《2型糖尿病基础胰岛临床应用中国专家指导建议》精编PPT课件.pptVIP

* 多项胰岛素治疗的经典研究，如LAPTOP、treat-to-target研究等，这些研究均证实：无论是与预混胰岛素相比，还是与NPH相比，长效胰岛素类似物在减少低血糖风险方面具备明显的优势。 * GALAPAGOS研究是一项多国的随机、开放、平行、为期24周的IV期研究，共纳入923例OAD治疗不佳（HbA1c：7.0-10.5%）的2型糖尿病患者，随机分为甘精胰岛素组和预混胰岛素组，以证实甘精胰岛素治疗方案相对于预混胰岛素治疗方案的优效性 * 在LANCELOT研究中同样可以观察到相似的基础胰岛素剂量与HbA1c关系曲线，显示随基础胰岛素剂量调整FPG和HbA1c逐步改善。 * 胰岛素剂量调整过程中除了低血糖，体重增加也是限制因素之一。该项meta分析可以看出，在达到相同的控糖目标时，与预混胰岛素相比，使用基础胰岛素的患者胰岛素用量更少，体重增加幅度也更低。 * 在同一个研究里，亚洲人和高加索人一样，随着A1C升高，FPG贡献度增加（同样在A1C〉8%时出现） greater contribution of postpran-dial hyperglycaemia at lower HbA1clevels was a phenomenonmore marked in Asians than in Caucasians. Second, the biphasicinsulin regimen with a prandial component – the twice-dailyinsulin lispro mix 75/25 – resulted in a greater improvementof postprandial excursions than the basal regimen with once-daily insulin glargine. In contrast, fasting hyperglycaemia wasimproved to the same degree with both regimens. These obser-vations suggest that evaluating the respective contributions ofpostprandial and fasting hyperglycaemia before the implemen-tation of insulin treatment could be an appropriate approachtowards individualizing treatment and achieving optimal targetsmore quickly. Our present analysis also confirms that Asians have agreater proportion of PHG than Caucasians, as previously sug-gested [13], possibly related to lower insulin secretion capacity.Accordingly, Asian patients may benefit more than Caucasiansfrom insulin regimens with a higher prandial component toimprove their lesser response, as shown in this analysis of bothinsulin lispro mix 25 and insulin glargine. These results con-firm a previous analysis of the whole patient population of theDURABLE study (and not just those with available plasma glu-cose values, as in this analysis), where a lower HbA1cresponserate was also observed in Asians compared with Caucasians [25]. * 一项日本随机对照研究，纳入45例接受基础餐时治疗的2型糖尿病患者，随机分为两组，C组继续接受原有基础/总计量比为0.35的基础餐时治疗，I组增加基础胰岛素占胰岛素总剂量的比例，达0.46±0.12，比较两组的治疗疗效。研究结果显示：基础胰岛素起始剂量比例增加显著改善血糖控制。治疗20周起，I组糖化血清白蛋白水平显著低于C组。 对