课件：从指南更新看抑制剂在糖尿病合并患者中的优选地位.pptVIP

* 一线治疗：分为常规方案、备选方案、其他方案 1、除非有肾损伤或其他禁忌证，考虑二甲双胍【唯一的常规方案一线推荐】，为估计肾小球滤过率（eGFR）在30~45 ml/（min·1.73 m2）之间时，应用二甲双胍是安全的，但在eGFR＜30ml/（min·1.73 m2）时，二甲双胍应慎用。 2、二甲双胍不耐受或禁忌，可使用磺脲类（避免格列本脲），备选方案 3、DPP-4抑制剂：与磺脲类共同作为一线备选方案推荐，并且是二线、三线联合治疗的常规推荐【地位加强，早期、长期治疗均可应用】 4、格列奈类可用于餐后血糖升高的老年患者一线治疗（其他方案） 要点提示 在2013年版AACE糖尿病综合管理指南中，对于基线H7.5%的2型糖尿病患者，GLP-1受体激动剂可作为一线治疗选择，其地位仅次于二甲双胍； 这一张图片是血糖管理的总体流程图，看似复杂，实则路径非常清晰！ 备注：颜色及药物推荐次序 颜色： 绿色，代表该药物较少的不良事件或者可能的获益 黄色，代表谨慎使用，具体根据该药物在低血糖/体重增加/心肾消化系统及骨骼等方面的安全性的整体考虑，详见原文第9张或者本套Slides 28 药物推荐顺序：所列药物顺序为用药推荐等级次序 单药治疗：标注绿色的药物均在标注黄色药物之前 两药或三药联合治疗：标注为绿色的药物未必在标注黄色药物之前（可能因为：不能单纯以药物的安全性来定位药物的推荐次序，还要考量药物的疗效依从性等其他多种因素） Speaker Notes: SAVOR-TIMI 53: An International, Multicenter, Phase 4 Study1,2 SAVOR-TIMI trial recruitment began in May 2010, and the study included a total of 788 sites1 located in 26 countries and 6 continents across the world.2 Recruitment by region of residency was:2 North America: 31.9% Western Europe: 26.0% Australia, South Africa, and Israel were considered with Western Europe by the SAVOR investigators because of similarities in practice patterns Eastern Europe: 17.3% Latin America: 16.4% Asia: 8.3% References Scirica BM et al. Saxagliptin and Cardiovascular Outcomes in Type 2 Diabetes Mellitus. N Engl J Med. 2013.10.1056/NEJMoa1307684 Mosenzon O, et al. Baseline characteristics of the patient population in the Saxagliptin Assessment of Vascular Outcomes Recorded in patients with diabetes mellitus (SAVOR)-TIMI 53 trial. Diabetes Metab Res Rev. 2013;29:417-426. * Inclusion criteria The SAVOR-TIMI 53 study included patients with documented type 2 diabetes mellitus (T2DM), a HbA1c ?6.5% and ≤12.0%, a history of established cardiovascular disease (CVD) or multiple risk factors for vascular disease but without established CVD.1 Scirica 2011/819/2/4 The proportion of patients with multiple risk factors alone is limited to not exceed 25% of the overall study population to ensure that the study population is at sufficiently high risk to achieve the s