从高血糖与糖尿病周围神经病变的关系反思研究和控制策略-文本资料课件

从高血糖与糖尿病周围神经病变的关系反思研究和控制策略北京大学人民医院纪立农1China

CardiometabolicRegistriesNation-wide,

prospective,

registry

seriesdesigned

to

better

understand

clinical

outcomes

ofcurrent

treatment

of

cardiovascular

and

metabolic

diseasesin

real

world

settingsOrganized

by

Chinese

Medical

Doctor

AssociationsSupervised

by

CCMR

International

Advisory

BoardManaged

by

VitalStrategic

Research

InstituteChina

Cardiometabolic

Registries22中国2型糖尿病患者心血管疾病危险因素的纵向队列研究研究者会议2011年5月14-15

日中国老年学学会（GSC）主办中国医师协会心血管内科医师分会(CCCP)

协办中国医师协会内分泌及代谢科医师分会(CEA)

协办中国心血管代谢病系列研究(CCMR)组织及专家委员会指导华斯泰生命策略研究所/上海华斯泰医学咨询有限公司(VSRI)执行默沙东(中国)有限公司赞助Nationwide

Assessment

of

Cardiovascular

RiskFactors--Blood

Pressure,

Blood

Lipid,

andBloodGlucose

in

Chinese

Patients

with

Type

2

DiabetesLinong

JiPeking

University

People’s

HospitalOn

behalf

of

CCMR

Advisory

BoardJi

et

al.

AJM，2013，in

press

3Ji

et

al.

AJM，2013，in

press44Study

Objectives

–

PrimaryPrimary

ObjectiveTo

assess

the

level

of

control

of

CVD

risk

factors,including

blood

pressure,

blood

lipid,

and

bloodglucose,

in

outpatients

with

type

2

DM

in

6representative

regions

in

China

and

in

three

tiersof

hospitalsTo

identify

the

gap

between

real

world

diabetesmanagement

situation

and

standard

of

careJi

et

al.

AJM，2013，in

press55Study

Objectives

-SecondarySecondary

ObjectivesTo

assess

the

proportion

of

microvascular

andmacrovasclar

diabetic

complications

in

outpatientswith

type

2

DMTo

assess

real-life

treatment

patterns

in

outpatientswith

type

2

DMTo

assess

the

proportion

of

hypoglyecemia

underthecurrent

treatmentTo

assess

the

influencing

factors

(hospitalclassification,

regional

distribution,

medical

history,educational

level

and

others)

on

DM

treatmentoutcomesNon-interventional,

observational,

cross-sectional

designType

2

diabetes

diagnosed

for

6

months

orlongerAmbulatory

patients

from

endocrinology,cardiology,

nephrology

clinics

in

all

3

tiers

ofhospitals

(Tier

1,

2,

and

3)

located

in

all

6main

regions

in

ChinaEstimated

sample

size

was

25,000

patientsin

order

to

have

sufficient

power

to

detectthe

difference

of

the

primary

assessmentineach

region6Ji

et

al.

AJM6

，2013，in

press66Study

DesignTargeted

to

enroll

25,000

patientsJi

et

al.

AJM，2013，in

press77Distribution

of

Participating

HospitalsNumber

of

sites

in

each

region

was

proportional

to

the

population

in

the

regionNational

RegionsTier

1Tier

2Tier

3SUMNorthEast46616North46818East57618NorthWest45514SouthWest59721Central

South45716SUM263839103Ji

et

al.

AJM，2013，in

press

8Characteristics

of

study

subjects8NumberPercentage

(%)All25454100.0Age

(yr)<

651385554.5>

651159945.5GenderMale1195547.0Female1349953.0ResidentUrban2277689.5RuralBMI

(kg/m2)267810.5<

241061741.7>

241483558.3Mean

age

=

62.6

+/-11.9

yearsDistribution

of

CVD

Risk

Factors28%

of

the

patients

had

T2D

only60%

of

the

patients

also

had

HTN

(T2D+HTN)About

42%

of

the

patients

also

had

DYLP

(T2D+DYLP)About

30%

of

the

patients

had

“3B”:

high

blood

glucose,

blood

lipid, and

blood

pressure

(T2D+HTN+DYLP)T2D

=

type

2

diabetes,

HTN

=

hypertension,

DYLP

=

dyslipidemiaJi

et

al.

AJM，2013，inpress99Diabetes

Duration

and

ComplicationsPrevalence

of

diabetic

complications

is

proportional

to

duration

of

diabetes(%)Ji

et

al.

AJM，2013，in

press1100Duration

of

DiabetesDiabetic

Complications

and

CVDRisk

Factors(%)Ji

et

al.

AJM，2013，in

press111112

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201213

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201214

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201215

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201216

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201217

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201218

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201219

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201220

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201221

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201222

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201223

Callaghan

BC

，et

al.

Cochrane

Database

Syst

Rev.

201224Gæde,

P.

et.

al.

N

Engl

J

Med

2003;348:383-3295

3Results

from

Patients

withType

2

Diabetes

-

STENO

2Diabetic

Neuropathy

in

Type

2

PatientsSural

nerve

biopsies

of

4MF2D

7

patientsPatients

can

be

classified

into

2groups

based

on

myelinated

fiberdensity

loss

over

52

weeksTRIGLYCERIDESWiggin

et

al,

Diabetes,

2009Gæde,

P.

et.

al.

N

E