糖尿病的药物治疗及围手术期处理-培训课件.pptVIP

The San Antonio Heart Study recorded baseline values for insulin resistance and insulin secretion in a group of 1,734 Mexican American and non-Hispanic whites, and correlated these values with the incidence of diabetes and cardiovascular disease risk factors Over the study period around 10% of these subjects converted to type 2 diabetes, and they were more likely to be insulin resistant with poor insulin secretion at baseline (54% of group) Slide 77 Slide V/13 Biguanides work principally at the liver, decreasing hepatic glucose output.155 Metformin, the only biguanide available, is particularly useful in obese patients as it does not produce weight gain and may facilitate weight reduction. Side effects, particularly those affecting the gastrointestinal system, are not uncommon, however, and care is necessary to avoid lactic acidosis, the most dangerous side effect. The UKPDS provides evidence of its benefit as single therapy, with equivocal results in combination with a sulfonylurea.107 Sulfonylureas reduce blood glucose concentrations by stimulating insulin secretion through their effect on ATP-sensitive potassium channels in the beta cell.155 Their use is associated with weight gain, their long-term safety as regards macrovascular disease has been in doubt since publication of the UGDP study;137 however, this was not confirmed in the UKPDS.50 Alpha-glucosidase inhibitors decrease glucose absorption by inhibiting the breakdown of disaccharides to monosaccharides. They reduce postprandial glycemia and HbA1c levels.156 Poor tolerability due to mild to moderate gastrointestinal side effects limits their use. The thiazolidinediones are a new class whose first member is troglitazone.157 These agonists for peroxisome proliferator-activated receptor (PPAR) gamma improve insulin sensitivity in muscle and adipose tissue.155 The class is effective alone and particularly in combination with sulfonylureas or metformin. Use of troglitazone requires careful monitoring because