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1、餐后血糖与心血管病,正常人餐后状态的定义及持续时间,早餐 午餐 晚餐 0:00 4:00 早餐am am,8:00 11:00 2:00 5:00am am pm pm,Time of blood sampling to obtain a diurnal blood glucose profile,餐后状态 餐后吸收状态 空腹状态,HbA1C =,PPG,FPG,+,餐后高血糖对HbA1c有非常大的影响,HbA1c,FBG,餐后高血糖 造成的差,随机化水平,0,3,6,9,Years,Beta 细胞功能下降,Adapted from UKPDS 16: Diabetes 1995: 44:12
2、49-1258,Beta 细胞功能 (%),自诊断的年份,UKPDS,2型DM的自然病程与-C功能的关系,-24 -10 0 30年DM,100%,IGT,胰岛素抵抗,肝葡萄糖输出,内源性胰岛素,餐后血糖,空腹血糖,内源胰岛素,IGT 糖尿病,微血管并发症,大血管并发症, 4-7 年 ,“诊断为糖尿病”,糖尿病的严重性,Clinical Diabetes Volume 18, Number 2, 2000,2 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
3、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,Haffner SM et al JAMA 1990; 263: 2893-2
4、898,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)
5、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 comp
6、lications- 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 an
7、d mortality increase stepwise with increasing IGTPBG,but not FBG is associated with CHD IGT,but not IFG,is a risk factor for CVD2-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 h
8、igh risk for CVD and should be re-evaluated”,Mealtime Glucose Excursions and risk of Cardiovascular Disease(2),Paris Prospective Study,1999 Whitehall Study,1999HOORN Study,1999,Death rates for CHD increasing 2hPBG levelsMen in the upper 2.5% of the 2hPBG distribution had significantly higher CHD mor
9、tality High PBG levels,especially 2h-load PBG concentrations and to a lesser extent,HbA1c values, indicate a risk for CVD mortality,Mealtime Glucose Excursions and risk of Cardiovascular Disease(3),Pacific and Indian Ocean Population Study,1999DECODE study,1999Theodora S. et al, 2000,Isolated 2h PBG
10、 challenge increases total mortality and CVD mortality,and carries a greater risk than isolated FBG CHD mortality is more related to 2-h PBG than to FPG.FPG does not identify subjects at risk for CHD PG and PGS are more strongly associated with carotid IMT than FBG and HbA1c,Importance of mealtime g
11、lucose excursions,Mealtime and post-meal hyperglycemia are typically the earliest manifestations of Type 2 diabetes,PBG Contributes to overall daily hyperglycemia(e.g as reflected in HbA1c and microvascular complications) PBG Associated with increased risk for macrovascular complications-IGT is a ri
12、sk factor for vascular complications-numerous epidemiologic studies show a relationship between PBG levels and risk for cardiovascular complications,Adjusted Survival According to Diabetes Category: Pacific and Indian Ocean Population,IFH - isolated fasting hyperglycemia (FPG7mmol/L;2h PG11.1mmol/L)
13、KD - known diabetes,KD,IPH,normal,IFH,males,J.E. Shaw et al. Diabetologia 1999;42: 1050,血压正常的不同糖耐量患者的临床特征（1）,李春霖，潘长玉，陆菊明等 中华内科杂1997;36(8):536-539,血压正常的不同糖耐量患者的 动态血压改变(XSx),为昼夜差值李春霖，潘长玉，陆菊明等 中华内科杂1997;36(8):536-539,组别 (例) (20) (20) (20) 男/女 12/8 14/6 13/7 年龄（岁） 52.22.3 52.0 1.9 53.2 1.9 0.10 0.9007 F
14、BS (mmol/L) 5.13 0.23 6.940.20 9.58 0.72 22.79 0.0001 PBS2h (mmol/L) 6.37 0.19 8.65 0.26 13.01.13 23.00 0.0001 ch(mmol/L) 3.870.16 5.460.23 5.040.17 17.39 0.0001 HbA1c (%) 5.390.15 7.42 0.21 9.790.71 23.42 0.0001 UAE (mg/L) 4.17/ 9.12/ 17.4 / 4.26 0.0202 0.48 0.43 0.29 FIns(mu/L) 3.63/ 4.47/ 8.13/ 5.90 0.00730.28 0.35 0.44 Ins2h(mu/L) 22.4 / 22.9/ 27.5/ 0.27 0.7638 0.33 0.42 00.42 IAI -2.98 -3.35 -4.07 9.69 0.0006 24hSBP(mmHg) 129 4 1272 133 4 0.67 0.5160,
