胡仁明糖尿病.ppt

2021/1/12 Indications and contraindications of  α-glucosidase inhibitors Indications Light cases using drug separately or combined IGT intervention，security Contraindications Allergic reactions Severe gastroenteropathy Dysfunction of renal and liver Acute complications Emergency Pregnant and breast feeding women 2021/1/12 thiazolidinedion〔TZD〕：insulin sensitizers Insulin sensitizers; agonist at the peroxisome proliferator-activated receptor ? 〔PPAR?〕;increase glucose utilization in peripheral tissues . Reducing insulin resistance，hyperglycemia and hyperlipaemia and hypertension can be improved at varies degrees For T2DM:used as monotherapy or in combination with SU,insulin. When used in combination with SU or insulin ,hyperglycemia Without insulin，it cannot reduce hyperglycemia Liver function should be monitored frequently. Stop using it in case liver dysfunction is found. Incidence of edema:4?5% It may cause Hb slightly↓ 2021/1/12 Meglitinides ：repaglinide Stimulate Pancreatic insulin secretion〔similar with SU〕：specific combinition with 36KDa protein K pathway close Stimulating the first phrase secretion of insulin Action: rapid onset ，short duration，suppressing postload hyperglycemia quickly Sites of excretion : kidney 8%，fecal 92% Used as monotherapy or in combination with biguanides ，α-glucosidase inhibitors Incidence of hypoglycemia is low 2021/1/12 Factors in choosing oral antidiabetic agents age weight Blood glucose level Function of liver and kidney Characteristic of drug costs 2021/1/12 Choose of oral antihyperglucemic agents Older patients：short term SU Obesity or hyperinsulinism patients：biguanides or acarbose 2hPG ：α－glucosidase Concentration of plasma glucose：270 ? 300mg/dl. the symptoms of hypertension are evident .Insulin therapy is available Impaired liver and kidney function：avoid using OHA Lean 、 fasting and after-excitation insulin all ：insulin 2021/1/12 Drug-Combined ther