困境与出路：糖尿病治疗中的体重挑战与应对.pptVIP

Key Points 比较艾塞那肽与甘精胰岛素对生物学标志物的影响 * Key Points 评价用艾塞那肽或甘精胰岛素52周强化治疗期间以及12周停药期对β细胞功能、血糖控制及体重的效果，以及对安全性的影响 Notes 入选标准: 年龄30-75岁; HbA1c 介于6.5%和9.5%之间 体重指数(BMI)介于25 kg/m2 和40 kg/m2之间 用二甲双胍治疗，至少2个月用药剂量不变 筛查前3个月内不能用其他降糖药 研究期间，已知可能影响β细胞功能的其他药物*的用药方案不能改变 用正常血糖-高胰岛素钳夹和高血糖钳夹两种方法联合测定胰岛素分泌情况和胰岛素敏感性 计算AUC180-190min，判断第一相C肽分泌情况 计算AUC190-260min，判断第二相C肽分泌情况 高血糖钳夹期间，葡萄糖稳态浓度15 mmol/L时，测定用精氨酸刺激后的最大胰岛素分泌能力 计算精氨酸刺激后的C肽分泌(AIRarg)，即超过空腹C肽浓度以上的AUC260-270min 分别在随机分组前(-2周), 治疗52周后和停药后4周进行钳夹试验 * Key Points 目前的治疗方案中，大都在降糖的同时引起体重增加 GLP-1可以达到血糖体重双降低 DISCUSSION: We have many choices approved for therapy, from oral medications to injectable medications, all of which have been shown to achieve the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD)-recommended HbA1c level of 7.0%1-9 Again, the primary goal of antidiabetic therapy is achieving glucose control, with weight loss being a secondary, yet important, benefit10 Remembering that more than 80% of patients with T2D are overweight or obese5 and the well-established benefits of weight maintenance, which agent would be the ideal next addition to meet those ADA goals? SLIDE BACKGROUND: See information about hypoglycaemia, nausea, or pancreatitis and the Important Safety Information included in this presentation, and the accompanying full Prescribing Information REFERENCES: Malone M. Medications associated with weight gain. Ann Pharmacother. 2005;39:2046-2055. Glucotrol [package insert]. New York, NY: Pfizer Inc; 2009. Actos [package insert]. Deerfield, IL: Takeda Pharmaceuticals America Inc; 2009. Avandia [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2007. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: update regarding thiazolidinediones: A consensus statement from the American Diabetes Association and the European Association for the Study of