2型糖尿病治疗的新动向解说.pptVIP

确诊糖尿病 饮食运动治疗 二甲双胍 HbA1C≥7% 加用基础胰岛素——最有效 加用格列酮类——无低血糖 加用磺脲类——最便宜 HbA1C≥7% HbA1C≥7% HbA1C≥7% 胰岛素强化治疗 加用基础胰岛素 加用基础胰岛素 加用磺脲类 HbA1C≥7% HbA1C≥7% HbA1C≥7% HbA1C≥7% HbA1C≥7% 胰岛素强化治疗 ＋ 二甲双胍+/-格列酮类 加用格列酮类* ADA和EASD共识推荐2型糖尿病治疗流程 治疗的转变： 更早 保护β细胞功能的治疗 适度 基于糖尿病病理生理的治疗 THE END * UKPDS showed that as type 2 diabetes progresses, monotherapy with traditional agents fails to maintain glycemic control. Of 1,704 overweight ( 120% ideal bodyweight) patients with newly diagnosed type 2 diabetes recruited to the study, 753 were included in a randomized trial of conventional therapy (diet alone, n = 411) versus intensive blood glucose control with metformin. Over 10 years, median HbA1c was 8.0% in the conventional group. In comparison, over 10 years, median HbA1c was 7.4% in the metformin group. A secondary analysis compared the 342 patients allocated metformin with 951 overweight patients allocated intensive blood-glucose control with chlorpropamide (n = 256), glyburide (n = 277), or insulin (n = 409). The patients assigned intensive control with sulfonylurea or insulin had similar HbA1c to the metformin group. UKPDS Group. UKPDS 34. Lancet 1998; 352:854–865. * Standards of Medical Care in Diabetes—2007. Diabetes Care 2007;30(suppl 1):S4-41. AACE 2005 IDF Clinical Guidelines Task Force. Brussels: IDF, 2005 中国糖尿病防治指南 2004 * Metformin works primarily by reducing endogenous glucose production in the liver, while rosiglitazone decreases insulin resistance in target tissues, leading to enhanced peripheral glucose uptake and reduced hepatic glucose output * 讨论 肠促胰素效应实际上就是口服葡萄糖和静脉用葡萄糖后胰腺β细胞反应的差别。 口服葡萄糖后的胰岛素反应 (通过C肽测定判断，C肽是胰岛素的替代指标)与静脉用葡萄糖后的胰岛素反应有明显差别。这种差别或效应就是肠促胰素效应，右图的阴影区面积就显示了这种效应。 口服和静脉用葡萄糖后，静脉血浆葡萄糖水平随时间的变化情况差别不大。 背景 这是一项健康人中的交叉研究。 6名年轻的健康志愿者口服25, 50或100g葡萄糖，或者静脉输注相同的葡萄糖。上面图中是用50g葡萄糖后的数据。 C肽可以作为判断胰岛素分泌的指标，比测定血浆胰岛素更好，因为C肽水平不受肝脏提取胰岛素的影响。 口服和静脉用葡