糖尿病(湘雅).pptVIP

* 更高的目标，模拟生理胰岛素分泌的模式，给患者提供最接近生理状态的胰岛素治疗， 越接近生理状态，胰岛素治疗的效果就越好，低血糖副作用就越少 现在的人胰岛素还是存在这方面的不足 * * ADA/EASD: Metabolic Management of Type 2 Diabetes This algorithm is part of a consensus statement by the ADA and European Association for the Study of Diabetes (EASD) for the management of hyperglycemia in patients with type 2 diabetes. Lifestyle modification is the most cost-effective means of controlling diabetes, but rarely effective long-term. Nevertheless, it should be included as a part of any diabetes management program unless contraindicated. The goal of this algorithm is based on achieving and maintaining glucose levels as close to the nondiabetic range as possible, initiating or changing therapy when the patient’s A1C level is =7%, and changing interventions, if necessary, as rapidly as titration of medications allow. Selection of antihyperglycemic agents is primarily based on their glucose-lowering efficacy. Exenatide, glinides, pramlintide, and a-glucosidase inhibitors are not included due to their lower overall efficacy in glycemic control, limited clinical data, and/or relative expense. Metformin therapy should be initiated at diagnosis (concurrent with lifestyle intervention) because of its efficacy in glycemic control (~1.5% expected decrease in A1C), low level of side effects, absence of hypoglycemia or weight gain, relatively low cost, and high level of acceptance. It should be titrated over 1 to 2 months to its maximally effective dose, as tolerated. If glycemic goals are not achieved or sustained within 2 to 3 months of treatment initiation, a second drug—insulin, a sulfonylurea, or a thiazolidinedione—should be added. There is no consensus on which of the 3 should be used. If the addition of a secondary medication does not achieve or sustain goal A1C, insulin therapy should be initiated or intensified. If A1C is close to goal (8.0%), a third oral agent may be considered instead of insulin; however, it may be more expensive and less effective than an i