从模式化治疗到个体化关爱案例.ppt

* * 然而，在9月份欧洲糖尿病研究协会 (EASD)的会议上公布的UKPDS30年随访研究，却明确提出原先的强化组受试者的大血管事件 (心肌梗死)及全因死亡在后续的10年观察期中显著减少，又给早期作强化治疗者增添了远期效果。 UKPDS从入组到RCT结束20年，继而又随访了10年总共观察了30年，2008年公布的结果为我们提供了令人信服的证据，即相比常规治疗组，早期的强化降糖治疗 (磺脲类／胰岛素，二甲双胍)不但可以长期持续减少微血管事件，而且可以显著减少远期大血管事件 (心肌梗死)及全因死亡。从而验证了EDIC研究于1型糖尿病患者所得出的结论：早期的强化血糖控制对远期大血管并发症是有益的，作者据此提出了降糖治疗的延续效应 (legacy effect)一词。 参考文献: Center Watch. FDA Approved Drugs for Endocrinology. Available at: /drug-information/fda-approvals/drug-areas.aspx?AreaID=4. Accessed 9 March 2012. IDF. Healthcare expenditures. Available at: /diabetesatlas/5e/healthcare-expenditures. Accessed 9 March 2012. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: Progressive requirement for multiple therapies (UKPDS 49). JAMA. 1999;281 (21):2005-2012. * * Staged Diabetes Management (SDM) is a disease state management programme, that was developed by the International Diabetes Center, Minneapolis, USA. Its primary aim is to achieve near‐normal to normal blood glucose control in all patients with diabetes, using community involvement and simple, complete clinical pathways. SDM contains methods of diagnosis, an overview of therapy, practice guidelines, and specific detailed treatment protocols (decision paths) for type 1 and type 2 diabetes and gestational diabetes (GDM). * Reference: Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32(1):193-203. * 参考文献: Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Car