糖尿病口服降糖药物治疗()祥解.ppt

* 肾衰时的代谢不受影响，但是因为水钠潴留，可使心衰风险增加，因此肾衰患者慎用TZD * * 肠促胰岛激素GLP-1和GIP的作用列表 GLP-1和GIP是目前已被证实的肠促胰岛激素 肠促胰岛激素是具有以下特性的激素： - 消化的食物，尤其是葡萄糖，刺激肠道释放这种激素。 血液循环中这种激素的浓度必须足够高以刺激胰岛素分泌。 仅在血糖水平升高时（葡萄糖依赖性），生理水平的激素才能刺激胰岛素的分泌。 GIP和GLP-1都是满足这3点要求的激素，因此他们是肠促胰岛激素。2 在空腹状态下，循环中的 GIP和GLP-1水平非常低。在进食后，他们的水平迅速升高并发挥刺激胰岛素分泌的作用。3,4 GLP-1以葡萄糖依赖模式刺激β细胞分泌胰岛素，同时以葡萄糖依赖模式抑制 α细胞释放胰高血糖素。GIP以葡萄糖依赖模式刺激β细胞分泌胰岛素。5幻灯片中总结了GLP-1和GIP的其它特点。 References 1. Creutzfeldt W. The [pre-] history of the incretin concept. Regul Pept. 2005;128：87–91. 2. Creutzfeldt W. The entero-insular axis in type 2 diabetes – incretins as therapeutic agents. Exp Clin Endocrinol Diabetes. 2001;109（suppl 2）：S288-S303. 3. Gautier JF，Fetita S，Sobngwi E，Salaün-Martin C. Biological actions of the incretins GIP and GLP-1 and therapeutic perspectives in patients with type 2 diabetes. Diabetes Metab. 2005;31：233–242. 4. Holst JJ，Gromada J. Role of incretin hormones in the regulation of insulin secretion in diabetic and nondiabetic humans. Am J Physiol Endocrinol Metab. 2004;287：E199–E206. 5. Meier JJ，Nauck MA. Glucose-dependent insulinotropic polypeptide/gastric inhibitory polypeptide. Best Pract Res Clin Endocrinol Metab. 2004;18：587–606 目的： 描述两种主要的肠促胰岛激素，GLP-1和GIP。 附： GLP-1和GIP在调节血糖稳态中都发挥了重要的作用。GLP-1和GIP都以葡萄糖依赖模式调节胰岛素的分泌，而GLP-1同时还以葡萄糖依赖模式抑制胰高血糖素释放。 * DISCUSSION: BYETTA?, like a pharmacologic dose of continuously infused GLP-12-6: Enhances glucose-dependent insulin production Restores first-phase insulin response Decreases postprandial glucagon production, thus decreasing hepatic glucose output Regulates gastric emptying, decreasing the rate of peak nutrient absorption from meals Decreases food intake BUT, one important difference–BYETTA is resistant to enzymatic degradation by DPP-4, thus extending the presence of BYETTA in plasma following an SC injection (measurable for up to 10 hours) SLIDE BACKGROUND: Following the SC administration of BYETTA to patients with T2D, BYETTA reaches median peak plasma concentrations in 2.1 hours The mean t