GSK代谢综合征新标准及T2DM控制—培训课件.pptVIP

45. 口服降糖制剂的安全性。 随着糖尿病长期强化治疗研究的不断深入，服药依从性对药物疗效的影响已为多项试验所证实。在美国进行的一项有关慢性疾病服药依从性的为期一年的试验证明，每日服药次数与服药依从性有着密切的关系。服药次数越多，患者的服药依从性越差，当每日需服药三次时，有接近一半的患者不能正确遵嘱服药。 41 40 The early, aggressive approach to type 2 diabetes management avoids the risk of early treatment failure by adopting an intensive therapeutic strategy immediately upon diagnosis. Combinations of agents with complementary modes of action targeting the dual defects underlying type 2 diabetes (insulin resistance and ?-cell dysfunction) are most likely to support tight, long-term glycemic control. Furthermore, combination therapy with OADs (oral anti-diabetics), should be considered earlier in the regimen to provide additional glycemic control. Campbell IW. Br J Cardiol 2000; 7:625–631. 罗格列酮主要作用是增加外周组织，也就是说，脂肪和肌肉组织的胰岛素敏感性，其继发效应是降低肝糖原输出。1,2 噻唑烷二酮类药物（TZDs）也改善 ?-细胞功能，无论是其对?-细胞的直接作用或者是其潜在的胰岛素增敏作用的间接结果。.3 二甲双胍主要通过减少肝脏外源性葡萄糖产生而达到降低血糖水平的作用1,4 二甲双胍治疗同样也能适当改善外周胰岛素抵抗。例如，一项研究发现，二甲双胍升高外周葡萄糖处置指数达13%，噻唑烷二酮类则增加54% .1 另一项研究发现，罗格列酮，可改善整体胰岛素敏感性和骨骼肌葡萄糖摄取，而二甲双胍没有这种作用。.5 Hence, 因此，尽管UKPDS研究发现二甲双胍可显著降低大血管并发症，可能与其适度的胰岛素增敏作用有关,6但一种较弱的胰岛素增敏剂（二甲双胍）和一种真正的胰岛素增敏剂（罗格列酮）联用，可获得额外的益处。 1. Inzucchi SE, et al. N Engl J Med 1998; 338:867–872. 2. Miyazaki Y, et al. Diabetologia 2001; 44:2210–2219. 3. Finegood DT, Topp B. Diabet Obes Metab 2001; 3 (Suppl 1):S20–S27. 4. Stumvoll M, et al. N Engl J Med 1995; 333:550–554. 5. Virtanen KA, et al. Diabetes 2003; 52:283–290. 6. UKPDS Group. Lancet 1998; 352:854–865. Patients were recruited to the multi-center, double-blind, randomized, parallel-group study at 63 centers in the USA. At screening, eligible patients (Male and female patients aged 18–75 with T2DM, defined according to the American Diabetes Association; HbA1c of 6.5–8.5% for subjects having received prior combination treatment and 7–10% for drug-naive or monotherapy patients; fasting plasma glucose [FPG] of 126–270 mg/dl [7.0–15.0 mmol/l]; and a body mass index ? 27 kg/m2 at the time of randomization) stopped taking their current anti-d