餐后高血糖和心血管危險(xiǎn)因素課件

1、Post Prandial Hyperglycemia: A Significant Cardiovascular Risk Factor & Treatable Precedent of Type 2 DiabetesDiagnostic Criteria for Type 2 DM Pathophysiology of type 2 DMPost Prandial Hyperglycemia (PPH) and diabetic complicationsPrevention of Type 2 DM餐后高血糖和心血管危險(xiǎn)因素1Post Prandial Hyperglycemia: Th

2、e increasing global burden of diabetesPopulation aged 20 yearsKing H, et al. Diabetes Care 1998;21:141431.Developed countriesDevelopingcountriesWorldtotalPrevalence (%)0246820252000餐后高血糖和心血管危險(xiǎn)因素2The increasing global burden oCVD drives the economic burden of type 2 diabetesCVD: cardiovascular diseas

3、eNichols GA, Brown JB. Diabetes Care 2002;25:4826.Copyright 2002 American Diabetes Association; reprinted with permission from The American Diabetes Association.1086420Cost in 1999 (x1,000 US$)No CVD,no diabetesn=13,286No CVD,diabetesn=11,130CVD,no diabetesn=2,894CVD anddiabetesn=5,050$2,562$4,402$6

4、,396$10,17231.9%48.1%20.0%28.6%40.3%31.2%17.2%31.8%51.0%21.1%28.0%50.9%PharmacyOutpatientInpatient餐后高血糖和心血管危險(xiǎn)因素3CVD drives the economic burdenPathophysiology of type 2 diabetesJanka HU. Fortschr Med 1992;110:63741.Macro-vasculardiseaseInsulin sensitivityInsulin secretionPlasma glucoseMicro-vasculard

5、iseaseImpaired glucose toleranceHyperglycemia餐后高血糖和心血管危險(xiǎn)因素4Pathophysiology of type 2 diabDiagnosing glucose intolerance criteria reflect a need for early intervention*Determined post 75g glucose load2h-PG: 2-hour postchallenge plasma glucose, FPG: fasting plasma glucose, IFG: impaired fasting glucos

6、e, IGT: impaired glucose tolerance World Health Organization, 1999.Diagnosis Venous plasma glucose concentration (mmol/L)DiabetesFPG or 7.02h-PG* 11.1IGTFPG (if measured) and 7.8 and 6.1 and 7.02h-PG* (if measured) 7.8餐后高血糖和心血管危險(xiǎn)因素5Diagnosing glucose intoleranceFPG and 2h-PG values identify differen

7、t people with diabetes2h-PG: 2-hour postchallenge plasma glucose, FPG: fasting plasma glucoseDECODE Study Group. BMJ 1998;317:3715.FPG40%Both FPG and 2h-PG28%Younger, more obesepeopleOlder,leanerpeople2h-PG32%餐后高血糖和心血管危險(xiǎn)因素6FPG and 2h-PG values identify The Relative Contribution of FPG and Mealtime G

8、lucose Spikes to 24-hour Glycemic LevelRiddle MC. Diabetes Care 1990;13:6766863002001000Plasma glucose (mg/dl)06001200180024000600Time (hours)MealtimeglucosespikesFastinghyperglycemiaNormal餐后高血糖和心血管危險(xiǎn)因素7The Relative Contribution of FKuusisto et al, 1994Glycemic Control and CHDCHD MortalityAll CHD Ev

9、ents餐后高血糖和心血管危險(xiǎn)因素8Kuusisto et al, 1994Glycemic CA Comparison of Hba1c Levels Achieved in the Conventional Versus Intensive Groups of Major Trials1098765012345678910Time from randomization (years)HbA1cDCCTKumamoto Study9876003691215Median HbA1c (%)Time from randomization (years)UKPDSConventional ther

