pro崔hongkong(中).pptVIP

* * Title Subtitle Slide 5 DCCT Relationship of HbA1c to Risk of Microvascular Complications In the Diabetic Control and Complications Trial (DCCT), the relative risk of developing microvascular complications of diabetes (progression of retinopathy, progression to clinical neuropathy, progression to severe nonproliferative or proliferative retinopathy, or progression to microalbuminuria) was directly related to glycosylated hemoglogin (HbA1c) level. In this stylized representation of the relationship between the risk of complications and HbA1c, the relative risk of complications is set to 1 at an HbA1c of 6%. Skyler J. Diabetic complications. The importance of glucose control. Endocrinol Metab Clin. 1996;25:243-254. * Title Subtitle Slide 11 UKPDS Effect of Treatment on HbA1c Patients assigned to the intensive treatment policy had lower median glycosylated hemoglobin (HbA1c) levels than did those assigned to the conventional treatment policy at all time points. After year 6, however, neither group maintained HbA1c levels below 7%, the current goal set by the American Diabetes Association (ADA); by year 15, even the intensive policy group had a median HbA1c level close to 8%, the current ADA action level. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-853. * Many doctors have already mention about this new approach about intensive insulin therapy. Dr. Leahy at 2003, raised question about the current traditional consecutive ladder strategy. Which start with life style modification, and move on to single oral agent. And later move on to two oral agents. And so on. And at the end add insulin. * * ??? ?2? ??? ??? ??? ????? ?? ????? ????? ? ? ? ?? ?? ????? ????, ??? ?? ????? ????? ????? ??? ?? ??? ??? ??? ?? ?????. * * * * * * * Title Subtitle * Title Subtitle In patients with