中國(guó)糖尿病領(lǐng)域新挑戰(zhàn)英文當(dāng)前1頁，總共39頁。2DeathfromDiabetes2.90Million(5.2%oftotalmortality)Worldwide:1of20deathisfromdiabetes

(About8,700death/dayor6death/min)About1of4death

isDMinAsia-PacificRegionDeathfromAIDS:3.0Million

WhatAIDSwasinthelast20yearsofthe20thcentury,diabetesisgoingtobeinthefirst20yearsofthiscenturyRoglicetal,2005TheRisingChallengeofDiabetes當(dāng)前2頁，總共39頁。3Lifestylechanges,UrbanizationandLongevityinChinaNationalNutritionandHealthSurvey

(1982–2002)Carbohydrate+10%,Meat

+57%eggs

+69%TotalCarloria:2254cal./person/day當(dāng)前3頁，總共39頁。4Prevalenceofoverweight/obesity

inChina(20-70years)Overweight/obesity(BMI≥25kg/m2)(WHOcriteria)DatafromNationalNutritionSurvey(1992),theWorkingGrouponObesityinChina(2002)Age-standardizedPrevalence(%)當(dāng)前4頁，總共39頁。5Prevalenceofoverweight/obesityin

Chinesechildren&adolescents(2002)Datafrom2002NationalNutritionandHealthSurveyWGOCcriteria%當(dāng)前5頁，總共39頁。6

Prevalenceofoverweight/obesityin

Chinesechildren&adolescents(1985-2000)JiCetal,ChineseJournalofEpidemiology2004

Prevalence(%)

BoysGirls

Ages7-12years13-18years7-12years13-18yearsYear1985Beijing5.1

Shanghai2.8

Coastalcities0.6

Inlandcities1.8Year1995Beijing17.518.112.011.6

Shanghai20.515.711.88.0

Coastalcities6.8

Inlandcities4.0Year2000Beijing29.025.017.314.6

Shanghai28.9

Coastalcities20.9

Inlandcities6.5當(dāng)前6頁，總共39頁。7當(dāng)前7頁，總共39頁。8Globalprevalenceofdiabetes

*In2007,thefivecountrieswiththelargestnumbersofpeoplewithdiabetesare:India,China,UnitedStates,Russia,GermanyBy2025,thelargestincreasesindiabetesprevalencewilloccurinlow-andmiddle-incomecountriesEachyearanadditional7millionpeopleworldwidedevelopdiabetes*DiabetesAtlas,3rdedition,InternationalDiabetesFederation,2006當(dāng)前8頁，總共39頁。9

People’sRepublicofChinaPrediabetes200333million(4%)202554million(5%)Diabetes200323million(3%)202546million(4%)TheprevalenceofDMisincreasingrapidly當(dāng)前9頁，總共39頁。10

Growingprevalenceof

diabetesandprediabetesinChinaNationalDiabetesResearchGroup.ChinJIntMed20:678,1981PanXR,etal.Diabetes20:1664,1997;GuD,etal.Diabetologia46:1190,2003*ScreeningwithFPGonly當(dāng)前10頁，總共39頁。11PrevalenceofIGTinallagegroupswashigherthanthatofDiabetesPrevalenceofIGTandDiabetesin11provinces,ChinaPrevalence（%）02468101220-3030-4040-5050-60>60DiabetesIGTChinJEpidemiol.1998;19(5):282-285.當(dāng)前11頁，總共39頁。12ShanghaiDiabetesInstituteIsolatedfastingDM:0.6%Isolatedpost-challengediabetes:2.4%CombinedDM:1.9%

Totalprevalenceof

newlydiagnosedDM:4.9%

Totalprevalenceofprediabetes:11.7%IsolatedIGT8.8%IsolatedIFG1.7%IFG+IGT1.2%75%15%10%JiaWPetal.Dibetologia2007Isolatedpost-challengeDMandIGTCommoninChina當(dāng)前12頁，總共39頁。13Newlydiagnoseddiabetes(OGTT)33%3%23%24%17%36%37%27%OGTTcohort(n=2,263)Wholepopulation(n=3,513)~2/3of

patientshavehyperglycaemia~3/4of

patientshavehyperglycaemiaPreviouslyknowndiabetesNewlydiagnoseddiabetes(FPGtest)NGTPrediabetesHuDY,PanCY,YuDM.EurHeartJ2006;27:2573–9.ChinaHeartSurvey–

