糖尿病药物治疗—问题与失误PPT.ppt

纪立农 北京大学糖尿病中心 北京大学人民医院;2型糖尿病的病因、病理生理和结局;血糖是最难控制的代谢异常;ASCOT: Reductions in Total and LDL Cholesterol;LIIFE 研究---相同的降压疗效;Saydah SH et al. JAMA. 2004;291:335-342.;Percentage of Patients With DiabetesHaving A1C 7%;在单药治疗时发现 HbA1c 8.0%后仍然维持单药治疗的时间*（2004年）;0;;多种代谢异常控制的重要性; A tight blood pressure control policy which achieved blood pressure of 144 / 82mmHg gave reduced risk of: 24% for any diabetes-related endpoint p=0.0046 32% for diabetes-related deaths p=0.019 44% for stroke p=0.013 37% for microvascular disease p=0.0092 56% for heart failure p=0.0043 ; UKPDS研究显示：严格降压比强化降糖更重要???? ;;;各种治疗达标的百分率;Targets for control; 2型糖尿病患者的药物治疗;Pancreatic b-cell;Sites of Action by Therapeutic Options;正常人血糖的波动;2型糖尿病高血糖的构??－空腹血糖增高;Riddle MC. Diabetes Care 1990;13:676–686;二甲双胍 磺脲类 噻唑烷二酮 胰岛素;Overweight or obese person with diabetes;Non-obese person with diabetes;2型糖尿病自然病程;针对2型糖尿病自然病程中不同时期的病理生理变化特点的药物治疗 ;7;口服药加基础胰岛素; 美国糖尿病药物的市场情况; “Combination therapy is standard” ; 口服糖尿病药物联合的策略;Inzucchi SE. JAMA 2002; 287:360–372.;Inzucchi SE. JAMA 2002; 287:360–372.;Inzucchi SE. JAMA 2002; 287:360–372.;2型糖尿病口服药物联合治疗思维的改变;*;N = 635 Patients were treated for 24 weeks All patients were inadequately controlled on MET 1 g/day alone *P 0.05 vs. MET 1 g/day + MET 1 g/day;–20;0.0;9%; 加强“内-心”合作，催生“预防血管病学”