第2型糖尿病-马偕纪念医院.ppt

糖尿病治療之新趨勢 王朝弘 醫師 內分泌暨新陳代謝科 馬偕醫院 92-11-25 07:30 ~08:20 第一型糖尿病的疾病生理發展階段 第一階段 基因體質 第二階段 環境觸發 第三階段 自家免疫啟動 第四階段 貝它細胞逐漸失能 第五階段 糖尿病顯現 Loss of Early-phase Insulin Release in Type 2 Diabetes Metabolic (Insulin Resistance) Syndrome Diabetes Treatment Goals Plasma Glucose (mg/dL) Preprandial Postprandial A1C (%) Correlation between A1C  mean plasma glucose level A1C (%) 6 7 8 9 10 11 12 Normal Physiology of Glucose Homeostasis Stepped Management of Type 2 Diabetes Treatment Strategies FPG (mg/dl) A1C (%) Finnish Diabetes Prevention Studymean duration of 3.2 years Intervention gr. Control gr. n = 265 n = 257 Specific dietary instruction oral or written information at baseline (diet exercise) Moderate exercise≧30min/d no specific individualized program DM developed n=27 n=59 DM developed 3%/yr 6%/yr Risk of T2DM reduced by 58% Diabetes Prevention Program 3 years of observation Intense therapeutic lifestyle change ．Metformin ．Placebo wt loss 7% ．850 mg b.i.d. ．IGT→T2DM Exercise 150 min/wk 11%/yr N=1073 ．N=1082 ． N=1079 Risk reduction 58% ．risk reduction 31% UKPDS For each 1% reduction in A1C Over a 6-year period, ~53% of pt’s treated with sulfonylureas needed additional insulin therapy 非藥物 生活型態之改變 飲食、營養之控制 規律之運動 Oral Antihyperglycemic Agents Agent Sulfonylureas Nateglinide Repaglinide Metformin Pioglitazone Rosiglitazone Acarbose Miglitol Contraindications and PrecautionsMetformin Hepatic disease, CHF (drugs treated) Hx of lactic acidosis Renal impartment — GFRs (60ml/min) or ?Srcr (men:1.5mg/dl, women:1.4mg/dl) Alcohol ingestion Shock Surgery Aging (?80 years) NovoNorm (4.3) Short acting Different binding site at SUR receptor Rapidly absorbed (peak ~45’) Action within 30’ 0.5 ~