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 Wysłany: Śro 21:38, 23 Mar 2011 Temat postu: Comprehensive and rigorous control of risk factors |
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Comprehensive and rigorous control of risk factors for diabetes
The amount of diuretics to Hydrochlorothiazide or indapamide better. 3.1 3 to correct dyslipidemia treatment goals: diabetic patients is often associated with lipid metabolism,[link widoczny dla zalogowanych], especially increased blood cholesterol levels. Numerous clinical studies have shown that strict control of cholesterol levels can significantly reduce major vascular events in diabetic patients and overall mortality. National Cholesterol Education Program Adult Treatment Group Ⅲ reports (NCEPATP-m) to diabetes and coronary heart disease and other risk factors as suggested by low-density lipoprotein cholesterol (LDL-C) as the main control indicators to HDL - c ~ a secondary target when the serum triglyceride (TG)> 500mg/dl TG mainly when the dynasties. A proposed ATP Ⅲ: Diabetic patients should be controlled in LDL 100mg/dL (2.6mmol / L) the following,[link widoczny dla zalogowanych], ≥ 100mg/dL may consider drug therapy,[link widoczny dla zalogowanych], ≥ 130mg/dL (3.4mmol / L) should start drug treatment,[link widoczny dla zalogowanych], and <100mg / (iL does not require treatment. 3.2 Treatment 3.2.1 lifestyle intervention: ATP Ⅲ emphasize the positive lifestyle intervention, including the following three aspects. (1) in the treatment of diet control to limit intake of saturated fatty acids and cholesterol. (2) increase the choice of food to enhance U) L decrease in unsaturated fatty acids increase the plant (2g / d) and soluble fiber (10 ~ 25g / d) intake. (3) emphasis on weight control and physical exercise. 3.2.2 Drug selection: a variety of lipid lowering drugs, commonly used in the treatment of diabetes with dyslipidemia There are two types of drugs 3.2.2.1HMG-C0A inhibitors (statins): mainly applicable to high blood cholesterol disease, for mild and moderate hypertriglyceridemia also has a certain effect. DI can reduce wide-C18 ~ 55% and TG7 ~ 30%, increased HDL__c5 ~ 15%, can reduce major vascular events in patients and overall mortality. Main drug simvastatin (20 ~ 80rra / d), lovastatin (20 ~ 80rng / d), pravastatin (20 ~ 40mg / d), fluvastatin (20 ~ 80mg / d), atorvastatin statins (10 ~ 80ri ~ / d), the West because of its side effects atorvastatin legislation has been discontinued. 3.2.2.2 Bedin acid (fiber acid or fibrates): mainly used in high-hyperlipidemia or hypertriglyceridemia with high TG-based mixed hyperlipidemia. Can reduce LDL-c5-20% 72I (; ONI'IIIIINGMIK) ICALIK ~ TIONVoI. 19. No. 112a at 5.11.15 (TG normal) may also be elevated LDL-c (with high, work B), the lower TG20 ~ 5O%, higher HDL_c10 ~ 20%. Can delay the development of coronary heart disease and reduce its related events. The main drugs gemfibrozil (6O0mg / time, 2 times / d), fenofibrate (200mg / d) and fibrate (1g / time, 2 times / d). ATP-mW ~. At present, China is doing of drawing more research, extensive discussions in order to develop the 1997 recommendations for prevention and treatment of blood lipid changes, develop new guidelines to guide clinical work. 4 correct Hyperinsulinemia Hyperinsulinemia and the occurrence of hypertension, can also lead to vascular endothelial cells and smooth muscle cell proliferation, and macrovascular complications are closely related, it is necessary to correct hyperinsulinemia. Attention to diet and exercise, weight loss can improve hyperinsulinemia. Insulin sensitizers (thiazolidinediones TZDs) and metformin can improve insulin sensitivity and reduce Suomin hyperinsulinemia. 5 to correct abnormal hemodynamic status of patients with diabetes with high blood coagulation and platelet function enhanced. A multi-center study showed that combined antiplatelet drugs can reduce microalbuminuria proteinuria of diabetic patients. Antiplatelet drugs significantly reduce the non-diabetic patients with the highest crown of a disease, illness events. At present, many clinicians have been no complications in diabetic patients routinely, hN amount of aspirin, but no major vascular complications in diabetic patients using anti-platelet drugs is also a lack of sufficient basis for evidence-based medicine. 6 quit smoking and limit alcohol smoking may cause short-term high blood pressure and vascular endothelial cell, smoking cessation can be effective in reducing the risk of cardiovascular disease. Excessive drinking can be glucose, lipid and blood pressure, while the sunset can be dirty, disease caused or induced low blood sugar. However, moderate drinking does not raise blood pressure, but also promote blood circulation. Per day and men should be ≤ 20 ~ 30g / d, women should be ≤ 10-20g / d, maternal alcohol. Drinking significantly increased blood pressure should reduce, or even alcohol. 【Received :2005-0201]
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