诺和锐30-胰岛素强化治疗.ppt

* * * 总 结 强化胰岛素治疗能显著降低血糖、减少并发症、改善?细胞功能 药代动力学、血糖谱监测、临床研究均证实： 诺和锐?30每日三次注射可作为一种简单的强化治疗选择 更好血糖控制的同时，未增加低血糖风险 每日注射总剂量无明显增多 较传统强化方案依从性明显提高，既可短期强化，亦可长期强化 一种胰岛素及一种注射装置可实现血糖强化及常规治疗，方案转换简单方便 * * * 研究2004年结束，平均观察了7年 * 国外大型的临床研究证实了这个观点。 DCCT（the Diabetes Control and Complications Trial ）研究:1441名1型糖尿病患者随机分成强化治疗组和常规治疗组。强化治疗组即应用胰岛素泵或一天三次或多次胰岛素皮下注射治疗，并进行血糖监测；常规治疗组即一天一次或两次胰岛素注射。患者随访平均6.5年，常规观察患者的视网膜病变、肾脏病变、神经病变等其他并发症的发生及进展情况。 研究结果：强化治疗组与常规治疗组在控制HbA1c及MBG 方面均差异（MBG即早、中、晚及睡前四点的平均血糖水平）。同时，在糖尿病并发症方面，如视网膜病变、微量及临床白蛋白尿等微血管病变及糖尿病神经病变强化治疗组较常规治疗组病变进展危险度均有所降低。 The mean (±SD) value for all glucose profiles in the intensive-therapy group was 155 ±30 mg per deciliter (8.6 ±1.7 mmol per liter), as compared with 231 ±55 mg per deciliter (12.8 ±3.1 mmol per liter) in the conventional-therapy group (P0.001). * 各时间点两组之间微量白蛋白尿发生趋势相比均具有显著差异（p0.01）。 New cases of microalbuminuria occurred during the EDIC study in 39 (6.8%) of the participants originally assigned to the intensive-treatment group vs 87 (15.8%) of those assigned to the conventional-treatment group, for a 59% (95% confidence interval [CI], 39%-73%) reduction in odds, adjusted for baseline values, compared with a 59% (95% CI, 36%-74%) reduction at the end of the DCCT (P.001 for both comparisons). * 在第一次心血管事件发生方面来比较，强化治疗组较传统治疗组发生风险降低了42%（P=0.02） the cumulative incidence of a first cardiovascular event showed that intensive treatment was associated with a 42 percent reduction in risk, as compared with conventional treatment (95 percent confidence interval, 9 to 63 percent; P=0.02) * Kumamoto 研究（2型糖尿）显示，入组时没有视网膜病变的病人，强化治疗后，与常规治疗组相比，视网膜病变的风险降低了68%，肾脏微血管病变的进展降低了74%（p=0.0022、0.029） In patients with no retinopathy at baseline (primary prevention cohort), intensive treatment reduced the risk of the development of retinopathy by 68% and the progression of nephropathy by 74% compared with conventional therapy (p = 0.022 and 0.029, respectively). In the secondary prevention cohort (data not shown), intensive treatment slowed the progression of