10、apyIntensive therapy121110987650122436486072MonthsHbA1c (%)餐后高血糖和心血管危險(xiǎn)因素9A Comparison of Hba1c Levels AFPG = fasting plasma glucose; PPG = postprandial plasma glucose.HbA1CPPGFPG+=餐后高血糖和心血管危險(xiǎn)因素10FPG = fasting plasma glucose; 4.85.05.25.45.65.86.06.26.4HbA1c (%)6080100120140160180200Fasting/2 hour pl

11、asma glucose (mg/dl)Harris MI et al Diabetes Care, 1998Hba1c, Fasting and 2hr Plasma Glucose餐后高血糖和心血管危險(xiǎn)因素114.85.05.25.45.65.86.06.26.4HbAUKPDS 10 yr-Cohort Data: Dissociation Between FPG & HbA1CHbA1cFPGDel Prato S. 2001PPG餐后高血糖和心血管危險(xiǎn)因素12UKPDS 10 yr-Cohort Data: DissoDuration of Daily Metabolic Condi

12、tionsBFLunchDinner0:00 am4:00 amBFPostprandialPostabsorptiveFastingMonnier L, Europ J Clin Invest, 2000餐后高血糖和心血管危險(xiǎn)因素13Duration of Daily Metabolic CoIntensive Treatment Policies DCCT Kumamoto Study UKPDS Fasting plasma glucose (mmol/l) 3.9 6.7 7.8 6 2-hr pp glucose (mmol/l) 10 11 Not defined 餐后高血糖和心血

13、管危險(xiǎn)因素14Intensive Treatment Policies DThe Funagata Cohort Population*Tominaga M et al. Diabetes Care, 1999NGT - IFG - DMAll causes of death0.8600.8800.9000.9200.9400.9600.9801.00001234567Years餐后高血糖和心血管危險(xiǎn)因素15The Funagata Cohort PopulationThe Funagata Cohort Population*Tominaga M et al. Diabetes Care,

14、1999*NGT - IGT - DM餐后高血糖和心血管危險(xiǎn)因素16The Funagata Cohort PopulationSummary 1. Type 2 DM begins as a postprandial disease2. Postprandial hyperglycemia contributes to elevations in HbA1c and complications3. Treatment of postprandial hyperglycemia is critical to achieving optimal outcomes in type 2 DM4. N

15、evertheless, treatment of postprandial hyperglycemia is inadequately addressed餐后高血糖和心血管危險(xiǎn)因素17Summary 1. Type 2 DM begins asSTOP-NIDDMStudy to Prevent Non-insulin Dependent Diabetes MellitusSTOPNIDDM餐后高血糖和心血管危險(xiǎn)因素18STOP-NIDDMSTOP餐后高血糖和心血管危險(xiǎn)因素18Study designSTOPNIDDMPlacebo t.i.d. (n=715)Acarbose 100mg

16、t.i.d. (n=714)1036612182430Months1234567891011121314VisitsPlacebon=1,4293 monthsplacebo60Close-out visitt.i.d.: three times dailyChiasson JL, et al. Lancet 2002;359:20727.餐后高血糖和心血管危險(xiǎn)因素19Study designSTOPPlacebo t.i.d.Acarbose reduces the risk of developing diabetesSTOPNIDDMAcarbose reduces the incide

17、nce of type 2 diabetes in individuals with IGT Based on onepositive OGTT 25%p=0.0015Based on two consecutivepositive OGTTs36%p=0.0017IGT: impaired glucose tolerance, OGTT: oral glucose tolerance testChiasson JL, et al. Diabetologia 2002;45(Suppl. 2):A104. 餐后高血糖和心血管危險(xiǎn)因素20Acarbose reduces the risk of

18、Acarbose has a rapid and sustained effect on diabetes riskAcarbose-associated reduction in risk of diabetes was evident after 1 year Acarbose significantly reduced the risk of diabetes at each follow-up time point The beneficial effects of acarbose persisted for the duration of the trialResults of t

