战胜糖尿病——现状及未来PPT.ppt

* Insulin detemir is an engineered analogue of insulin, produced by recombinant DNA techniques. The amino acid threonine at the B30 position has been removed, and a 14-carbon fatty acid has been attached to the amino acid lysine at position B29. These modifications to the insulin molecule radically change its properties of absorption and distribution, leading to a protracted action profile. Insulin detemir is also soluble at neutral pH. * The mechanism of protraction of insulin detemir is believed to occur by a combination of hexamer-aggregation and albumin binding. Insulin detemir is injected as hexamers, and these hexamers aggregate by contact between the 14-carbon fatty acid side chains. Importantly, insulin detemir binds to interstitial albumin at the injection site. It is released slowly from this albumin as monomers, which are absorbed into the circulation. Here, the insulin detemir monomer again binds to albumin, protracting its distribution to the target tissue. Insulin detemir is more than 98% albumin-bound in plasma. Finally, albumin binding in the target tissue may further protract the action of insulin detemir, because only the free (unbound) insulin detemir is available to interact with the insulin receptor. As well as being largely albumin-bound, the subcutaneous depot of insulin detemir differs to that of other long-acting insulins, such as NPH and glargine, in that it is soluble rather than crystalline. This means it has a greater surface area and is therefore expected to to be absorbed with less variability. Incretin治疗2型糖尿病的现状与展望天津医科大学代谢病医院? ???谢云 于德民----------------------------------------------------------------? ? 肠促胰岛素(incretin)包括葡萄糖依赖性促胰岛素分泌多肽(GIP)和胰高血糖素样肽-1(GLP-1),它不仅在糖尿病治疗领域具有十分重要的作用,而且其降糖以外的作用也将为临床上一些常见病和罕见病(如肥胖症、骨质疏松症、库欣综合征、肢端肥大症等)的治疗带来新希望。本文特就此次大会中有关incretin研究的新进展作一简要综述。? ? ? ? Incretin的作用机制及临床意义? ???1964年Elirick等报道口服葡萄糖对胰岛素分泌的促进作用明显优于静脉注射,他们把这种现象描述为“incretin效应”,将肠胰之间的功能描述为“肠-胰岛轴”,并认为incretin与2型糖尿病的发病机制和治疗有关。? ??