dysglycemiaiscommoninpatientswithCAD當(dāng)前13頁，總共39頁。14WPJia,etal.Diabetologia,2006(inpress)EpidemiologicalcharacteristicsDMandIGTinaChineseadultpopulation:theShanghaiDiabetesStudies(SHDS)Prevalence(%)Incidence(%)three-yearcumulativeincidenceratesincidenceratesperyear1999-2001,n=56282002-2004,n=2709當(dāng)前14頁，總共39頁。15ChineseindividualswithIGTprogresstotype2diabetes

fasterthanAmericanindividualswithIGT2hPGlevelsofIGTcontrolsinDa-QingStudyandDPPweresimilar(meanvalue160mg/dL)02468101214161820Chinese

BMI22.4kg/m2Chinese

BMI27.5kg/m2American

BMI34.2kg/m2Incidence/100pysChineseIGTpopulationis

athighriskofDMPanXR,etal.DiabetesCare1997;20:537–44.KnowlerWC,etal.NEJM2002;346:393–403.當(dāng)前15頁，總共39頁。16DaQingIGTinterventionStudy577IGT519Control

4%IGT0.4%NGTTheappearanceofECGconsistentwithCHD

IGTandtheriskofCVDDiabetesCare1993:16.150-156當(dāng)前16頁，總共39頁。17IGTandAtherosclerosis

-StudyfromPLAGeneralHospitalinChina***IGTNGTDMIGTIGTNGTNGTDMDMN:97(NGT),51(IGT),73(DM)Adjustedbyageandsex*P<0.05,P<0.005,v.s.NGTJingWS,PanCY,LuJM,etal.ChinJEndocrinol&Metab2004;20(2):136-139

當(dāng)前17頁，總共39頁。18ThecumulativerateofCVDCox’sProportionalHarzardModel

XuXj,PanCYTianH.etal,ChinJGerontol.2001.0.970.980.991.001234YearNGTIGTDMTheCVDRiskofIGTandDiabetes-

StudyfromPLAGeneralHospitalinChinaCumulativerate

0當(dāng)前18頁，總共39頁。19CODIC2

ControlofType2DiabetesinChinaBiaoX,PanCY,JiLN,etal.CODIC2,2007,inpressN=1530N=2054N=524當(dāng)前19頁，總共39頁。20SurveillanceofType2Diabetes

inChinaGradeofHospitalsNo.ofHospitalsPatientNumbers1998327243020012&34922482003330272920061,2&36027792001hospitalsdistribution:Grade3:32(65%),Grade2:17(35%)2006hospitalsdistribution:Grade3:43(72%),Grade2:16(27%),Grade1:1(2%)PatientPopulation當(dāng)前20頁，總共39頁。21BMIAnti-obesityTreatment:

2001

2003

20061.5%

1.0%

1.0%BMIwasanalysedforpatients≥18yearsonly24.624.324.023.710152025301998200120032006BMI(kg/m2)PanCY.InternJournEndocr.&Mtab.2005,25(3):174-178.當(dāng)前21頁，總共39頁。22WAIST90.887.280859095100105MaleFemaleWaist(cm)MeanWaistin2006%Waist≥90cm(Male)

≥

80cm(Female)

20032006Waistwasanalysedforpatients≥18yearsonly51.175.954.978.340455055606570758085MaleFemaleProportionofPatients(%)PanCY.InternJournEndocr.&Mtab.2005,25(3):174-178當(dāng)前22頁，總共39頁。23MEANHbA1cLEVELS%HbA1c<6.5%

8%

26%

11%

23%%HbA1c<7%

18%

41%

26%

41%LocalHbA1c(past12month):57%(1998),31%(2001),55%(2003),54%(2006)

7.60123456789101112MeanHbA1c(%)6.5%NineyearschangeindiabetesmanagementDIABCAREStudyResult(1998-2006)2003200119982006PanCY.InternJournEndocr.&Mtab.2005,25(3):174-178當(dāng)前23頁，總共39頁。24LIPIDPROFILESTargetTC:<4.5mmol/LHDL-c:>1.1mmol/LTG:<1.5mmol/L

43%

41%

41%

41%

32%

31%

28%

34%52%

60%

60%

61%5.01998200120032006mmol/L1.41.01.41.519982001200320061.92.01.82.01998200120032006TCHDL-cTGPanCY.InternJournEndocr.&Mtab.2005,25(3):174-178當(dāng)前24頁，總共39頁。25TypeofTreatmentfor