19、he STOP-NIDDM show that acarbose has long-term therapeutic efficacy in individuals with IGT IGT: impaired glucose intolerance, STOP-NIDDM: Study to Prevent Non-insulin Dependent Diabetes MellitusChiasson JL, et al, Lancet 2002;359:20727.STOPNIDDM餐后高血糖和心血管危險(xiǎn)因素21Acarbose has a rapid and sustaEfficacy

20、of acarbose is unaffected by baseline BMI or ageSTOPNIDDMBMI: body mass indexChiasson JL, et al. Lancet 2002;359:20727.p 25%0.0015 21% 0.0559 31% 0.008423%0.038229%0.008924%0.026930%0.011500.51.01.52.0FavoursacarboseOverallAge (years) 55 Sex Male FemaleBMI (kg/m2) 30 30FavoursplaceboReduction in inc

21、idence 餐后高血糖和心血管危險(xiǎn)因素22Efficacy of acarbose is unaffeAcarbose increases the reversion of IGT to NGTNGTIGTDiabetesAt baselineAcarbose group (%)Placebo group (%)324228253531At end of treatment100%*No post-randomisation dataIGT: impaired glucose tolerance, NGT: normal glucose toleranceChiasson JL, et al

22、. Lancet 2002;359:20727.STOPNIDDM餐后高血糖和心血管危險(xiǎn)因素23Acarbose increases the reversAcarbose an exceptional safety profile*Events starting on the first day and up to 7 days after last day of treatmentBayer AG, data on .Adverse events 155 (21.7)277 160 (22.4)260experiencedBody as a whole56 (7.8)77 58 (8.1)7

23、2Cardiovascular33 (4.6)48 39 (5.5)61Endocrine4 (0.6)5 5 (0.7)5Haemic2 (0.3)2 4 (0.6)4and lymphaticMetabolic and 2 (0.3)2 1 (0.1) 1 nutritionalAdverse events* Acarbose (n=714) Patients Events No. (%) No. Placebo (n=715) Patients EventsNo. (%) No.STOPNIDDM餐后高血糖和心血管危險(xiǎn)因素24Acarbose an exceptional safeAca

24、rbose reduces the risk of cardiovascular diseaseSTOPNIDDM*Reduction in risk of developing hypertensionData were analysed using the Cox proportional hazard modelChiasson JL, et al. Diabetologia 2002;45(Suppl. 2):A104. Hypertension*MyocardialinfarctionAny cardio-vascular eventp=0.0059p=0.0226p=0.03263

25、4%91%49%餐后高血糖和心血管危險(xiǎn)因素25Acarbose reduces the risk of SReducing postprandial hyperglycaemia decreases the risk of diabetes and CVDSTOPNIDDMAcarbose treatment resulted in a Relative risk reduction of 25% for the development of diabetes (p=0.0015)1Relative risk reduction of 36% using two consecutive OGT

26、Ts (p=0.0017)130% increase in the incidence of normal glucose tolerance (p0.0001)2Statistically significant reduction in the risk ofhypertensionmyocardial infarctionany cardiovascular eventCVD: cardiovascular disease, OGTT: oral glucose tolerance test1. Chiasson JL, et al. Diabetologia 2002;45(Suppl

27、. 2):A104. 2. Bayer AG, data on .餐后高血糖和心血管危險(xiǎn)因素26Reducing postprandial hyperglyChinese studies support the efficacy of acarbose in patients with IGT NGT IGT DiabetesControl27.737.434.9 (n=83)Diet and exercise28.147.424.6 (n=60)Metformin44.443.212.4(n=88)Acarbose71.122.9 6.0(n=88)Percentage of patientsIGT: impaired glucose tolerance, NGT: normal glucose tolerance Wenying Y, et al. Chin J Endocrinol Metab 2001;17:1316.Study group餐后高血糖和心血管危險(xiǎn)因素27Chinese studies support the efAn emerging algorithm to manage IGT Development of evidence-based systems to identify those with IGT at most risk o