中国2型糖尿病患者的特点和适合中国患者的起始胰岛素治疗方案ppt课件.ppt

* 指南中指出：在我国2型糖尿病患者的平均BMI在24kg/m2左右，因此再次提示我们中国患者大多数非肥胖，胰岛素抵抗并不是主要问题，更重要的是B细胞功能差。 * 美国进行的一项研究显示，在无糖尿病的人群中，华裔美国人的胰岛素抵抗力及?细胞功能均低于非西班牙裔白种人（89%vs98.3% P=0.0011）[1] 1.Diabetes Care 27:354-361,2004 * 2007年11月中国胰岛素分泌研究组进行了华夏胰岛素分泌特性调查，探讨关于中国2型糖尿病β细胞功能及胰岛素抵抗状况。 * 华夏胰岛素分泌特性调查结果 结果显示，2型糖尿病随着血糖水平升高，胰岛素敏感逐级下降，FPG低于125 mg/dL组胰岛素敏感已为正常人的60%，FPG高于175 mg/dL组胰岛素敏感已仅为正常人的30%。与胰岛素敏感性变化相比，胰岛素分泌功能下降更为严重，FPG低于125 mg/dL组早期胰岛素分泌已为正常人的1/4，在FPG高于175 mg/dL组已仅为正常人的1/20。 在血糖水平不同的糖尿病亚组中，胰岛素抵抗和胰岛素分泌缺乏对血糖水平升高贡献不同。这提示对血糖水平不同的人群治疗药物的选择应有所不同。 * * * IVGTT first-phase insulin concentration area under the curve (AUC) Broken line: interface between normoglycaemia(NG; FPG 6.1 mmol/l) and impaired fasting glucose (IFG:6.1–7.0 mmol/l) Abstract Aims/hypothesis. Our aim was to define the level of glycaemia at which pancreatic insulin secretion,particularly first-phase insulin release, begins to decline. Methods. Plasma glucose and insulin concentrations were measured during an IVGTT in 553 men with non-diabetic fasting plasma glucose concentrations. In 466 of the men C-peptide was also estimated. IVGTT insulin secretion in first and late phases was assessed by: (i) the circulating insulin response; (ii) population parameter deconvolution analysis of plasma C-peptide concentrations; and (iii) a combined model utilising both insulin and C-peptide concentrations. Measurements of insulin sensitivity and elimination were also derived by modelling analysis. Results. As fasting plasma glucose (FPG) increased,IVGTT first-phase insulin secretion declined by 73%, 71% and 68% for the three methods respectively. The FPG values at which this decline began, determined by change point regression, were 4.97, 5.16 and 5.42 mmol/l respectively. The sensitivity of late-phase insulin secretion to glucose declined at FPG concentrations above 6.0 mmol/l. Insulin elimination, but not insulin sensitivity, varied with FPG. Conclusions/interpretation. The range of FPG over which progressive loss of the first-phase response begins m