课件：糖尿病肾病临床处理新策略.pptVIP

* 诺和龙降低HbA1c水平明显优于阿卡波糖和那格列奈 与磺脲类、双胍类相当 * * * * * * * Benefit of Angiotensin Receptor Blockers in Diabetes: Important Findings of 3 Major Clinical Trials Nephropathy develops in about 40% of patients with type 2 diabetes. Therapy for diabetic nephropathy is not curative; renal disease may progress in spite of current, adequate management. Microalbuminuria, the earliest clinical evidence of diabetic nephropathy, is associated with a ten-fold increase in the risk of progression to overt nephropathy and eventual end stage renal disease (ESRD). More than 50% of patients starting dialysis are type 2 diabetics. Unfortunately, the prevalence of diabetes is increasing at an alarming rate. Therefore, new therapeutic advances in the prevention and treatment of diabetic nephropathy are needed. Three major studies – the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study, the Irbesartan Microalbuminuria Type 2 Diabetes in Hypertensive Patients (IRMA II) study, and the Irbesartan in Diabetic Nephropathy Trial (IDNT) – were initially presented as late breaking clinical trials at the 16th Annual Scientific Meeting of the American Society of Hypertension in San Francisco on May 19, 2001, and later published in the same September 2001 issue of the New England Journal of Medicine. Each trial of 2-3 years duration showed that selective AT-1 angiotensin receptor blocker (ARB) is effective in reducing the progression of renal disease in patients with type 2 diabetes and high blood pressure (BP). Standard care for diabetes was maintained. Using conventional high BP therapy such as diuretics, beta-blockers, and calcium channel blockers (but no ACE inhibitors or other ARBs), BP control was similar in the placebo and ARB-treated groups. Thus, the concept has emerged from these 3 trials that ARBs protect the kidney independent of BP reduction. References: Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM,