2型糖尿病的胰島素治疗进展与规范-李延兵.pptVIP

Insulin or not？ 目前尚无令人信服的证据支持对AMI病人采取更为严格的血糖控制。 尽管多数研究获得阴性结果，却不能因此认为AMI的治疗措施中已经没有胰岛素的一席之位。 HI-5研究的领导者N.W.Cheung在2008年对这些研究结果进行回顾时指出： The question remains not so much whether we should treat hyperglycaemia following AMI, but what the appropriate glucose targets should be. Tighter or Looser？ 小结 UKPDS十年随访研究显示：早期强化血糖控制可维持减轻微血管并发症的益处，还显著减少心肌梗塞发生，降低全因死亡 在疾病早期使用短期胰岛素强化干预，可休整Β细胞功能，延缓病程进展；使用CSII疗效优于OHA，且不显著增加低血糖及体重增加的风险 对病程长、伴多重心血管危险因素者进一步强化血糖控制并未证实有心血管获益（需更长时间？） 结合患者具体病情、意愿、和生活方式，制定个体化强化治疗目标和方案 应注意选择更生理化的胰岛素制剂和合适的胰岛素治疗方案，减少强化治疗伴随的低血糖和体重增加 * * * * Hypothesis slide to illustrate factors involved in decline of b-cell function 1) well accepted that chronic hyperglycemia is detrimental for b-cell function familiar concept of glucose toxicity. 2) newer concept of lipotoxicity now emerging- growing amount of evidence implicates chronic elevations of FFA as being detrimental to b-cell function. Both elevated FFA and glucose can be regarded as secondary consequences of insulin resistance. 3) some very new pre-clinical data also suggests that elevated FFA can accelerate amyloid deposition and amylin oligomers have been shown to be toxic to the beta cell and induce aopoptosis 4)In addition beta cell damage might be a consequence of oxidative stress (increased reactive oxygen and nitrogen species) and inflammatory action * * DIGAMI-2研究的目的在于回答DIGAMI 遗留的问题；遗憾的是，其答案却是阴性的。 该结果和ADVANCE研究非常类似。 * DIGAMI和DIGAMI-2研究的血糖干预方式均为住院+后续治疗，为了观察围心梗期，应用胰岛素严格控制血糖的治疗是否改善AMI的预后，澳大利亚研究者进行了HI-5研究。 然而这个结论却并没有回答本研究所针对的问题，因为干预组和对照组之间血糖控制并没有统计学差异！ * 问题不是该不该降糖，而是，应该降到什么程度？ * * * * * A total of 13 RCTs (7, 4 and 2 with lispro, aspart and glulisine, respectively) were retrieved and included in the analysis. Short-acting analogues reduced HbA1c by 0.4% (0.1–0.6%) (p = 0.027) in comparison with HRI. A significant improvement was observed also in self-monitored 2 h postbreakfast and dinner blood glucose. The overall rate of severe hypoglycaemia was not significantly different with short-acting analogues and