HbA1c达标的临床意义及强化血糖达标的十个步骤提要1.HbA1c临床意义2.不能达标的主要原因3.全球合作伙伴“强化血糖控制达标的十点建议”血红蛋白的糖基化GlucoseentersredbloodcellswhereitreactswiththehemoglobinThisiswhyredbloodcellsneedtobelysedtofreeupHemoglobinandofcourseHbA1cHb、GHb与HbA1cHbHbA0HbA1HbA1aHbA1bHbA1cHbA(ßß)HbA2()HbF()97%0.5%2.5%AdultHbFetalHbNon-glycatedGlycatedincreasedinpatientswithß-thalassemia,whileHbA1cisreduced;inthiscaseGHbshouldbemeasured6%94%-mainglycohemoglobin-usedsince>20yearsforglycemiccontrolwithHPLC5%A1aandA1b:concentrationverylowHbA1c形成的动力学寿命：120days.50%的HbA1c值与过去30天内的平均血糖水平相关40%的HbA1c值与过去31－90天平均血糖水平相关.10%HbA1c与过去91－120天平均血糖水平相关.HbA1c治疗目标及血糖HbA1c空腹血糖(mg/dl)餐后2h血糖全天平均血糖＜7%＜120mg＜160mg＜170mg＜6.5%＜110mg＜140mg＜152mg(1)RohlfingCLandGoldsteinDEetal.DefiningtheRelationshipBetweenPlasmaGlucoseandHbA1c.DiabetesCare.25;275278.2002.(2)ADAStandardsofMedicalCareforPatientswithDiabetes.DiabetesCare.26(supplement1):S33-S50,2003.++PPG:PPG:•基础血糖基础血糖•胰岛素分泌胰岛素分泌•进食量进食量•外周组织对胰岛素外周组织对胰岛素的敏感性的敏感性FPGFPG：：•肝糖生成肝糖生成•肝细胞对胰岛素的敏肝细胞对胰岛素的敏感性感性..HbAHbA1c1c==葡萄糖对HbA1c的贡献那个更重要？空腹和餐后血糖的增量对2型糖尿患者每日总高血糖的贡献MonnierL,LapinskiH,ColetteC.DiabetesCare26:881-885,2003方法•290例(男139,女151)•治疗(单药/联合治疗)•控制饮食•双胍类:二甲双胍(~1,700mg/day)•磺脲类:Glyburide(5-15mg/day)•未用胰岛素或拜糖平•进餐时间：8:00am与12:00am•抽静脉血时间：8:00am,11:00am,2:00pm5:00pm(+5°PPG)•所有患者均同时采用持续血糖监测(CGMS)MonnierStudy分析方法(AUC-AB)(AUC-A)(AUC-B)MonnierStudy结果－五分位动态(1)MonnierL,LapinskiH,ColetteC.ContributionsofFastingandPostprandialPlasmaGlucoseIncrementstotheOverallDiurnalHyperglycemiaofType2DiabeticPatients.DiabetesCare26:881-885,2003.MonnierStudy结果－AUCABAB基础增量餐后增量总增量六年内平均HbA1c与微量白蛋白尿累计发病率100806040200...
