纪立农-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

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ChinaCardiometabolicRegistries2Nation-wide,prospective,registryseriesdesignedtobetterunderstandclinicaloutcomesofcurrenttreatmentofcardiovascularandmetabolicdiseasesinrealworldsettingsOrganizedbyChineseMedicalDoctorAssociationsSupervisedbyCCMRInternationalAdvisoryBoardManagedbyVitalStrategicResearchInstituteChinaCardiometabolicRegistries研究者会议2011年5月14-15日中国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NationwideAssessmentofCardiovascularRiskFactors--BloodPressure,BloodLipid,andBloodGlucoseinChinesePatientswithType2DiabetesLinongJiPekingUniversityPeople’sHospitalOnbehalfofCCMRAdvisoryBoardJietal.AJM，2013，inpressStudyObjectives–Primary•PrimaryObjective•ToassessthelevelofcontrolofCVDriskfactors,includingbloodpressure,bloodlipid,andbloodglucose,inoutpatientswithtype2DMin6representativeregionsinChinaandinthreetiersofhospitals•Toidentifythegapbetweenrealworlddiabetesmanagementsituationandstandardofcare4Jietal.AJM，2013，inpressStudyObjectives-Secondary•SecondaryObjectives1)Toassesstheproportionofmicrovascularandmacrovasclardiabeticcomplicationsinoutpatientswithtype2DM2)Toassessreal-lifetreatmentpatternsinoutpatientswithtype2DM3)Toassesstheproportionofhypoglyecemiaunderthecurrenttreatment4)Toassesstheinfluencingfactors(hospitalclassification,regionaldistribution,medicalhistory,educationallevelandothers)onDMtreatmentoutcomes5Jietal.AJM，2013，inpress•Non-interventional,observational,cross-sectionaldesign•Type2diabetesdiagnosedfor6monthsorlonger•Ambulatorypatientsfromendocrinology,cardiology,nephrologyclinicsinall3tiersofhospitals(Tier1,2,and3)locatedinall6mainregionsinChina•Estimatedsamplesizewas25,000patientsinordertohavesufficientpowertodetectthedifferenceoftheprimaryassessmentineachregion666StudyDesignTargetedtoenroll25,000patientsJietal.AJM，2013，inpressDistributionofParticipatingHospitals7NumberofsitesineachregionwasproportionaltothepopulationintheregionNationalRegionsTier1Tier2Tier3SUMNorthEast46616North46818East57618NorthWest45514SouthWest59721CentralSouth45716SUM263839103Jietal.AJM，2013，inpressCharacteristicsofstudysubjects8NumberPercentage(%)All25454100.0Age(yr)651385554.5651159945.5GenderMale1195547.0Female1349953.0ResidentUrban2277689.5Rural267810.5BMI(kg/m2)241061741.7241483558.3Meanage=62.6+/-11.9yearsJietal.AJM，2013，inpressDistributionofCVDRiskFactorsT2DOnly27.9%T2D+HTN30.1%T2D+HTN+DYLP29.8%T2D+DYLP12.2%28%ofthepatientshadT2Donly60%ofthepatientsalsohadHTN(T2D+HTN)About42%ofthepatientsalsohadDYLP(T2D+DYLP)About30%ofthepatientshad“3B”:highbloodglucose,bloodlipid,andbloodpressure(T2D+HTN+DYLP)9T2D=type2diabetes,HTN=hypertension,DYLP=dyslipidemiaJietal.AJM，2013，inpressDiabetesDurationandComplications10Prevalenceofdiabeticcomplicationsisproportionaltodurationofdiabetes01020304050601Year1-5Years5-10Years10YearsMicro-VascularComplicationMacro-VascularComplicationBothmicro-andmacro-VascularComplications(%)DurationofDiabetesJietal.AJM，2013，inpressDiabeticComplicationsandCVDRiskFactors11051015202530T2DOnlyT2D+DYLPT2D+HTNT2D+HTN+DYLP(%)Jietal.AJM，2013，inpressCallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012CallaghanBC，etal.CochraneDatabaseSystRev.2012Gæde,P.et.al.NEnglJMed2003;348:383-393ResultsfromPatientswithType2Diabetes-STENO2DiabeticNeuropathyinType2Patients•Patientscanbeclassifiedinto2groupsbasedonmyelinatedfiberdensitylossover52weeksMFD•Suralnervebiopsiesof427patientsTRIGLYCERIDESWigginetal,Diabetes,2009Gæde,P.et.al.NEnglJMed2003;348:383-393DiabeticNeuropathyHyperglycemiaDyslipidemiaInflammationCellularstressandinsulinresistanceAcuteinjuryMitochondrialinjury&energyfailureInheritedsusceptibilityandgeneticinfluencesOXIDATIVESTRESSEndocrinologist