胰岛素治疗-指时南到实践.ppt

* * * * * * * * * * * * * Tier 1: well-validated core therapies These interventions represent the best established and most effective and cost- effective therapeutic strategy for achieving the target glycemic goals. The tier one algorithm is the preferred route of therapy for most patients with type 2 diabetes. Tier 2: less well-validated therapies In selected clinical settings, this secondtier algorithm may be considered. When hypoglycemia is particularly undesirable , the addition of exenatide or pioglitazone may be considered. Rosiglitazone is not recommended. If promotion of weight loss is a major consideration and theA1Clevel is close to target (8.0%), exenatide is an option. If these interventions are not effective in achieving target A1C, or are not tolerated, addition of a su could be considered. Alternatively, the tier two interventions should be stopped and basal insulin started. * * Normally, insulin secretion can be divided into two basic components, basal and stimulated. Basal insulin is secreted continuously between meals and throughout the night, reduces hepatic glucose production. In diabetic patients, treatment with intermediate-acting or long-acting insulin attempts to mimic the basal secretory pattern. Stimulated insulin secretion occurs in response to a meal and results in insulin concentrations of 60 to 80 mU/L from just before to 30 minutes after the meal. Concentrations return to basal levels in 2 to 4 hours. Regimens of regular insulin attempt to mimic the stimulated insulin secretory pattern. * Normally, insulin secretion can be divided into two basic components, basal and stimulated. Basal insulin is secreted continuously between meals and throughout the night, reduces hepatic glucose production. In diabetic patients, treatment with intermediate-acting or long-acting insulin attempts to mimic the basal secretory pattern. Stimulated insulin secretion occurs in response to a meal and results in insulin concentrations of 60 to 80