中国糖尿病领域新挑战.ppt

1,TheRisingChallengeofDiabetesinChina,ChangYuPanDepartmentofEndocrinology,ChinesePLAGeneralHospitalChinesePLAEndocrinologyandMetabolismCentreandKeyLaboratoryApr.11-2008,2,MedicalandHealthAnnualEncyclopaediaBritannica,1999,3,3,DeathfromDiabetes2.90Million(5.2%oftotalmortality)Worldwide:1of20deathisfromdiabetes(About8,700death/dayor6death/min)About1of4deathisDMinAsia-PacificRegionDeathfromAIDS:3.0Million,WhatAIDSwasinthelast20yearsofthe20thcentury,diabetesisgoingtobeinthefirst20yearsofthiscentury,Roglicetal,2005,TheRisingChallengeofDiabetes,4,Lifestylechanges,UrbanizationandLongevityinChina,NationalNutritionandHealthSurvey(19822002)Carbohydrate+10%,Meat+57%eggs+69%TotalCarloria:2254cal./person/day,5,Prevalenceofoverweight/obesityinChina(20-70years),Overweight/obesity(BMI25kg/m2)(WHOcriteria),DatafromNationalNutritionSurvey(1992),theWorkingGrouponObesityinChina(2002),Age-standardizedPrevalence(%),6,Prevalenceofoverweight/obesityinChinesechildrenGuD,etal.Diabetologia46:1190,2003,*ScreeningwithFPGonly,12,PrevalenceofIGTinallagegroupswashigherthanthatofDiabetes,PrevalenceofIGTandDiabetesin11provinces,China,ChinJEpidemiol.1998;19(5):282-285.,13,ShanghaiDiabetesInstitute,IsolatedfastingDM:0.6%,Isolatedpost-challengediabetes:2.4%,CombinedDM:1.9%,TotalprevalenceofnewlydiagnosedDM:4.9%,Totalprevalenceofprediabetes:11.7%,IsolatedIGT8.8%,IsolatedIFG1.7%,IFG+IGT1.2%,75%,15%,10%,JiaWPetal.Dibetologia2007,Isolatedpost-challengeDMandIGTCommoninChina,14,Newlydiagnoseddiabetes(OGTT),33%,3%,23%,24%,17%,36%,37%,27%,OGTTcohort(n=2,263),Wholepopulation(n=3,513),2/3ofpatientshavehyperglycaemia,3/4ofpatientshavehyperglycaemia,Previouslyknowndiabetes,Newlydiagnoseddiabetes(FPGtest),NGT,Prediabetes,HuDY,PanCY,YuDM.EurHeartJ2006;27:25739.,ChinaHeartSurveydysglycemiaiscommoninpatientswithCAD,15,WPJia,etal.Diabetologia,2006(inpress),EpidemiologicalcharacteristicsDMandIGTinaChineseadultpopulation:theShanghaiDiabetesStudies(SHDS),Prevalence(%),Incidence(%),three-yearcumulativeincidencerates,incidenceratesperyear,1999-2001,n=5628,2002-2004,n=2709,16,ChineseindividualswithIGTprogresstotype2diabetesfasterthanAmericanindividualswithIGT,ChineseIGTpopulationisathighriskofDM,PanXR,etal.DiabetesCare1997;20:53744.KnowlerWC,etal.NEJM2002;346:393403.,17,DaQingIGTinterventionStudy577IGT519Control4%IGT0.4%NGT,TheappearanceofECGconsistentwithCHD,IGTandtheriskofCVD,DiabetesCare1993:16.150-156,18,IGTandAtherosclerosis-StudyfromPLAGeneralHospitalinChina,*,*,*,IGT,NGT,DM,IGT,IGT,NGT,NGT,DM,DM,N:97(NGT),51(IGT),73(DM)Adjustedbyageandsex*P0.05,P0.005,v.s.NGT,JingWS,PanCY,LuJM,etal.ChinJEndocrinol20(2):136-139,19,ThecumulativerateofCVD,CoxsProportionalHarzardModel,XuXj,PanCYTianH.etal,ChinJGerontol.2001.,0.97,0.98,0.99,1.00,1,2,3,4,Year,NGT,IGT,DM,TheCVDRiskofIGTandDiabetes-StudyfromPLAGeneralHospitalinChina,Cumulativerate,0,20,CODIC2ControlofType2DiabetesinChina,BiaoX,PanCY,JiLN,etal.CODIC2,2007,inpress,N=1530,N=2054,N=524,21,SurveillanceofType2DiabetesinChina,2001hospitalsdistribution:Grade3:32(65%),Grade2:17(35%)2006hospitalsdistribution:Grade3:43(72%),Grade2:16(27%),Grade1:1(2%),PatientPopulation,22,BMI,Anti-obesityTreatment:2001200320061.5%1.0%1.0%,BMIwasanalysedforpatients18yearsonly,24.6,24.3,24.0,23.7,10,15,20,25,30,1998,2001,2003,2006,BMI(kg/m2),PanCY.InternJournEndocr.109:11011107.,延迟或预防死亡,68,230,(2,0003,000),35,Diabetesmortalitycontinuesitssteadyescalation,FreidVM,etal.NationalCenterforHealthStatistics,2003.,36,CauseofdeathinChina,DatafromNationalDiseaseSurveillanceSystemofChina(1991-2000),Top3fataldiseasesin2000,1,412,999,2,488,266,1,530,423,CauseofdeathinChina,37,MotalityofDiabetesinUrbanChinese,Sources:MinistryofHealthofChina:AnnualStatisticalReportsofDeath,injuriesandCauseofDeath2001,38,WPDD2002./downloads/Diabetes_Book.pdf.,EarlyDiagnosisofPrediabetesisessential,WesternPacificDiabetesDeclaration(WPDD)Guidelines:“TheriskofComplicationsisRelatedtotheDurationofDiabetes,aswellastheDegreeofHyperglycaemia.However,duetoDelayedDiagnosis,theseComplicationsmayAlreadybePresentatDiagnosis.”Earlydiagnosisandmanagementofprediabetescanreducetheriskofbothtype2diabetesandcardiovasculardisease,39,Summary,TheprevalenceofDMandIGTisincreasingrapidlyasaresultoflifestylechanges,urbanizationandlongevity.ChinaiscurrentlythesecondonthelistofthetoptencountrieswiththehighestDMburdenEstimatedthatasthepopulationofChinareaches1.3billionintheearly21stcentury,700,000newcasesoftype2diabetesoccureveryyearamong24-74year-oldHbA1candCVDriskfactorscontrolwithcurrenttreatmentispoor;InChina,81%OftotaldirectmedicalcostforpatientswithcomplicationsEvenIGTareas