心血管疾病中降糖药物治疗选择.pptVIP

MANAGEMENT GUIDELINESCombination Therapy in Type 2 Diabetes:Pragmatic Approach Early combination of insulin secretagogue + insulin sensitizer Most simple and cost effective: Combination of selective sensitizers If target HbA1c 7% not achieved: Try triple therapy? Continue oral agent(s) + Insulin Rx at PM or HS using Insulin Pen once-daily Sulfonylurea (AM) + Metformin (PM) 5-20 Combination Therapy in Type 2 Diabetes:Decision Considerations HbA1c efficacy Reductions from baseline Reaching target Synergy of mechanisms of action Side effects and toxicity profile Frequency and severity of hypoglycemia Effect on weight gain Avoiding polypharmacy and complex regimens Compliance and convenience Cost 5-1a 糖尿病患者缺乏抗氧化因子，同时内皮功能异常 维生素 E 和 C : 在一组大系列的研究中T2DM患者是缺乏的。 (Sundaram, et al. Clin Sci 1996;90:255-60) 浙江114例糖尿病患者和100例健康人 糖尿病组的血浆维生素C、维生素E和β－胡萝卜素平均含量显著降低 随着病程延长，患者血浆维生素C、维生素E和β－胡萝卜素逐渐降低； 病程与维生素E 、 β－胡萝卜素水平相关最密切。 顾惠娟等,实用新医学.2000,2(9).-769-770 Liver Increased Glucose Production Adipose Tissue Increased Lipolysis Increased Free Fatty Acids Pancreatic Beta Cells Decreased Insulin Secretion Thiazolidinedinones (TZDs) Increase Glucose Uptake Skeletal Muscle Decreased Glucose Uptake Defective Insulin Secretion Insulin Resistance Small Intestine Carbohydrate Absorption Hyperglycemia Glucotoxicity Sulfonylureas and Nonsulfonylurea Secretagogues Increase Insulin Secretion TZDs Biguanides Decrease Hepatic Glucose Production TZDs Decreased Lipolysis Lipotoxicity Lipotoxicity a-Glucosidase Inhibitors Delay Intestinal Carbohydrate Absorption * Slide 4-4 Antihyperglycemic Agents for Type 2 Diabetes: The Six Classes Six classes of pharmacotherapeutic agents are employed in the treatment of type 2 diabetes mellitus; these include insulin and five classes of orally active agents. Among the oral agents, the sulfonylureas and the biguanides are generally preferred for initial therapy. Two newer sulfonylureas, glimepiride and extended-release glipizi