中国2型糖尿病防治指引控制目标及降糖降压降脂.ppt

临床试验证明，胰岛素类似物与人胰岛素相比控制血糖的能力相似，但在模拟生理性胰岛素分泌和减少低血糖发生风险方面胰岛素类似物优于人胰岛素 * ■ 1型糖尿病患者在发病时就需要胰岛素治疗，而且需终生胰岛素替代治疗 ■ 2型糖尿病患者在生活方式和口服降糖药联合治疗的基础上，如果血糖仍然未达到控制目标，即可开始口服药和胰岛素的联合治疗。一般经过较大剂量多种口服药联合治疗后HbA1c仍大于7.0%时，就可以考虑启动胰岛素治疗 ■ 对新发病且与1型糖尿病鉴别困难的消瘦的糖尿病患者，应该把胰岛素作为一线治疗药物 ■ 在糖尿病病程中（包括新诊断的2型糖尿病患者），出现无明显诱因的体重显著下降时，应该尽早使用胰岛素治疗 ■ 根据患者的具体情况，可选用基础胰岛素或预混胰岛素起始胰岛素治疗 * * 1-2-3 Study 77% of Patients Reached ADA Goal With NovoLog? Mix 70/30 48-week, open-label, observational study in 100 patients 18 years and older with type 2 diabetes for ≥12 months and A1C levels between 7.5% and 10%. Patients had been previously treated on a stable antidiabetic regimen for at least 3 months. NovoLog? Mix 70/30 was initiated once daily during phase 1 and titrated in phases to dosing schedules of BID (phase 2) and TID (phase 3) as needed to reach treatment goals. Subjects achieving an A1C level of ≤6.5% in each phase were considered to have completed the study. Patients not achieving A1C ≤6.5% continued through phase 3. Results include phases 1, 2, and 31 The percentage of patients achieving an ADA A1C target of 7% was assessed1: 41% achieved A1C 7% with once-daily dosing at dinnertime 70% achieved A1C 7% with once- or twice-daily dosing (dinner and breakfast dosing) 77% achieved A1C 7% with once-, twice-, or three times–daily dosing (dinner, breakfast, and lunchtime dosing) Patients who achieved goal with once-daily dosing experienced an average A1C reduction of 2.4%2 Each time the dosing schedule was titrated, NovoLog? Mix 70/30 provided additional benefits without an increase in major hypoglycemia1 Conclusion: NovoLog? Mix 70/30 gets the majority of patients to A1C goal with once-, twice-, or three times–daily dosing1 References Garber AJ, Wahlen J, Wahl T, et al. Attainment of glycaemic goals in type 2 diabetes with once-, twice-, or thrice-daily dosing with biphasic insulin aspart 70/30 (the 1-2-3 study). Diabetes Obes Metab. 2006;8:58-66. Data on file. Princeton, NJ: Novo Nordisk Inc.; 2007. * * 在这项为期24