糖尿病治疗进展及与心血管疾病的关联经典.pptVIP

Mortality of NGT，IGT and DM (1986-2009) Incidence of Stroke and MI in NGT,IGT and New-DM (1986-2009) 血糖控制越来越严格 UKPDS -7.0% ADVANCE-6.5% ACCORD - 6.0% ACCORD 用药、低血糖和体重增加 AACE2013 对今后SU的应用影响 口服降糖药应用是科学还是艺术? ‘是科学，更是艺术?’ Silvio E. Inzucchi MD Yale University School of Medicine，USA    难治性高血糖,难在何处? 难! 肥胖---刀枪不入 难! 低血糖---CVD 风险+用药进退两难 难! 天天面对老年病人---并发症视为畏途 心脏病合并糖尿病者可能上述三难齐备 低血糖‘无处不在， 无时不有’ 也许离你十万八千里 若不用降血糖药 最多离你两星期 初次SU或胰岛素 低血糖----糖尿病糖尿病治疗中难以避免副产品 后果可能非常严重，远远超过高血糖 New AACE Algorithm Addresses All Aspects of Type 2 Diabetes For patients under 7.5% at entry, monotherapy can include 1 of 7 of the currently available drugs. However, those that are considered safer and therefore more desirable are (in order of preference) metformin, a glucagonlike peptide-1 (GLP-1) receptor agonist, a dipeptidyl peptidase-4 (DPP-4) inhibitor, or an alpha-glucosidase inhibitor. Medications to be used with caution include sodium-dependent glucose cotransporter 2 (SGLT2) inhibitors, thiazolidinediones, and sulfonylureas. New AACE Algorithm Addresses All Aspects of Type 2 Diabetes A separate algorithm addresses insulin treatment specifically, another new feature. what to do when basal insulin fails, the new thinking is that it may be preferable to add an incretin [GLP-1 agonist or DPP-4 inhibitor] rather than prandial insulin, although both options are listed in the algorithm. When you add the prandial insulin, you get a lot more hypoglycemia and a lot more weight gain. New AACE Algorithm Addresses All Aspects of Type 2 Diabetes 低血糖和肥胖是需要认真对付的 医生和患者都梦想 有一天能找到 一个既能有效降血糖 不诱发低血糖 又能减肥的药物 胰岛素抵抗--- ?细胞功能衰竭的源头 AACE发布的2013指南 本次AACE发布的指南特色: 降糖目标和减少心血管疾病的目标捆绑在一起。 在选择糖尿病药物时，在有效降糖的前提下，需要同时兼顾降低心血管疾病风险的考虑，优先选择有益于减少心血管疾病风险的药物。 　降糖治疗策略的革新性转变 几项公认的大型临床研究均未证明严格血糖控制可以减少心血管