老年糖尿病的最新治疗精编PPT课件.ppt

Whitmer RA, et al. Hypoglycemic Episodes and Risk of Dementia in Older Patients With Type 2 Diabetes Mellitus JAMA. 2009; 301: 1565–1572; Bonds DE, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study BMJ. 2010; 340: b4909; Barnett AH. Avoiding hypoglycaemia while achieving good glycaemic control in type 2 diabetes through optimal use of oral agent therapy Curr Med Res Opin. 2010; 26: 1333–1342; J?nsson L, et al. Cost of Hypoglycemia in Patients with Type 2 Diabetes in Sweden Value Health. 2006; 9: 193–198; Foley JE, Jordan J. Weight neutrality with the DPP-4 inhibitor, vildagliptin: Mechanistic basis and clinical experience Vasc Health Risk Manag. 2010; 6: 41–548; Begg IS, et al. Canadian Diabetes Association’s Clinical Practice Guidelines for Diabetes and Private and Commercial Driving Can J Diabetes. 2003; 27: 128–140; McEwan P, et al. Understanding the inter-relationship between improved glycaemic control, hypoglycaemia and weight change within a long-term economic model Diabetes Obes Metab. 2010; 12: 431–436. * * SU 类降糖药能与胰岛β 细胞膜外侧特异性受体—SU 受体（sulphonylurea receptor，SUR）结合，后者能与特异的ATP 敏感的K+通道紧密关联。首先，是细胞膜上ATP 敏感的K+通道关闭，使得K+外流受限，β 细胞内K+浓度升高，细胞膜去极化；从而使细胞膜上L 型电压依赖的Ca2+通道开放，细胞外的Ca2+进入β 细胞，细胞内Ca2+浓度上升，促使胰岛素的小囊泡由β 细胞骨架向细胞表面运动，并向细胞外释放胰岛素。此时，胞质内升高的Ca2+水平活化了另一种K+通道—Ca2+依赖的K+通道，它的开放，导致了膜电位复极化，再次关闭细胞膜上L 型电压依赖的Ca2+通道，为下次胰岛素的分泌做准备 * 上边删除 * DISCUSSION Sulphonylureas and meglitinides block the sulphonylurea receptor and ATP-sensitive potassium channels in pancreatic ? cells. Their chief adverse events are hypoglycaemia and weight gain. Insulin exerts its effect through the insulin receptor and has hypoglycaemia and weight gain as prominent adverse events. The mode of action of the biguanides (metformin) is not known. Their most significant adverse events are gastrointestinal distress and lactic acidosis. The thiazolidinediones are PPAR-gamma agonists. Their chief adv