多因素介入对糖尿病的影响.ppt

Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes
Gæde, P., Lund-Anderen, H., Hans-Henrik, P., and O. Pedersen
N Engl J Med 2008;358:580-91
Peter Karacki
GIM Journal Club
March 25, 2008
Diabetes Background
In 2005, . prevalence of DM = million people or ~ 7% of the population
6th leading cause of death in the . in 2004
Risk of death is 2x for an individual with diabetes vs. one without it at the same age
From 1991 to 2001, the CDC found a 61% increase in diagnosis of diabetes
plications
Heart Disease – 2-4x death rates vs. adults w/o DM
CVA – risk = 2-4x higher vs. adults w/o DM
Retinopathy –#1 cause of blindness in adults 20-74 yoa.
Nephropathy –#1 cause of CRF
Nervous system damage
Acute hypoglycemia or hyperglycemia
Peripheral vascular plications during pregnancy
Steno-2 Study: Intensive therapy vs. conventional therapy for DMII (2003)
Intensive therapy
Benefits: (n = 80)
Hazard ratio
Confidence Interval
1. CV Disease

to
2. Nephropathy

to
3. Retinopathy

to
4. Autonomic
neuropathy

to
Gæde et al. Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes. NEJM. 2003;348:383-393
Steno-2 Follow-up: Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes (2008)
Steno-2 mean length = yrs
Steno-2 f/u mean length = + yrs
“Where are they now?”
Original Steno-II Selection Criteria
Inclusion Criteria
Diabetes per 1985 WHO criteria
Microalbuminuria – 30-300 mg urine albumin in ≥ 4 of 6 24 h collections
Exclusion Criteria
Age ≥ 65 or ≤ 40
A stimulated C-peptide [] <600 pmol/L 6 min after 1 mg glucagon stimulation
Pancreatic insufficiency or diabetes 2º to pancreatitis
ETOH abuse
Non-diabetic kidney disease
Malignancy
Life-threatening disease with death expected ≤ 4 years
Study Population
End of Steno II
Beginning of f/u
Steno II
Steno-II Treatment Objectives
Gæde et al. Multifactorial Interven