从东西方指南差异谈基础胰岛素的治疗讲解课件.pptVIP

主 要 内 容 聚焦胰岛素治疗：东西方指南的差异 基础胰岛素的应用 选择更理想的基础胰岛素 东西方指南：胰岛素起始及强化治疗的推荐 2010年CDS《指南》与 2011版ADA指南的区别（胰岛素治疗） 东西方饮食习惯的差别 东方患者血糖异常分布以餐后高血糖为主 亚洲人群早时相胰岛素分泌受损较白种人更为明显 中国糖尿病前期患者，胰岛素分泌量明显减少 2010年《中国2型糖尿病防治指南》推荐 中国T2DM胰岛素治疗策略 基于中国2型糖尿病患者的特点—— 尽早使用胰岛素，保护 β 细胞，补充体内胰岛素需求 同时控制空腹及餐后血糖，以现实血糖的全面达标 应该在补充基础胰岛素的同时，积极补充餐时胰岛素需求，模拟早时相分泌 主 要 内 容 聚焦胰岛素治疗：东西方指南的差异 基础胰岛素的应用 选择更安全的基础胰岛素 基础胰岛素的“适应症” 基线HbA1c水平较低，FPG升高为主 病程较短 标准餐后2h C肽水平较高 主 要 内 容 聚焦胰岛素治疗：东西方指南的差异 基础胰岛素的应用 选择更理想的基础胰岛素 传统中效人胰岛素制剂的不足 ~有明显的作用高峰，易于造成夜间低血糖 ~作用时间不足够长 ~皮下是晶体状态，溶解吸收不稳定 ~体重增加明显 NPH的吸收变异性导致GIR的不稳定 理想的基础胰岛素 理想的长效胰岛素类似物设计 药代动力学曲线相对平缓无峰，变异性低 作用时间延长，保证一天一次注射 良好的安全性 中长效胰岛素一天一次有效控制血糖 理想的基础胰岛素 理想的基础胰岛素 * p0.001 for all comparisons of AUC This slide summarises nicely the improvements that have been made with Levemir?. The slide shows some glucose infusion rate (GIR) curves for individuals with type 1 diabetes, with the range illustrated based on four repeated measurements in a clamp study (Heise et al. 2004). The brown curves show the profiles for patients given four separate NPH injections, each preceding a 24-hour clamp. The pink curves show equivalent data for insulin glargine, and the green curves for Levemir?. Firstly, it is striking that the Levemir? curves are notably longer and flatter in comparison with the NPH curves showing a more prolonged absorption, with less of a peak effect. Secondly, it is striking that the Levemir? curves are much more closely spaced for each patients in comparison with those of NPH and glargine. This shows that, under clamp conditions at least, Levemir? produces a much more reproducible effect from one injection to the next in an individual patient helping to better control of glycaemia. The final panel shows the calculated values for the coefficient of variation (CV) for GIRAUC(0–24 h), which is a measure of the variability in the total glucose-lowering effect over 24 hours. Levemir? was significantly less variable in this parameter than either NPH or glargine (p0.001, both comparisons