糖尿病及降糖药物.pptVIP

拜耳医药公司在新近的医学论坛报上刊登了一篇“阿卡波糖——着眼餐后、真正强化血糖控制”的访谈文章,文章将餐后高血糖的意义作了无实证证据支持的夸大。以下就该访谈中片面夸大“餐后高血糖”的观点逐一进行批驳。 Comparing the effects of the marketing Oral Antidiabetic drugs, The effects in reducing glycemic parameters with TZDs seems comparable to that with Metformin or sulfonylurea, at least in short term therapy, but meta analysis showed there could be better control with TZDs than with metformin (Clinical Ther. 2004; 26:805), although the perspective clinical researches on effects of TZD in glycemic parameter, comparing Metformin, in long term is going on. The benefits of TZD therapy is in emphasis on dyslipidemia, reduction of TG and increase HDL will bring more benefits to patients. The lack of effects on LDL-C seems not to produce some risk to diabetic patients, because of reduction of sdLDL and increase of buoy LDL, after TZD therapy. In term of different mechanism of improvement of glycemic parameters for TZD and metformin, it is proven that the predominant effect of metformin is inhibition of hepatic glucose production, whereas the primary effect of TZDs is reduction of insulin resistance and promotion of peripheral glucose uptake.(Clinical Ther. 2004; 26:805) 由于服用拜唐苹的最终结局无非是使碳水化合物吸收减少，而饮食控制也可在一定程度上达到此种目的。加之病人对拜唐苹的耐受性也极差，如 UKPDS 研究中就发现患者服用拜唐苹的退出率就极高。同时在《ADA专家委员会对糖尿病的诊断与分类》中也认为拜唐苹的肠道不良反应（指胀气、排气等）严重。因此加用拜唐苹并非理想选择。 《ADA专家委员会对糖尿病的诊断与分类》中列出，在5大类糖尿病用药中，只有拜唐苹对“胰岛素分泌、肝糖输出以及外周糖摄取”方面无任何作用，其他药物对与肝糖输出的抑制以及外周糖摄取方面均能起到一定作用。而格华止对于肝糖输出的抑制作用最为显著。 STOP-NIDDM研究是一项有9个国家40多个研究中心参与的随机对照临床研究。其目的是评价拜唐苹对IGT转变成2型糖尿病的延缓或预防作用。 潜在的肝毒性 肝毒性 类似结构的曲格列酮因肝毒性，导致肝功能衰竭（死亡或需肝移植），已被限定为二线用药 肝酶(SGPT)升高 目前无长期临床验证来排除此副反应 需定期检测肝功能（至少2月一次） 当前94页，共98页，星期日。 第九十四页，共九十八页。 PROactive试验 当前95页，共98页，星期日。 第九十五页，共九十八页。 Begin with metformin Use sulfonylureas when metformin fails to control glucose concentrations totarget levels, or as a first-line option in the person who is not overweight. Rapid-acting insulin secretagogues may be useful as an alternative to sulfonylureas in some insulin-sensiti