一体化胰岛素治疗方案的选择教材.pptVIP

In an extension of the Boehm 2002 study, patients with type 2 diabetes continued receiving their treatment over a total period of 2 years. Over the 2-year period, only 5% of patients treated with NovoMix? 30 experienced one or more episodes of major hypoglycaemia, compared with 14% of patients treated with premixed human insulin, despite HbA1c levels being equivalent throughout the study. In the second study year, there were no major hypoglycaemic events in the NovoMix? 30 treatment group, whereas 10% of the human insulin group reported one or more major episodes (p=0.04). Minor hypoglycaemic episodes were similar between the treatment groups, with 63% of patients in each group reporting minor episodes. Data for the intent-to-treat (ITT) population, which comprises all patients enrolled in the trial, is shown. Once-daily dosing of NovoMix? 30 allowed 21% of all patients to achieve the HbA1c target ≤ 6.5% and 41% of all patients to achieve the HbA1c target 7.0%. After twice-daily dosing of NovoMix? 30 during Phase 2, the majority of all patients were able to achieve the target ≤ 6.5% . By the end of the study, 60% of the 100 patients achieved the goal of HbA1c 7.0%. Key Point: ITT 分析，分析实验中所有入组患者的数据 诺和锐30从QD到TID，HbA1c达标的比例越来越高，TID治疗后有77%的患者HbA1c达标 诺和锐30一天一次注射HbA1c达标最低，而一天二次及三次治疗HbA1c达标率提高较多。 对于胰岛素B细胞倘有一定功能的患者，一天一次治疗可能更有效。在中国，胰岛素的使用大多较晚，此时B细胞功能已经很差，以一天二次作为起始治疗可能更有意义。 诺和诺德胰岛素治疗的一体化解决方案 胰岛素 注射装置 针头 诺和关怀售后服务 谢谢! 张素华教授 重庆医科大学附属第一医院 内科学教授，主任医师，博士生导师 重庆市内分泌与代谢病学术带头人 享受国务院特殊津贴 擅长内分泌与代谢病的诊治，主研方向糖尿病 正常人的胰岛素分泌分为基础胰岛素和餐时胰岛素两部分，大约各占50%。正常的生理性餐时胰岛素的特点是在进餐后迅速出现胰岛素分泌高峰，以降低进餐后升高的血糖，之后在血糖下降后能够迅速的回落到基础水平。正常的生理性基础胰岛素的特点是24小时作用平稳，无明显的作用高峰，能够维持进餐以外的24小时血糖在正常水平。而糖尿病患者的餐时胰岛素分泌高峰后延、峰值低，不能够控制餐后血糖，基础胰岛素的分泌水平下降。从而导致高血糖。 生理性胰岛素的释放包括两个部分： 持续的基础胰岛素分泌，抑制肝糖原的输出，抑制两餐间和夜间血糖的产生；水平几乎保持不变；全天约占总量的50% 餐时胰岛素分泌，促进葡萄糖的利用和储存，并抑制肝糖原输出，控制餐后高血糖；1小时出现胰岛素尖锐峰值 ；每餐剂量占全天总量的10% to 20% 胰岛素治疗的目的在于模拟生理性胰岛素释放：基础加餐时胰岛素。 胰岛素不断研发进步的趋势是动物胰岛素逐渐被人胰岛素所替代, 人胰岛素将会在未来的几年中被胰岛素类似物逐步替代. 目前全球胰岛素类似物量的使用率已经占到胰岛素市场的?%, 对于