餐后高血糖和心血管危险因素.

PostPrandialHyperglycemia ASignificantCardiovascularRiskFactor TreatablePrecedentofType2Diabetes DiagnosticCriteriaforType2DMPathophysiologyoftype2DMPostPrandialHyperglycemia PPH anddiabeticcomplicationsPreventionofType2DM Theincreasingglobalburdenofdiabetes CVDdrivestheeconomicburdenoftype2diabetes Pathophysiologyoftype2diabetes Diagnosingglucoseintolerance criteriareflectaneedforearlyintervention Determinedpost75gglucoseload2h PG 2 hourpostchallengeplasmaglucose FPG fastingplasmaglucose IFG impairedfastingglucose IGT impairedglucosetoleranceWorldHealthOrganization 1999 FPGand2h PGvaluesidentifydifferentpeoplewithdiabetes TheRelativeContributionofFPGandMealtimeGlucoseSpikesto24 hourGlycemicLevel RiddleMC DiabetesCare1990 13 676 686 3002001000 Plasmaglucose mg dl 06001200180024000600 Time hours MealtimeglucosespikesFastinghyperglycemiaNormal Kuusistoetal 1994 GlycemicControlandCHD CHDMortality AllCHDEvents AComparisonofHba1cLevelsAchievedintheConventionalVersusIntensiveGroupsofMajorTrials 1098765 012345678910 Timefromrandomization years HbA1c DCCT KumamotoStudy 9876 0 03691215 MedianHbA1c Timefromrandomization years UKPDS ConventionaltherapyIntensivetherapy 12111098765 0122436486072 Months HbA1c FPG fastingplasmaglucose PPG postprandialplasmaglucose HbA1C PPG FPG HbA1c Fasting 2hourplasmaglucose mg dl HarrisMIetalDiabetesCare 1998 Hba1c Fastingand2hrPlasmaGlucose UKPDS10yr CohortData DissociationBetweenFPG HbA1C DelPratoS 2001 DurationofDailyMetabolicConditions Postabsorptive Fasting MonnierL EuropJClinInvest 2000 IntensiveTreatmentPolicies DCCT Kumamoto Study UKPDS Fastingplasma glucose mmol l 3 9 6 7 7 8 6 2 hrppglucose mmol l 10 11 Notdefined TheFunagataCohortPopulation TominagaMetal DiabetesCare 1999 NGT IFG DM TheFunagataCohortPopulation TominagaMetal DiabetesCare 1999 NGT IGT DM Summary 1 Type2DMbeginsasapostprandialdisease2 PostprandialhyperglycemiacontributestoelevationsinHbA1candcomplications3 Treatmentofpostprandialhyperglycemiaiscriticaltoachievingoptimaloutcomesintype2DM4 Nevertheless treatmentofpostprandialhyperglycemiaisinadequatelyaddressed STOP NIDDMStudytoPreventNon insulinDependentDiabetesMellitus STOPNIDDM Studydesign STOPNIDDM Acarbosereducestheriskofdevelopingdiabetes STOPNIDDM Acarbosehasarapidandsustainedeffectondiabetesrisk STOPNIDDM EfficacyofacarboseisunaffectedbybaselineBMIorage STOPNIDDM AcarboseincreasesthereversionofIGTtoNGT STOPNIDDM Acarbose anexceptionalsafetyprofile STOPNIDDM Acarbosereducestheriskofcardiovasculardisease STOPNIDDM Reducingpostprandialhyperglycaemiadecreasesth