理想的胰岛素治疗模式网络版ppt课件.ppt

SOLVETM 国际研究是一项观察性研究，即在真实临床环境中观察口服药失效的T2DM患者起始一天一次地特胰岛素治疗的安全性和有效性。 在SOLVETM 国际研究中由研究者根据经验来决定诺和平?剂量调整，研究对基线、12周、24周的访视资料收集并进行分析。 共纳入了来自10个国家，2817个研究中心的17374名2型糖尿病患者，其中包括了3272例中国的患者，中国患者居全球第二。 * RESEARCH DESIGN AND METHODS:We undertook a prospective intervention trial to assess the relative contribution of controlling FPG and PPG for achieving recommended HbA1c goals. One hundred and sixty-four patients (90 male and 74 female) with unsatisfactory glycemic control (HbA1c /=7.5%) were enrolled in an individualized forced titration intensified treatment program. RESULTS:After 3 months HbA1c levels decreased from 8.7+/-0.1 to 6.5+/-0.1% (p0.001); FPG decreased from 174+/-4 to 117+/-2mg/dl (p0.001); PPG decreased from 224+/-4 to 159+/-3mg/dl (p0.001) and daylong hyperglycemia (average of premeal, postprandial and bedtime plasma glucose excluding FPG) decreased from 199+/-4 to 141+/-2mg/dl (p0.0001). Patients weight remained unchanged (84.0+/-1.4kg versus 82.9+/-1.5kg, p=0.36). No severe hypoglycemia occurred. Only 64% of patients achieving FPG targets of 100mg/dl achieved an HbA1c target of 7% whereas 94% of patients achieving the postprandial target of 140mg/dl did. Decreases in PPG accounted for nearly twice as much for the decreases in HbA1c as did decreases in FPG. PPG accounted approximately 80% of HbA1c when HbA1c was 6.2% and only about 40% when HbA1c was above 9.0%. CONCLUSIONS:Control of fasting hyperglycemia is necessary but usually insufficient for achieving HbA1c goals 7%. Control of postprandial hyperglycemia is essential for achieving recommended HbA1c goals. 仅补充基础胰岛素不能长期控制血糖是因为基础胰岛素无法针对餐后高血糖。在严格控制空腹血糖5.6mmol/l的病人中，仅有64％的病人的糖化血红蛋白7%，但如果同时控制空腹及餐后血糖均达标，有高达94％的患者其糖化血红蛋白达到了7％的控制目标，因此，可以说同时针对空腹和餐后血糖的治疗方案是保证患者血糖全面达标的保证。 * * * * 一项采用24h-正糖钳夹试验比较诺和锐30每日三次注射同基础-餐时方案的药效动力学研究，纳入了23例2型糖尿病患者，晚上开始使用第一针胰岛素，纵坐标是葡萄糖输注率，横坐标是葡萄糖钳夹的时间，在这项研究中，诺和锐每日三次注射的时间分别为07：00,13:00和19:00，甘精胰岛素注射的时间为23:00，横坐标-10表示的是在正糖钳夹前10小时，即前一天晚上19:00注射诺和锐30的时间，也就是试验开始的时间。钳夹试验显示，诺和锐30每日三次注射同基础-餐时降糖方案具有类似的