DyslipidaemiaTreatedforDyslipidaemia%Statin%200125122003251320062717PanCY.InternJournEndocr.&Mtab.2005,25(3):174-178當(dāng)前25頁，總共39頁。26HYPERTENSION++sbp/dbp130/80(recommendationonoptimalcontrolofADA[2004]&APguidelines[2002])TreatmentforHypertension2001:44%2003:48%2006:53%

1998200120032006Smoking:14%

18%

17%

21%Drinking:14%

11%

11%

16%Patientiscurrentlyasmokerorconsumesalcohol(Regularconsumptionisdefinedasmorethan3timesperweek)

76.177.20102030405060708020032006ProportionofPatients(%)

responserate98%99%PanCY.InternJournEndocr.&Mtab.2005,25(3):174-178當(dāng)前26頁，總共39頁。27METABOLICSYNDROMECriteriaMS%CDS61.4IDF59.9CDS-ChineseDiabetesSocietyIDF-InternationalDiabetesFederation

當(dāng)前27頁，總共39頁。28About55%DMoutpatients

havecomplicationsBiaoX,PanCY,JiLN,etal.CODIC2,2007,inpressTopthreecomplicationsComplicationofType2DiabetesinChina當(dāng)前28頁，總共39頁。29Globalcostofdiabetes*EconomicandsocietalcostsmainlyarisefromcomplicationsofdiabetesEconomicconsequencesresultlargelyfrom:CostofcareLossofproductivityduetodisabilityandprematuredeathIn2007,globalhealthexpenditurestotreatandpreventdiabetestotalatleastUS$232billion*DiabetesAtlas,3rdedition,InternationalDiabetesFederation,2006當(dāng)前29頁，總共39頁。30TotalDirectMedicalCostoftreatingType2DMinurbanChinaBillionRMB4.38%ChenXingbao.Chinesehealtheconomics,2003*TangLing.ChinaDiabeticJournal.2003*當(dāng)前30頁，總共39頁。31DirectMedicalCostforpatientswithDiabetesinChinaBillionRMB18.9%81.1%0.00%50.00%100.00%DirectMedicalCostDirectMedicalCostforpatientswithcomplication)(DirectMedicalCostforpatientswithoutcomplications)ChenXingbao.Chinesehealtheconomics,2003*TangLing.ChinaDiabeticJournal.2003*當(dāng)前31頁，總共39頁。32EffectofcomplicationsoncostsIncreaseincostsvs.nocomplications?218%?313%?935%ChenXingbao.Chinesehealtheconomics,2003*TangLing.ChinaDiabeticJournal.2003*TotalDirectMedicalCostoftreatingType2DMinurbanChinaRMB當(dāng)前32頁，總共39頁。33

CHDdeathsthanexpectedfrom

baseline

mortalityratesDatafromEnglandandWalesbetween1981and2000inmenandwomenaged35–84yearsTherewere68,230fewerCHDdeathsthanexpectedfrombaselinemortalityratesin1981-100,000-80,000-60,000-40,000-20,000020,000Deathspreventedorpostponed

in2000FactorsCHDdeathsincludesmoking,

cholesterol,andBPandchangesintreatmentsFactorsCHDdeathsincludediabetesandobesityUnalB,etal.Circulation2004;109:1101–1107.延遲或預(yù)防死亡

68,230(

2,000–3,000)當(dāng)前33頁，總共39頁。34Diabetesmortalitycontinues

itssteadyescalationFreidVM,etal.NationalCenterforHealthStatistics,2003.YearAge-adjusteddeathrate

relativeto1980cerebrovasculardisease406080100120140198019902000HeartdiseaseCancerDiabetes當(dāng)前34頁，總共39頁。35

CauseofdeathinChinaDatafromNationalDiseaseSurveillanceSystemofChina(1991-2000)

Top3fataldiseasesin20001,412,9992,488,2661,530,423

CauseofdeathinChina當(dāng)前35頁，總共39頁。36MotalityofDiabetesinUrbanChineseSources:MinistryofHealthofChina:AnnualStatisticalReportsofDeath,injuriesandCauseofDeath2001當(dāng)前36頁，總共39頁。37

WPDD2002./downloads/Diabetes_Book.pdf.

EarlyDiagnosisofPrediabetesisessentialWesternPacificDiabetesDeclaration(WPDD)Guidelines:“