早期强化胰岛素治疗在2型糖尿病中的作用.ppt

强 化 降 糖 血糖良好控制 低血糖 依从性不佳 体重增加 疗效的 争议 比我们现在做到的更早开始胰岛素治疗和胰岛素强化治疗，生活质量不会因胰岛素的使用而受到影响。 Analyses adjusting for insulin sensitivity showed that β-cell function was compromised in IGT, DM2h, DMf, and DM, relative to NGT, by 13, 12, 59, and 62% (HOMA-B) and by as much as 40, 60, 80, and 75%, using AIR. * * Results Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea–insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002). Conclusions Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. * * RESULTS— After 1 year the glucagon-stimulated C-peptide response was increased in the insulin-treated group by 0.140.08 nmol/l, whereas it was decreased by 0.120.08 nmol/l in the glibenclamide group, P 0.02 for difference between groups. After 2 years, fasting insulin levels were higher after treatment withdrawal in the insulin-treated versus the glibenclamidetreated group (P 0.02). HbA1c levels decreased significantly during the first year in both groups; however, at the end of the second year, HbA1c had deteriorated in the glibenclamide group (P 0.01), but not in the insulin-treated group. The difference in evolution of HbA1c during the second year was significant between groups, P 0.02. A questionnaire indicated no difference in well-being