Warram J,et al:Ann Intem Med 1990,113:909-915 2.Mitrakou A,et al: N Engl J Med 1992,326:22-29 3.Ninneen SF: Diabetic Med 1997,14(suppl 3):s19-s24 “Ticking Clock”(钟摆)假说 钟摆动已始于 微血管并发症 高血糖出现时 大血管并发症 发展在糖尿病前期 IMPORTANDCE OF MEALTIME GLUCOSE EXCURSIONS Mealtime and postprandial hyperglycemia are typically the earliest clinical manifestations of Type 2 diabetes Worsens pre-existing prediabetic defects of insulin secretion and action,and contributes to overall daily hyperglycemia(as reflected in HbA1c) Control of PBG optimizes overall glycemic control “Therapy focused on lowering PBG,not FBG may be superior for lowering HbA1c” (Basyr et al Diabetes Care 23:1236,2000) Leads to reactive hyperinsulinemia Associated with increased risk for macrovascular complications - IGT is a risk factor for CVD complications - Epidemiologic studies show a relationships between PBG and risk for CVD complications Mealtime Glucose Excursions and risk of Cardiovascular Disease(1) Honolulu heart program,1987 Diabetes Intervention Study,1998 Funagata Diabetes Study,1999 The Rancho Bernardo Study,1998 CHD incidence and mortality increase stepwise with increasing IGT PBG,but not FBG is associated with CHD IGT,but not IFG,is a risk factor for CVD 2-hPBG? alone more than doubles the risk of fatal CVD and CVD in older adults “…the use of FBG alone for DM screening or diagnosis may fail to identify most older adults at high risk for CVD and should be re-evaluated” Mealtime Glucose Excursions and risk of Cardiovascular Disease(2) Paris Prospective Study,1999 Whi