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Post Prandial Hyperglycemia A Significant Cardiovascular Risk Factor 211414–31.Developed countriesDevelopingcountriesWorldtotalPrence 0246820252000CVD drives the economic burden of type 2 diabetesCVD cardiovascular diseaseNichols GA, Brown JB. Diabetes Care 2002;25482–6.Copyright ?2002 American Diabetes Association; reprinted with permission from The American Diabetes Association.1086420Cost in 1999 x1,000 USNo CVD,no diabetesn13,286No CVD,diabetesn11,130CVD,no diabetesn2,894CVD anddiabetesn5,0502,5624,4026,39610,17231.948.120.028.640.331.217.231.851.021.128.050.9PharmacyOutpatientInpatientPathophysiology of type 2 diabetesJanka HU. Fortschr Med 1992;110637–41.Macro-vasculardiseaseInsulin sensitivityInsulin secretionPlasma glucoseMicro-vasculardiseaseImpaired glucose tolerance HyperglycemiaDiagnosing glucose intolerance –criteria reflect a need for early intervention*Determined post 75g glucose load2h-PG 2-hour postchallenge plasma glucose, FPG fasting plasma glucose, IFG impaired fasting glucose, IGT impaired glucose tolerance World Health Organization, 1999.Diagnosis Venous plasmaglucose concentrationmmol/L DiabetesFPG or 7.02h-PG* 11.1 IGTFPG if measured and 7.8 and 6.1 and 7.02h-PG* if measured 7.8FPG and 2h-PG values identify different people with diabetes2h-PG 2-hour postchallenge plasma glucose, FPG fasting plasma glucoseDECODE Study Group. BMJ 1998;317371–5.FPG40Both FPG and 2h-PG28Younger, more obesepeopleOlder,leanerpeople2h-PG32The Relative Contribution of FPG and Mealtime Glucose Spikes to 24-hour Glycemic LevelRiddle MC. Diabetes Care 1990;13676–6863002001000Plasma glucose mg/dl0600 1200 1800 2400 0600Time hoursMealtimeglucosespikesFastinghyperglycemiaNormalKuusisto et al, 1994Glycemic Control and CHDCHD Mortality All CHD EventsA Comparison of Hba1c Levels Achieved in the Conventional Versus Intensive Groups of Major Trials10987650 1 2 3 4 5 6 7 8 9 10Time from randomization yearsHbA1cDCCT Kumamoto Study987600 3 6 9 12 15Median HbA1cTime from randomization yearsUKPDSConventional therapyIntensive therapy121110987650 12 24 36 48 60 72MonthsHbA1c FPG fasting plasma glucose; PPG postprandial plasma glucose.HbA1CPPGFPG
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