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Insulin
resistance
Blood
glucose
10
Prevention
IGT/IF
G of IGT
Prevention
0
Diagnosis
Treatment
10
Years
Type 2
diabetes
Amputation or
death for PAD
6
Retinal or renal
disease
Hazard Ratio
5
4
Cataract extraction
Heart failure
Myocardial infarction
Stroke
3
2
1
0
5.5
6.5
7.5
8.5
9.5
Landmarks Studies on DM
And Its Complications
UKPDS
PTM 2007
ACCORD
2008
VADT
2008
Advance
on
Myocardial
Infarction
Microvascular
Endpoints
5
10
11
ADVANCE
10. 251
10 yrs
11. 140
8 yrs
35 %
6.4 vs. 7.5
32 %
6.5 vs. 7.3
+ 22 % (p=0.04)
CV mortality
+ 39 % (p=0.02)
21 % (p=0.006)
VADT
1. 791
11.5 yrs
40 %
6.9 vs. 8.4
33 % (p=0.001)
ns
-13% ns
- 12 %
+ 6.5 % ns
+ 25 % ns
Riddle MC, Karl DM. Practical lessons from ACCORD etc. Diabetes Care. 2012:35;2100-7
ADVANCE
10. 251
10 yrs
11. 140
8 yrs
35 %
6.4 vs. 7.5
32 %
6.5 vs. 7.3
+ 22 % (p=0.04)
CV mortality
+ 39 % (p=0.02)
21 % (p=0.006)
VADT
1. 791
11.5 yrs
40 %
6.9 vs. 8.4
33 % (p=0.001)
ns
-13% ns
- 12 %
+ 6.5 % ns
+ 25 % ns
Riddle MC, Karl DM. Practical lessons from ACCORD etc. Diabetes Care. 2012:35;2100-7
VADT
ACCORD
ADVANCE
VADT
No Severe
Hypoglycemia
(n=231)
(n=10909)
Major
macrovascular
33 (15.9%)
1114 (10.2%)
3.53 (2.41-5.17)
Major
microvascular
24 (11.5%)
1107 (10.1%)
2.19 (1.40-3.45)
45 (19.5%)
986 (9.0%)
3.27 (2.29-4.65)
CVD death
22 (9.5%)
520 (4.8%)
3.79 (2.36-6.08)
Events
0.1
1.0
10.0
Zoungas S et al.
NEJM
2010;363:1410
9%
All-cause mortality
CV mortality
15 %
Severe Hypoglycemia
HR
HR
2.48
10 %
All-cause mortality
CV mortality
RR
15 %
RR
RR 2.43
Riddle MC, Karl DM. Practical lessons from ACCORD etc. Diabetes Care. 2012:35;2100-7
MAGE
HbA1c
Gensini Score
r=0.41, p<0.01
r=0.85, p<0.01
r=0.45, p<0.01
r=0.38, p<0.1
p=NS
p=NS
r=0.36, p<0.01
r=0.16, p=0.08.
R = Neutrophyl/Lymphocyte Ratio
HsCRP = high sensitive C Preactive Protein
ABP=Urinary Liver Type Fatty Acid Binding Protein marker chronic kidney disea
U = P2y12 reaction Unit
I = Reaction Hyperemia Index
Diabetes Care.2013;36(4):1026-32
Impact of admission glycemic variability, glucose,
and glycosylated hemoglobin on major adverse
cardiac events after acute myocardial infarction
Gong Su, Shu-hua Mi, Hong Tao, Zhao Li, Hong-Xia Yang, Hong Zheng, Yun
Zhou, and
Lei Tian,
in
Treatment Strategies
Glucose Triad
HbA1c
FPG
PPG
Excursion
Glycemic Variability
Should we and can we prevent it?
Louis Monnier, Claude Colette,
Diabetes Care.2008 ; 31 (Supplement 2 ):S150-S154
ADVANCE-ON
2 primary outcomes :
- Death from any cause
- Major cardiovascular events
Composite of cardiovascular
death,
myocardial infarction, or ischemic
stroke
Worldwide
Orientation
Plan 2013-2014
White
et al. NEJM
369(2013)1327-35
Glycemic Variabilities ?
hypoglycaemia were:
increased age, duration of diabetes and creatinine
level
lower BMI and cognitive function
use of 2 oral glucose lowering drugs
history of smoking
history of microvascular disease
allocation to intensive glucose control (all p<0.05)
Severe hypoglycemia*
Gliclazide
n/1000 person years0.85
Glipizide
8.70
GlimepirideTolbutamide
ChlorpropamidGlyburide
0.86
3.50
e
16.00
16.00
*<50 mg/dL.
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