心内科医生应掌握的糖尿病知识.ppt
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参见附件(3015kb)。
?-细胞的胰岛素分泌调节
不同糖耐量状态个体在OGTT试验中的血糖曲线
Nomenclature and description term
defined by FPG and 2hr PPG
Nomenclature and description term
defined by FPG and 2hr PPG
Nomenclature and description term
defined by FPG and 2hr PPG
空腹和餐后血糖增高的临床表现
Impaired glucose tolerance is a cardiovascular risk factor (Funagata Study)
糖尿病是冠心病的等位症
UKPDS研究中心梗与不同治疗间的关系
Introduction
? ± 30% of patients in surgical ICUs need >5 days intensive care (long-stay patients)
? Long-stay ICU patients
- 20% risk of death in ICU
- High morbidity due to specific complications
? Sepsis and inflammation
? Multiple organ failure
? Wasting, polyneuropathy, weakness
- Consume large fraction of scarce ICU resources
Hyperglycaemia in ICU
? Current practice:
- Hyperglycaemia is common
- Caused by insulin resistance
- Adaptive?
- Only treated when blood glucose >215 mg/dL (>12 mmol/L)
? Key hypothesis:
- Hyperglycaemia (>110 mg/dL, >6.1 mmol/L)
predisposes to specific ICU complications,prolonged intensive care dependency, and death
Prospective, randomised, controlled trial
All mechanically ventilated patients admitted to ICU
Consent from closest family member
Stratified for on-admission diagnosis and randomised to:
Study design
? Protocol
- Standard feeding regimen started on admission
- Insulin by continuous i.v. infusion (syringe pump)
- Whole blood glucose monitored every 1 to 4 hours
- Insulin dose adjusted by ICU nurses and a study physician not involved in clinical decision making
? Primary outcome measure
- Death from any cause in ICU
(cause of death confirmed by autopsy-blinded pathologist)
? Secondary outcome measures
- In-hospital mortality
Study design
? Secondary outcome measures: morbidity
- Bloodstream infections*
- Inflammation*
- Acute renal failure and need for dialysis/haemofiltration* ......
?-细胞的胰岛素分泌调节
不同糖耐量状态个体在OGTT试验中的血糖曲线
Nomenclature and description term
defined by FPG and 2hr PPG
Nomenclature and description term
defined by FPG and 2hr PPG
Nomenclature and description term
defined by FPG and 2hr PPG
空腹和餐后血糖增高的临床表现
Impaired glucose tolerance is a cardiovascular risk factor (Funagata Study)
糖尿病是冠心病的等位症
UKPDS研究中心梗与不同治疗间的关系
Introduction
? ± 30% of patients in surgical ICUs need >5 days intensive care (long-stay patients)
? Long-stay ICU patients
- 20% risk of death in ICU
- High morbidity due to specific complications
? Sepsis and inflammation
? Multiple organ failure
? Wasting, polyneuropathy, weakness
- Consume large fraction of scarce ICU resources
Hyperglycaemia in ICU
? Current practice:
- Hyperglycaemia is common
- Caused by insulin resistance
- Adaptive?
- Only treated when blood glucose >215 mg/dL (>12 mmol/L)
? Key hypothesis:
- Hyperglycaemia (>110 mg/dL, >6.1 mmol/L)
predisposes to specific ICU complications,prolonged intensive care dependency, and death
Prospective, randomised, controlled trial
All mechanically ventilated patients admitted to ICU
Consent from closest family member
Stratified for on-admission diagnosis and randomised to:
Study design
? Protocol
- Standard feeding regimen started on admission
- Insulin by continuous i.v. infusion (syringe pump)
- Whole blood glucose monitored every 1 to 4 hours
- Insulin dose adjusted by ICU nurses and a study physician not involved in clinical decision making
? Primary outcome measure
- Death from any cause in ICU
(cause of death confirmed by autopsy-blinded pathologist)
? Secondary outcome measures
- In-hospital mortality
Study design
? Secondary outcome measures: morbidity
- Bloodstream infections*
- Inflammation*
- Acute renal failure and need for dialysis/haemofiltration* ......
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